Liver

Cirrhos
is
 Objectives
This case study aims to come
up with a more in-depth
understanding of the
disease, Liver Cirrhosis for us
(and other nursing students)
to be able to come up with
the best nursing care plan in
the care of patients with the
said disease.
Cirrhosis of the Liver
The liver, the largest organ in the
body, is essential in keeping the body
functioning properly. It removes or
neutralizes poisons from the blood,
produces immune agents to control
infection, and removes germs and
bacteria from the blood. It makes
proteins that regulate blood clotting
and produces bile to help absorb fats
and fat-soluble vitamins. You cannot
live without a functioning liver.
Cirrhosis of the Liver
Cirrhosis is a potentially life-
threatening condition that occurs
when scarring damages the liver.
This scarring replaces healthy tissue
and prevents the liver from working
normally. Cirrhosis usually develops
after years of liver inflammation.
When chronic diseases cause the
liver to become permanently injured
and scarred, the condition is called
Cirrhosis.
Three major forms
Laennec’s (alcohol
induced) Cirrhosis
 Three major forms
Postnecrotic
(micronodular) Cirrhosis
Three major forms
Biliary Cirrhosis
Patient’s Profile
ETIOLO
GY
Chronic alcoholism
Chronic Hepatitis C, B
and D
Autoimmune
Hepatitis
Inherited
Diseases
 Nonalcoholic
Steatohepatitis
Blocked Bile
Ducts
Drugs, toxins and
infections
 Clinical
Manifestations
Weakness,
fatigue
Anorexia
Stomatitis
Tea colored
Urine
Clay colored
Stool
Amenorrhea
 Decrease
sexual urge
 Loss of
pubic/axilla hair
Hepatomegaly
Jaundice
Pruritus or
Urticaria
Hematological
Changes
Endocrine
Changes
GIT Changes
Neurological
Changes
Complic
ations
Edema and
Ascites
Bruising and
Bleeding
Jaundice
Itching
Gallstones
Toxins in the blood
or brain
Sensitivity to
medication
 Portal
Hypertension
Varices
Insulin resistance
and type 2 DM
Liver Cancer
Problems in other
organs
Pathophysiolo
gy
Persistent
Fibrotic
changes
Injury toor
Fibrosis
the liverwill
occur
Drugs
virus
toxins
alcoholis
syste
infectio
mic
ns m
 Alteration in
physiologic function

Nutritional
metabolism
Fibrosis
Increase Portal
Pressure
Process can
Without adequate
and proper
be arrested
regeneration
with
adequate
liver
regeneratio
Deat n
Diagnostic
Evaluation
 Ultrasound of Whole
Abdomen
The liver is unenlarge exhibiting smooth
contour and heterogenous parenchymal
echopatter. There is no focal mass. Undilated
bile canaliculi, portal and systemic vessels.
There is no free peritoneal fluid.

The Gallbladder is undilated with even,

unthickened wall. No luminal shadowing
calculus or focal mass is seen.
IMPRESSION: Mild liver parenchymal
changes
Vitros Clinical Chem.
Report
 HEMATOLOGY
Hemoglobin: 147 g/1; normal: M =
140-170g/1
WBC: 12.8 x 109/1; nomarl: 5-10 x
109/1
Hematocrit: 45vo1%; normal: M = 40-
50 vo1/%
 Other Diagnostic
Procedures for Liver
Liver biopsy - detects destruction and
fibrosis of hepatic tissue.
 Other Diagnostic
Procedures for Liver
Liver scan- shows abdominal thickening
and liver mass
 Other Diagnostic
Procedures for Liver
CT scan- determines the size of the liver
and its irregular nodular surface.
 Other Diagnostic
Procedures for Liver
Esophagoscopy – to determine
esophageal varices.
 Other Diagnostic
Procedures for Liver
Paracentesis – to examine ascetic
fluid for cell, protein and bacterial
count.
 Other Diagnostic
Procedures for Liver
Laparoscopy – permits direct
visualization of the liver.
 Other Diagnostic
Procedures for Liver
Serum liver function test – results are
elevated.
Medical Management
Pharmacologic Interventions:
2. Provide asymptomatic relief measures
such as pain medications and
antiemetics.
3. Diuretic therapy, frequently with
spironolactone, a potassium-sparing
diuretic that inhibits the action of
aldosteroe on the kidneys.
4. I.V albumin to maintain osmotic pressure
and reduce ascites.
5. Administration of lactulose or neomycin
through a nasogastric tube or retention
enema to reduce ammonia levels during
periods of hepatic encephalopathy.
Medical Management
Surgical Interventions:
2. Transjugular intrahepatic
portosystemic shunt may be
performed in patients whose
ascites prove resistant. This
percutaneous procedure creates a
shunt from the portal to systemic
circulation to reduce portal
pressure and relieve ascites.
3. Orthotopic liver transplantation
may be necessary.
Nursing Intervention
Promoting Activity Tolerance

