The nurse is caring for a client with a diagnosis of hepatitis with experiencing pruritis. Which would be the most appropriate nursing intervention?

Appeared in: DHS 2018 shift 1st

Explanation

Pruritus (itching) in hepatitis is primarily caused by the accumulation of bile salts under the skin due to impaired liver function.
The main goal of nursing intervention is to maintain skin moisture and prevent further irritation to soothe the skin.
Adding baby oil to bath water acts as an emollient, which lubricates the skin, helps retain moisture, and provides a soothing barrier against the irritant effects of bile salts.
This intervention directly addresses the skin dryness that accompanies and worsens pruritus.

Option A: Frequent bathing (two times per day) with warm water strips the skin of its natural protective oils, leading to excessive dryness and worsening the pruritus.
Option C: Powders are hygroscopic agents that absorb moisture. Applying powder would further dry out the skin, making the itching more severe.
Option D: Hot water causes vasodilation (widening of blood vessels), which increases blood flow to the skin and can intensify the sensation of itching.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing interventions for pruritus associated with hepatitis to guide bedside assessment, documentation, and the next nursing action.
Managing pruritus is a critical nursing responsibility for patient comfort and preventing complications like skin excoriation, breakdown, and secondary infections in clients with hepatic dysfunction.
Patient education is a key nursing role. The nurse must teach the patient and family about appropriate skin care, including bathing practices, use of emollients, and avoiding triggers like heat and harsh fabrics.
What if? If the patient's pruritus is severe and does not respond to topical measures like bath oils, the nurse should anticipate the need for prescribed systemic medications, such as cholestyramine (to bind bile salts) or antihistamines, and report the ineffectiveness of current interventions to the healthcare provider.

How to Approach the Question

First, identify the core clinical problem presented in the question: a client with hepatitis is experiencing pruritus (itching).
Next, recall the underlying pathophysiology. In hepatitis, impaired liver function leads to the accumulation of bile salts under the skin, causing intense itching and skin dryness.
Establish the primary goal of nursing intervention for this problem, which is to soothe the skin, maintain moisture, and prevent further irritation.
Evaluate each option based on this goal. Analyze whether the action will moisturize or dry the skin, and whether it will soothe or stimulate itching.
Option A (frequent warm showers) and Option C (powder) both lead to skin dryness. Option D (hot water) increases vasodilation and itching.
Select the option that directly promotes skin hydration and comfort. Adding baby oil to the bath is an emollient therapy that achieves this goal.

Concept Tested & Keywords

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E6 Nursing Brunner Adult Health 3SA Vol 1 Part 4 p. 69-71

Practise the full DHS 2018 shift 1st

Attempt every question from this paper in a timed mock, then review the full solution for each one.