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Knowledge Deficit — Liver Cirrhosis

LC-Knowledge Deficit

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NURSING DIAGNOSIS: Knowledge Deficit

May be related to
  • Lack of exposure/recall; information misinterpretation
  • Unfamiliarity with information resources
Possibly evidenced by
  • Questions; request for information, statement of misconception
  • Inaccurate follow-through of instructions/development of preventable complications
Desired Outcomes
  • Verbalize understanding of disease process/prognosis, potential complications.
  • Correlate symptoms with causative factors.
  • Identify/initiate necessary lifestyle changes and participate in care.

Nursing Interventions & Rationale

Nursing Interventions Rationale
 Review disease process/prognosis and future expectations.  Provides knowledge base from which patient can make informed choices.
 Stress importance of avoiding alcohol. Give information about community services available to aid in alcohol rehabilitation if indicated.  Alcohol is the leading cause in the development of cirrhosis.
 Inform patient of altered effects of medications with cirrhosis and the importance of using only drugs prescribed or cleared by a healthcare provider who is familiar with patient’s history.  Some drugs are hepatotoxic (especially narcotics, sedatives, and hypnotics). In addition, the damaged liver has a decreased ability to metabolize all drugs, potentiating cumulative effect and/or aggravation of bleeding tendencies.
Review procedure for maintaining function of peritoneovenous shunt when present.  Insertion of a Denver shunt requires patient to periodically pump the chamber to maintain patency of the device. Patients with a LeVeen shunt may wear an abdominal binder and/or engage in a Valsalva maneuver to maintain shunt function.
Assist patient identifying support person(s).  Because of length of recovery, potential for relapses, and slow convalescence, support systems are extremely important in maintaining behavior modifications.
Emphasize the importance of good nutrition. Recommend avoidance of high-protein/salty foods, onions, and strong cheeses. Provide written dietary instructions.  Proper dietary maintenance and avoidance of foods high in sodium and protein aid in remission of symptoms and help prevent ammonia buildup and further liver damage. Written instructions are helpful for patient to refer to at home.
 Stress necessity of follow-up care and adherence to therapeutic regimen.  Chronic nature of disease has potential for life-threatening complications. Provides opportunity for evaluation of effectiveness of regimen, including patency of shunt if used.
 Discuss sodium and salt substitute restrictions and necessity of reading labels on food and OTC drugs.  Minimizes ascites and edema formation. Overuse of substitutes may result in other electrolyte imbalances. Food, OTC/personal care products (e.g., antacids, some mouthwashes) may contain sodium or alcohol.
 Encourage scheduling activities with adequate rest periods.  Adequate rest decreases metabolic demands on the body and increases energy available for tissue regeneration.
 Promote diversional activities that are enjoyable to patient.  Prevents boredom and minimizes anxiety and depression.
 Recommend avoidance of persons with infections, especially URI.  Decreased resistance, altered nutritional status, and immune response (e.g., leukopenia may occur with splenomegaly) potentiate risk of infection.
Identify environmental dangers, e.g., carbon tetrachloride–type cleaning agents, exposure to hepatitis. Can precipitate recurrence.
Instruct patient/SO of signs/symptoms that warrant notification of healthcare provider, e.g., increased abdominal girth; rapid weight loss/gain; increased peripheral edema; increased dyspnea, fever; blood in stool or urine; excess bleeding of any kind; jaundice. Prompt reporting of symptoms reduces risk of further hepatic damage and provides opportunity to treat complications before they become life-threatening.
Instruct SO to notify healthcare providers of any confusion, untidiness, night wandering, tremors, or personality change. Changes (reflecting deterioration) may be more apparent to SO, although insidious changes may be noted by others with less frequent contact with patient.
 Source: http://ncplist.blogspot.com/2012/05/knowledge-deficit-liver-cirrhosis.html