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Nursing Care Plan for Cirrhosis (Liver)

Pathophysiology

Liver cirrhosis is a chronic, irreversible liver disease. Inflammation and fibrosis of liver cells (hepatocytes) lead to 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 Outome

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

Cirrhosis (Liver) Nursing Care Plan

Subjective Data:

  • 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:

  1. Complete vitals and respiratory assessment
    • Note impaired gas exchange and compromised respiratory function
      Assess for decreased or labored breathing
  2. 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

      Decrease in weight and blood pressure may indicate effectiveness of interventions
  3. Initiate bleeding precautions per facility protocol: No straight razors, Use 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 risk of bleeding.
  4. 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.
  5. 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.
  6. 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
  7. Provide adequate nutrition and education, encourage lifestyle changes
    • Malnutrition is often a complication of liver disease but may go unnoticed due to increase in weight. Encourage and education patient to maintain diet low in sodium and fat.
      Avoid alcohol, seek treatment for alcohol dependence.

References

Date Published - Jun 4, 2017
Date Modified - Oct 31, 2018