A nurse is caring for a 38-year-old client with chronic hepatitis C who is being discharged home. Which discharge instruction is most important for the nurse to emphasize?
1Avoid all forms of alcohol consumption
2Take prescribed antiviral medications as directed
3Follow a low-protein diet to reduce liver workload
4Ensure household members are vaccinated against hepatitis B✓ 정답
해설
Emphasizing vaccination for household members is the priority discharge instruction to prevent hepatitis B transmission. Other instructions are important but less critical for infection control.
Core Nursing ExplanationKey Concept Analysis: This question assesses the nurse's ability to prioritize discharge teaching for a patient with Chronic Hepatitis C. The core theme is infection control and prevention of disease transmission to close contacts. While all options contain relevant health information, the NCLEX-RN often tests the ability to identify the Key Point! of preventing a Watch out for confusion!different, but more severe, co-infection.
Answer Rationale: The correct answer is ④ Ensure household members are vaccinated against hepatitis B. This is the most important instruction because Key Point! patients with chronic hepatitis C have a damaged liver and are at extremely high risk for severe, potentially fatal liver disease if they contract Hepatitis B (HBV). HBV vaccination for household members is a primary prevention strategy to protect the patient from a secondary infection. This intervention addresses patient safety at its core.
Distractor Analysis:
① Avoid all forms of alcohol consumption: This is a very important instruction because alcohol is hepatotoxic and can accelerate liver damage in hepatitis C. However, it is a secondary priority compared to preventing a life-threatening co-infection.
② Take prescribed antiviral medications as directed: Adherence to direct-acting antiviral (DAA) therapy is crucial for curing hepatitis C. Yet, this focuses on treating the existing condition, not preventing a new, dangerous complication for the patient.
③ Follow a low-protein diet to reduce liver workload: This instruction is incorrect and potentially harmful. Patients with chronic liver disease, including hepatitis C, typically require a well-balanced diet with adequate protein to prevent muscle wasting and support liver regeneration. A low-protein diet is usually reserved for patients with advanced liver failure and Hepatic encephalopathy.
Related Concepts: The principle here is "Prevention over Treatment" and protecting a vulnerable patient from a preventable, catastrophic health event. Nursing prioritization must consider which action has the greatest impact on preventing harm.Nursing Clinical Practice GuideClinical Scenario: You are preparing Mr. Johnson, a 38-year-old with newly diagnosed chronic Hepatitis C, for discharge. He lives with his wife and two teenage children. He is starting a 12-week course of antiviral pills.
Nursing Intervention Strategy:
Assessment: Verify the hepatitis B vaccination status of all household members. Assess the patient's understanding of his diagnosis and transmission routes (primarily blood-to-blood).
Planning & Implementation:
Priority Education: Firmly explain, "Because your liver is already working hard to fight Hepatitis C, getting Hepatitis B could cause very serious liver failure. The best way to protect you is to make sure everyone in your home is vaccinated against Hepatitis B. This is for your safety." Provide resources for low-cost vaccination clinics.
Comprehensive Teaching: Reinforce other key points: complete abstinence from alcohol, importance of medication adherence, need for a balanced diet (not low-protein), and safe practices to prevent transmission (e.g., not sharing razors or toothbrushes, covering open wounds).
Coordination: Document the need for HBV vaccination in the discharge summary and communicate this to the primary care provider for follow-up.
Patient Safety and Precautions: Never recommend a restrictive diet without a specific medical order. Monitor for signs of depression or stigma related to the diagnosis, as this can affect adherence.
Nursing Procedure & Medication Flow
For Hepatitis C Antiviral (e.g., Sofosbuvir/Ledipasvir):
Administration: Usually once daily, with or without food. Emphasize taking it at the same time every day.
Patient Education: Stress that even if symptoms improve, the full course must be completed to achieve a cure (Sustained Virologic Response - SVR). Report any severe fatigue, jaundice, or signs of depression immediately.
A Word from Your Senior Nurse
In the real world, patients often fixate on their own medication or diet. Your critical thinking as a nurse must see the bigger picture. Protecting an immunocompromised or chronically ill patient from a preventable secondary infection is a cornerstone of safe, holistic care. This question tests that protective instinct. Remember, your role isn't just to educate the patient, but to be an advocate for their entire health ecosystem, which includes their family.
Hepatitis C — A viral infection caused by the Hepatitis C virus (HCV) that leads to inflammation of the liver, often becoming chronic and causing cirrhosis or liver cancer.
Hepatitis B Vaccination — A vaccine that provides immunity against the Hepatitis B virus (HBV). It is a critical preventive measure for contacts of patients with chronic liver disease to prevent co-infection.
Co-infection — The simultaneous infection of a host by two or more pathogenic agents. In this context, HBV/HCV co-infection can lead to accelerated liver damage and failure.
Direct-Acting Antivirals — A class of medications used to treat Hepatitis C. They target specific steps in the HCV life cycle and have high cure rates with fewer side effects than older therapies.
Hepatic Encephalopathy — A decline in brain function that occurs as a result of severe liver disease. Toxins the liver normally removes build up in the bloodstream and affect the brain. A low-protein diet may be used in its management.