Critical clinical manifestations that point towards a

Critical
thinking is an integral component of any nursing career that involves the use
of quality and ethical decision making while practicing. When considering the subjective
and objective information in this scenario, there are multiple pieces of data
that are pertinent in forming a diagnosis. It is first important to note that
this 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 and
tenderness of the liver when palpating. According to Mayo Clinic, “hepatitis B
signs and symptoms may include: abdominal pain, fever, loss of appetite, nausea
and vomiting, weakness and fatigue, and yellowing of your skin and the whites
of your eyes” (“Hepatitis B,” 2017). Mr. Smith has all the clinical
manifestations that point towards a medical diagnosis of hepatitis B. The information
mentioned earlier is pertinent because it allows the healthcare team to form a
professional opinion based on the patient’s clinical manifestations, objective
data, and subjective data. The patient’s vital signs are also pertinent
information because vital signs are a diagnostic tool that monitors a patient’s
physiological status and allows healthcare professionals to synthesize information
and deduce a clinical judgment. This patient’s blood pressure, pulse, and
temperature is elevated which means there is some type of stress occurring
within the body, such as an infection. The patient’s social history of relying
on injection drugs is also pertinent information because it gives healthcare
professionals a possible cause of his contraction of hepatitis B infection.
Hepatitis B can be spread easily “through needles and syringes contaminated
with infected blood” (“Hepatitis B,” 2017). If the patient shared any IV drug
paraphernalia during his deep depression, this could be the cause of his
current HBV infection. Information that is also pertinent is the fact that the
patient’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 accurate
diagnosis of HBV. According to the CDC, “Acute HBV infection is characterized by the
presence of HBsAg and immunoglobulin M (IgM) antibody to the core antigen,
HBcAg” (“Hepatitis B FAQs,” 2016).

Although
the patient’s medical diagnosis is of extreme importance, forming a nursing
diagnosis to the patient’s response to the medical condition is very beneficial
in the clinical setting. Based on the information from this case and knowledge
about his clinical manifestations, the nursing diagnoses for the actual
problems consist of imbalanced nutrition: less than body requirements related
to altered absorption and metabolism of ingested foods, insufficient intake to
meet metabolic demands, and nausea/vomiting as evidenced by patient reports of
severe stomach pain, nausea/vomiting, and tenderness upon palpation of liver; fatigue
related to decreased metabolic energy production by liver and altered body
chemistry evidenced by patient reports of lack of energy and patient diagnosis
of hepatitis B; and deficient knowledge related to lack of exposure to certain
disease process evidenced by questions and statements of misinterpretation or
confusion. The rationales for the nursing diagnosis is that the patient has a
loss of appetite, severe abdominal pain, and nausea and vomiting which are
clear signs that his body is not processing and digesting foods properly which
is 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 knowledge
about HBV, which is evident in his statements to the physician. The nursing
diagnosis for potential problems is risk for deficient fluid volume and
electrolyte imbalance related to excessive fluid loss through nausea and
vomiting manifested by patients report of nausea and vomiting; risk for
infection related to a compromised immune system as evidenced by medical
diagnosis of hepatitis B and insufficient knowledge to avoid exposure to
pathogens. The rationales for the nursing diagnosis because the patient could
potentially experience a fluid volume deficit if persistent vomiting occurs which
could place his body in an alkalotic state further comprising his immune system
making him more susceptible to pathologic diseases.

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After
forming a nursing diagnosis, it is vital to synthesize goals and outcomes that
you would like the patient to achieve upon discharge. This is an important part
of the nursing process because it allows the nurse to measure the patient’s
progression from admittance to the hospital to discharge. For this patient, the
desired patient goal for imbalanced nutrition would be patient displays
nutritional ingestion sufficient to meet metabolic needs, patient shows no sign
of malnutrition, and the patient will experience a decrease in nausea/vomiting
within 24 hours, and nausea and vomiting will be completely gone by discharge.
The goals regarding fatigue are the patient will report improved sense of
energy, and the patient will perform activities of daily living and participate
in any desired activities at full level of ability. The patient will be able to
do this without any complaints of tiredness or exhaustion and will rate any
pain a tolerable level of 3 or less on a pain scale of 1-10 at the time of
discharge. The goals regarding the potential diagnosis of risk for infection is
the patient will verbalize understanding of individual causative and risk
factors for diseases. Patient will also demonstrate techniques, such as proper
hand washing, to avoid reinfection/transmission to others upon discharge. The
goal regarding risk for deficient fluid volume is the patient will maintain
adequate hydration as evidenced by stable vital signs. Upon discharge, the
patient will be able to verbalize understanding of the pathophysiology, correlate
symptoms with causative factors, and any potential complications. The patient
will also modify any behaviors or lifestyle changes to fit the treatment
regimen. All patient goals will be achieved upon discharge.

In
order to attain these goals, nursing actions must be implemented to guide the
patient throughout their healing process and hospitalization. The main nursing
interventions would be to ensure the patient is intaking the recommended daily
caloric intake, which should include breakfast, lunch, and dinner with snacks
as well. Another nursing intervention is to teach the patient
non-pharmacological ways to decrease nausea and to administer nausea and
vomiting medication as ordered by the physician. The nurse can also encourage
the patient to ambulate and perform activities of daily living unless help is
required. The nurse can also educate the patient on preventive measures to
increase knowledge and prevent recurrent infections. Other nursing
interventions would include monitoring of vital signs frequently and monitoring
the patient’s response to therapeutic treatment. The nurse would also assess
the patient’s liver functioning as well.

Delivering
quality care to patients requires many disciplines in nursing to enhance the
healing process. Another discipline that should be involved in this patient’s
care is a nutritionist. Nutritionists “identify nutrition problems and… develop
diet plans and counsel patients on special diet modifications” (“Roles of a Dietitian,”
2016). This is important in this patient’s case because his nutrition is
imbalanced due to his loss of appetite and nausea and vomiting symptoms from
his current medical diagnosis. A nutritionist would provide the right dietary
advice to ensure the patient is receiving a well-balanced nutrition.

Regarding
this patient’s condition, the healthcare team should not inform the patient’s
wife and kids about the patient’s medical diagnosis and required treatment. It
is unethical to do so and could cause many repercussions on the physician and
the hospital. It can also cause the patient to be embarrassed about their
condition. Although it is necessary for this diagnosis to be shared with the
family, it should not be shared by healthcare professionals because it would
violate HIPAA and patient privacy. The patient should share his medical
diagnosis with his family, that way he has control over his situation.