Cirrhosis is a chronic disease of the liver characterized by alteration in structure, degenerative changes and widespread destruction of hepatic cells, impairing cellular function and impeding blood flow through the liver. Causes include malnutrition, inflammation (bacterial or viral), and poisons (e.g., alcohol, carbon tetrachloride, acetaminophen). Cirrhosis is the fourth leading cause of death in the United States among people ages 35 to 55 and represents a serious threat to long-term health.
8 Liver Cirrhosis Nursing Care Plans
- Imbalanced Nutrition — Liver Cirrhosis
- Excess Fluid Volume — Liver Cirrhosis
- Impaired Skin Integrity — Liver Cirrhosis
- Ineffective Breathing Pattern — Liver Cirrhosis
- Risk for Injury — Liver Cirrhosis
- Risk for Acute Confusion — Liver Cirrhosis
- Disturbed Body Image/Self-Esteem — Liver Cirrhosis
- Knowledge Deficit — Liver Cirrhosis
- Maintain adequate nutrition.
- Prevent complications.
- Enhance self-concept, acceptance of situation.
- Provide information about disease process/prognosis, potential complications, and treatment needs.
- Nutritional intake adequate for individual needs.
- Complications prevented/minimized.
- Dealing effectively with current reality.
- Disease process, prognosis, potential complications, and therapeutic regimen understood.
- Plan in place to meet needs after discharge.
Other Nursing Diagnoses
- Fatigue—decreased metabolic energy production, states of discomfort, altered body chemistry (e.g., changes in liver function, effect on target organs, alcohol withdrawal).
- Nutrition: imbalanced, less than body requirements—inadequate diet; inability to process/digest nutrients; anorexia, nausea/vomiting, indigestion, early satiety (ascites); abnormal bowel function.
- Therapeutic Regimen: risk for ineffective management—perceived benefit, social support deficit, economic difficulties.
- Family Processes, dysfunctional: alcoholism—abuse of alcohol, resistance to treatment, inadequate coping/lack of problem-solving skills, addictive personality/codependency.
- Caregiver Role Strain, risk for—addiction or codependency, family dysfunction before caregiving situation, presence of situational stressors, such as economic vulnerability, hospitalization, changes in employment.
- Liver scans/biopsy: Detects fatty infiltrates, fibrosis, destruction of hepatic tissues, tumors (primary or metastatic), associated ascites.
- Percutaneous transhepatic cholangiography (PTHC): May be done to rule out/differentiate causes of jaundice or to perform liver biopsy.
- Esophagogastroduodenoscopy (EGD): May demonstrate presence of esophageal varices, stomach irritation or ulceration, duodenal ulceration or bleeding.
- Percutaneous transhepatic portal angiography (PTPA): Visualizes portal venous system circulation.
- Serum bilirubin: Elevated because of cellular disruption, inability of liver to conjugate, or biliary obstruction.
- Liver enzymes:
- AST/ALT, LDH, and isoenzymes (LDH5): Increased because of cellular damage and release of enzymes.
- Alkaline phosphatase (ALP) and isoenzyme (LAP1): Elevated because of reduced excretion.
- Gamma glutamyl transpeptidase (GTT): Elevated.
- Serum albumin: Decreased because of depressed synthesis.
- Globulins (IgA and IgG): Increased synthesis.
- CBC: Hb/Hct and RBCs may be decreased because of bleeding. RBC destruction and anemia is seen with hypersplenism and iron deficiency. Leukopenia may be present as a result of hypersplenism.
- PT/activated partial thromboplastin time (aPTT): Prolonged (decreased synthesis of prothrombin)
- Fibrinogen: Decreased.
- BUN: Elevation indicates breakdown of blood/protein.
- Serum ammonia: Elevated because of inability to convert ammonia to urea.
- Serum glucose: Hypoglycemia suggests impaired glycogenesis.
- Electrolytes: Hypokalemia may reflect increased aldosterone, although various imbalances may occur. Hypocalcemia may occur because of impaired absorption of vitamin D.
- Nutrient studies: Deficiency of vitamins A, B12, C, K; folic acid, and iron may be noted.
- Urine urobilinogen: May/may not be present. Serves as guide for differentiating liver disease, hemolytic disease, and biliary obstruction.
- Fecal urobilinogen: Decreased.