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
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
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