3. Encourage alternating periods of

rest and ambulation.
4. Maintain some periods of bed rest
with legs elevated to mobilize
edema and ascites.
5. Encourage and assist with
gradually increasing periods of
exercise.
Nursing Intervention
Improving Nutritional Status

3. Encourage patient to eat high

calorie, moderate protein meal
and to have supplementary
feedings.
4. Suggest small, frequent feedings
and attractive meals in an
aesthetically pleasing setting at
meal time.
5. Encourage and assist with
gradually increasing periods of
Nursing Intervention
Protecting Skin Integrity

3. Note and record degree of

jaundice of skin and sclera and
scratches on the body.
4. Encourage frequent skin care,
bathing without soap, and
massage with emollient lotions.
5. Advise patient to keep fingernails
short.
Nursing Intervention
Patient Education and Health
Maintenance
Ø Stress the necessity of giving up
alcohol completely.
Ø Urge acceptance of assistance
from a substance abuse program.
Ø Provide written dietary
instructions.
Ø Encourage daily weighing for self-
monitoring of fluid retention
depletion.
Ø Discuss adverse effects of diuretic
Nursing Intervention
Patient Education and Health
Maintenance
Ø Emphasize the importance of rest,
a sensible lifestyle, and an
adequate, well-balanced diet.
Ø Involve the person closest to the
patient because recovery usually
is not easy and relapses are
common.
Ø Stress the importance of
continued follow –up for laboratory
test and evaluation by a health
care provider
Nursing Care Plan
 Evaluation
Achievement of outcomes is successful if the
patient with cirrhosis:

• Has clear breath sounds throughout lung fields and normal

percussion results from thoracic cavity.
• Increases involvement in daily self-care activities and
ambulation in hospital hallways.
• Loses 1 to 2 lb/day until dry weight is reached; has
decreasing edema, decreasing abdominal girth, and urine
output of 500 to 1000 ml greater than intake until dry
weight is reached.
• Has normal body temperature and no indications of
infections.
 Evaluation
Achievement of outcomes is successful if the
patient with cirrhosis:
• Shows normal prothrombin time and
hematocrit; hemoglobin levels that are
increasing; no orthostatic vital sign changes;
and no falls, cuts, or other injuries.
• Maintains adequate food intake to regain or
keep weight as appropriate with incorporation
of foods from all food groups and restriction of
sodium and protein as necessary.
• Shows no evidence of scratching and states
that itching is decreased and controlled.
• Makes positive statements about self and
realistic statements about future goals.
• Maintains intact skin and appropriate healing
 Recommendation
• Avoid further hepatic damage: abstain from
alcohol; abstain from any drugs not prescribe
by physician, including over-the-counter drugs,
such as analgesics or cold remedies; avoid
exposure to hepatotoxins in the work and
home environments.
• Dietary regimen (may include sodium and/or
protein restrictions) should be well balanced
and include sources high in protein such as
milk, eggs, fish, and poultry.
• Fluid restriction if required; how to incorporate
 Recommendation
• Signs and symptoms requiring immediate
follow-up: weight gain; increased abdominal
girth; recurrence of edema, fever, or bleeding
(blood in urine, stool, or vomitus; epistaxis;
cuts that continue to bleed); change in metal
function or behavior.
• Measures that lessen chance of bleeding.
• Activity plan than promotes adequate rest.
• Care measures that help to control prurirus.