Criticalthinking is an integral component of any nursing career that involves the useof quality and ethical decision making while practicing.
When considering the subjectiveand objective information in this scenario, there are multiple pieces of datathat are pertinent in forming a diagnosis. It is first important to note thatthis patient is running a low-grade fever, has severe abdominal pain, loss of appetite,nausea and vomiting, and fatigue. The patient has yellowing of the sclera andtenderness of the liver when palpating.
According to Mayo Clinic, “hepatitis Bsigns and symptoms may include: abdominal pain, fever, loss of appetite, nauseaand vomiting, weakness and fatigue, and yellowing of your skin and the whitesof your eyes” (“Hepatitis B,” 2017). Mr. Smith has all the clinicalmanifestations that point towards a medical diagnosis of hepatitis B. The informationmentioned earlier is pertinent because it allows the healthcare team to form aprofessional opinion based on the patient’s clinical manifestations, objectivedata, and subjective data. The patient’s vital signs are also pertinentinformation because vital signs are a diagnostic tool that monitors a patient’sphysiological status and allows healthcare professionals to synthesize informationand deduce a clinical judgment.
This patient’s blood pressure, pulse, andtemperature is elevated which means there is some type of stress occurringwithin the body, such as an infection. The patient’s social history of relyingon injection drugs is also pertinent information because it gives healthcareprofessionals a possible cause of his contraction of hepatitis B infection.Hepatitis B can be spread easily “through needles and syringes contaminatedwith infected blood” (“Hepatitis B,” 2017).
If the patient shared any IV drugparaphernalia during his deep depression, this could be the cause of hiscurrent HBV infection. Information that is also pertinent is the fact that thepatient’s lab results were positive for Hepatitis B Surface Antigen (HBsAg),IgM Antibody to Hepatitis B Core Antigen (IgM anti-HBc), and Hepatitis B “e”Antigen (HBeAg). This is important information because it confirms an accuratediagnosis of HBV. According to the CDC, “Acute HBV infection is characterized by thepresence of HBsAg and immunoglobulin M (IgM) antibody to the core antigen,HBcAg” (“Hepatitis B FAQs,” 2016).Althoughthe patient’s medical diagnosis is of extreme importance, forming a nursingdiagnosis to the patient’s response to the medical condition is very beneficialin the clinical setting. Based on the information from this case and knowledgeabout his clinical manifestations, the nursing diagnoses for the actualproblems consist of imbalanced nutrition: less than body requirements relatedto altered absorption and metabolism of ingested foods, insufficient intake tomeet metabolic demands, and nausea/vomiting as evidenced by patient reports ofsevere stomach pain, nausea/vomiting, and tenderness upon palpation of liver; fatiguerelated to decreased metabolic energy production by liver and altered bodychemistry evidenced by patient reports of lack of energy and patient diagnosisof hepatitis B; and deficient knowledge related to lack of exposure to certaindisease process evidenced by questions and statements of misinterpretation orconfusion. The rationales for the nursing diagnosis is that the patient has aloss of appetite, severe abdominal pain, and nausea and vomiting which areclear signs that his body is not processing and digesting foods properly whichis due to his current liver infection.
This is placing stress on target organs,and the patient can feel these effects. The patient shows a lack of knowledgeabout HBV, which is evident in his statements to the physician. The nursingdiagnosis for potential problems is risk for deficient fluid volume andelectrolyte imbalance related to excessive fluid loss through nausea andvomiting manifested by patients report of nausea and vomiting; risk forinfection related to a compromised immune system as evidenced by medicaldiagnosis of hepatitis B and insufficient knowledge to avoid exposure topathogens. The rationales for the nursing diagnosis because the patient couldpotentially experience a fluid volume deficit if persistent vomiting occurs whichcould place his body in an alkalotic state further comprising his immune systemmaking him more susceptible to pathologic diseases. Afterforming a nursing diagnosis, it is vital to synthesize goals and outcomes thatyou would like the patient to achieve upon discharge.
This is an important partof the nursing process because it allows the nurse to measure the patient’sprogression from admittance to the hospital to discharge. For this patient, thedesired patient goal for imbalanced nutrition would be patient displaysnutritional ingestion sufficient to meet metabolic needs, patient shows no signof malnutrition, and the patient will experience a decrease in nausea/vomitingwithin 24 hours, and nausea and vomiting will be completely gone by discharge.The goals regarding fatigue are the patient will report improved sense ofenergy, and the patient will perform activities of daily living and participatein any desired activities at full level of ability. The patient will be able todo this without any complaints of tiredness or exhaustion and will rate anypain a tolerable level of 3 or less on a pain scale of 1-10 at the time ofdischarge. The goals regarding the potential diagnosis of risk for infection isthe patient will verbalize understanding of individual causative and riskfactors for diseases. Patient will also demonstrate techniques, such as properhand washing, to avoid reinfection/transmission to others upon discharge. Thegoal regarding risk for deficient fluid volume is the patient will maintainadequate hydration as evidenced by stable vital signs.
Upon discharge, thepatient will be able to verbalize understanding of the pathophysiology, correlatesymptoms with causative factors, and any potential complications. The patientwill also modify any behaviors or lifestyle changes to fit the treatmentregimen. All patient goals will be achieved upon discharge. Inorder to attain these goals, nursing actions must be implemented to guide thepatient throughout their healing process and hospitalization.
The main nursinginterventions would be to ensure the patient is intaking the recommended dailycaloric intake, which should include breakfast, lunch, and dinner with snacksas well. Another nursing intervention is to teach the patientnon-pharmacological ways to decrease nausea and to administer nausea andvomiting medication as ordered by the physician. The nurse can also encouragethe patient to ambulate and perform activities of daily living unless help isrequired.
The nurse can also educate the patient on preventive measures toincrease knowledge and prevent recurrent infections. Other nursinginterventions would include monitoring of vital signs frequently and monitoringthe patient’s response to therapeutic treatment. The nurse would also assessthe patient’s liver functioning as well. Deliveringquality care to patients requires many disciplines in nursing to enhance thehealing process. Another discipline that should be involved in this patient’scare is a nutritionist. Nutritionists “identify nutrition problems and… developdiet plans and counsel patients on special diet modifications” (“Roles of a Dietitian,”2016). This is important in this patient’s case because his nutrition isimbalanced due to his loss of appetite and nausea and vomiting symptoms fromhis current medical diagnosis.
A nutritionist would provide the right dietaryadvice to ensure the patient is receiving a well-balanced nutrition.Regardingthis patient’s condition, the healthcare team should not inform the patient’swife and kids about the patient’s medical diagnosis and required treatment. Itis unethical to do so and could cause many repercussions on the physician andthe hospital. It can also cause the patient to be embarrassed about theircondition.
Although it is necessary for this diagnosis to be shared with thefamily, it should not be shared by healthcare professionals because it wouldviolate HIPAA and patient privacy. The patient should share his medicaldiagnosis with his family, that way he has control over his situation.