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Nursing Care Plan for Cirrhosis (Liver)

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Pathophysiology

Liver cirrhosis is a chronic, irreversible liver disease. Inflammation and fibrosis of liver cells (hepatocytes) lead to the formation of scar tissue within the liver, which causes obstruction of hepatic blood flow and impedes proper liver function.  This impaired blood flow leads to edema, ascites, esophageal varices, hemorrhoids, and varicose veins, among many other things. Since the liver is responsible for making many of the chemicals required by the body to function, breaking down and detoxifying substances and storing vitamins and minerals, many of the body’s systems fail to function when the liver is damaged.

Etiology

Liver cirrhosis is primarily caused by diseases that damage the liver and leave scar tissue in place of healthy tissue. Alcoholic liver disease (26%) and Hepatitis C (21%) are the cause behind 47% of liver cirrhosis cases in the United States. Other factors such as nonalcoholic fatty liver disease, Hepatitis B and D, autoimmune disease, and chronic heart failure with liver congestion may also result in cirrhosis.

Desired Outcome

Minimize progressive liver damage, optimize nutrition, maximize hepatic circulation, minimize and prevent respiratory complications

Cirrhosis (Liver) Nursing Care Plan

Subjective Data:

  • The patient may not have symptoms
  • RUQ abdominal pain
  • Fatigue
  • Poor appetite
  • Nausea
  • Itchy skin

Objective Data:

  • Bruising and bleeding easily
  • Confusion or memory loss
  • Dependent edema
  • Ascites
  • Jaundice
  • Dark-colored urine
  • Spider-like blood vessels on the skin
  • Clay-colored stool
  • Asterixis (flapping hand tremor)
  • Decreased reflexes
  • Anemia
  • Malaise
  • Hepatomegaly
  • Splenomegaly

Nursing Interventions and Rationales

  • Complete vitals and  respiratory assessment
  Note impaired gas exchange and compromised respiratory function Assess for decreased or labored breathing  
  • Monitor fluid and electrolyte  balance
    • Daily weights
    • Assess for JVD
 

  • Liver impairment may also affect renal function. Ascites and dependent edema may be indicators of hyponatremia.
  • Increasing weight and blood pressure may indicate vascular congestion
  • The decrease in weight and blood pressure may indicate the effectiveness of interventions

 

  • Initiate bleeding precautions per facility protocol
    • No straight razors
    • Use a soft toothbrush and good oral hygiene
    • Use stool softeners to avoid straining with bowel movements
  Coagulation chemicals such as prothrombin and fibrinogen. Damage to the liver may alter the production of these chemicals and increase the risk of bleeding.  
  • Promote rest to conserve energy
  Impaired liver function can cause the patient to be easily fatigued. Encourage rest periods and cluster care to conserve energy for nutrition and self-care.  
  • Assist with paracentesis as necessary
  If ascites progresses, it may be necessary to perform paracentesis to drain the abdominal fluid. Assist with set-up and positioning of patient, post-procedure site assessments, and monitoring.  
  • Administer medications appropriately
    • Diuretics
    • Lactulose
    • Analgesics
    • Blood products
    • Vitamin K
 

  • Diuretics- are often given to manage the accumulation of fluid and edema
  • Lactulose- a man-made sugar that is given to help reduce the amount of ammonia in the blood and prevent hepatic encephalopathy
  • Analgesics- given to manage pain; avoid acetaminophen
  • Blood products- excessive bleeding and complications following surgery may require blood transfusions
  • Vitamin K- helps to promote clotting and avoid complications from bleeding

 

  • Provide adequate nutrition and education, encourage lifestyle changes
  Malnutrition is often a complication of liver disease but may go unnoticed due to an increase in weight. Encourage and educate patients to maintain a diet low in sodium and fat. Avoid alcohol, seek treatment for alcohol dependence.  

References

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  • Question 1 of 5

The nurse is caring for a client who has cirrhosis of the liver. Which assessment finding is NOT consistent with this diagnosis?

  • Question 2 of 5

The nurse is reviewing orders on a newly admitted client who has cirrhosis of the liver with various complications. Which of the following orders would the nurse question?

  • Question 3 of 5

The nurse is caring for a client with severe liver cirrhosis. Which of the following nursing interventions is appropriate for this client? Select all that apply.

  • Question 4 of 5

A nurse is caring for a client that has been diagnosed with cirrhosis. Which of the following assessment findings is NOT consistent with this diagnosis?

  • Question 5 of 5

A nurse is caring for a client being tested for cirrhosis. Which lab panel does the nurse anticipate will be ordered for this client?

Module 0 – Nursing Care Plans Course Introduction
Module Obstetrics (OB) & Pediatrics (Peds) Care Plans

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