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NCP Imbalanced Nutrition — Liver Cirrhosis

Nursing Diagnosis: Nutrition: imbalanced, less than body requirements

LC-Imbalanced Nutrition
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May be related to
  • Inadequate diet; inability to process/digest nutrients
  • Anorexia, nausea/vomiting, indigestion, early satiety (ascites)
  • Abnormal bowel function
Possibly evidenced by
  • Weight loss
  • Changes in bowel sounds and function
  • Poor muscle tone/wasting
  • Imbalances in nutritional studies
Desired Outcomes
  • Demonstrate progressive weight gain toward goal with patient-appropriate normalization of laboratory values.
  • Experience no further signs of malnutrition.

Nursing Interventions & Rationale

Nursing Interventions Rationale
 Measure dietary intake by calorie count.  Provides information about intake, needs/deficiencies.
 Weigh as indicated. Compare changes in fluid status, recent weight history, skinfold measurements.  It may be difficult to use weight as a direct indicator of nutritional status in view of edema/ascites. Skinfold measurements are useful in assessing changes in muscle mass and subcutaneous fat reserves.
 Assist/encourage patient to eat; explain reasons for the types of diet.Feed patient if tiring easily, or have SO assist patient. Consider preferences in food choices.  Improved nutrition/diet is vital to recovery. Patient may eat better if family is involved and preferred foods are included as much as possible.
 Encourage patient to eat all meals/supplementary feedings.  Patient may pick at food or eat only a few bites because of loss of interest in food or because of nausea, generalized weakness, malaise.
 Recommend/provide small, frequent meals.  Poor tolerance to larger meals may be due to increased intra-abdominal pressure/ascites.
 Provide salt substitutes, if allowed; avoid those containing ammonium.  Salt substitutes enhance the flavor offood and aid in increasing appetite; ammonia potentiates risk of encephalopathy.
 Restrict intake of caffeine, gas-producing or spicy and excessively hot or cold foods.  Aids in reducing gastric irritation/diarrhea and abdominal discomfort that may impair oral intake/digestion.
 Suggest soft foods, avoiding roughage if indicated.  Hemorrhage from esophageal varices may occur in advanced cirrhosis.
Encourage frequent mouth care, especially before meals.  Patient is prone to sore and/or bleeding gums and bad taste in mouth, which contributes to anorexia.
Promote undisturbed rest periods, especially before meals. Conserving energy reduces metabolic demands on the liver and promotes cellular regeneration.
Recommend cessation of smoking. Reduces excessive gastric stimulation and risk of irritation/bleeding.
Monitor laboratory studies, e.g., serum glucose, prealbumin/albumin, total protein, ammonia. Glucose may be decreased because of impaired glycogenesis, depleted glycogen stores, or inadequate intake. Protein may be low because of impaired metabolism, decreased hepatic synthesis, or loss into peritoneal cavity (ascites). Elevation of ammonia level may require restriction of protein intake to prevent serious complications.
Maintain NPO status when indicated. Initially, GI rest may be required in acutely ill patients to reduce demands on the liver and production of ammonia/urea in the GI tract.
 Consult with dietitian to provide dietthat is high in calories and simple carbohydrates, low in fat, and moderate to high in protein; limit sodium and fluid as necessary. Provide liquid supplements as indicated.  High-calorie foods are desired inasmuch as patient intake is usually limited. Carbohydrates supply readily available energy. Fats are poorly absorbed because of liver dysfunction and may contribute to abdominal discomfort. Proteins are needed to improve serum protein levels to reduce edema and to promote liver cell regeneration.Note: Protein and foods high in ammonia (e.g., gelatin) are restricted if ammonia level is elevated or if patient has clinical signs of hepatic encephalopathy. In addition, these individuals may tolerate vegetable protein better than meat protein.
 Provide tube feedings, TPN, lipids if indicated.  May be required to supplement diet or to provide nutrients when patient is too nauseated or anorexic to eat or when esophageal varices interfere with oral intake.