Cirrhosis is a chronic hepatic disease that is characterized by destruction of the functional liver cells, which leads to cellular death. In cirrhosis, the damaged liver cells regenerate as fibrosis areas instead of functional cells, causing alterations in liver structure, function, blood circulation, and lymph damage. The major cellular changes include irreversible chronic injury of the functional liver tissue and the formation of regenerative nodules. These changes result in liver cell necrosis, collapse of liver support networks, distortion of the vascular bed, and nodular regeneration of the remaining liver cells. This disease alters liver structure and normal vasculature, impairs blood and lymph flow, and ultimately causes hepatic insufficiency.
Causes for Cirrhosis depending on the type for Cirrhosis
- Hepatocellular disease, Postnecrotic cirrhosis called portal, nutritional, or alcoholic cirrhosis stems from various types of hepatitis e.g. A, B, C, or D viral hepatitis or toxic exposures. Damage of the Livver results from malnutrition and overuse of alcohol. Fibrous tissue forms in portal areas and around central veins. Autoimmune disease, such as sarcoidosis and chronic inflammatory bowel disease, may result in cirrhosis.
- Cholestatic diseases, Cholestatic diseases include diseases of the biliary tree and sclerosing cholangitis.
- Metabolic diseases, metabolic diseases include disorders such as Wilson’s disease, alpha1-antitrypsin deficiency, and hemochromatosis.
- Other types of cirrhosis, other types of cirrhosis include Budd-Chiari syndrome, cardiac cirrhosis, and cryptogenic cirrhosis. Cardiac cirrhosis is rare; the liver damage results from right-sided heart failure. Cryptogenic refers to cirrhosis of unknown cause
Complications for Cirrhosis
- Portal hypertension,
- Bleeding esophageal varices
- Hepatic encephalopathy
- Hepatorenal syndrome.
Diagnostic tests for Cirrhosis
- Liver biopsy
- Abdominal X-rays
- Computed tomography and liver scans
- Esophagogastroduodenoscopy
- Blood and Urine and stool studies disclose increased urine levels of bilirubin and urobilinogen; fecal urobilinogen levels decrease
Common Nursing diagnoses found on Nursing care Plans for Cirrhosis
- Activity intolerance
- Disturbed thought processes
- Excess fluid volume
- Hopelessness
- Imbalanced nutrition: Less than body requirements
- Risk for deficient fluid volume
- Risk for impaired skin integrity
- Risk for injury
Nursing Key outcomes nursing care Plans for Cirrhosis
The patient will:
- Perform ADL activities of daily living without excessive fatigue or exhaustion.
- Remain oriented to his environment.
- Show no signs of circulatory overload.
- Participate in decisions about care.
- Maintain adequate caloric intake.
- Patient’s fluid volume will remain within normal parameters.
- Patient’s skin integrity will remain intact.
- Avoid or minimize complications.
Nursing interventions nursing care Plans for Cirrhosis
- Monitor vital signs, intake and output, and electrolyte levels to determine fluid volume status.
- Assess fluid retention
- Weigh the patient daily and document his weight.
- Administer diuretics, potassium, and protein or vitamin supplements as ordered.
- Restrict sodium and fluid intake as ordered.
- Assist and provide oral hygiene before and after meals.
- Determine food preferences and provide them within the patient’s prescribed diet limitations.
- Provide frequent, small meals.
- Observe and document the degree of sclera and skin jaundice.
- Give the patient frequent skin care.
- Observe for bleeding gums, ecchymosed, epitasis, and petechiae.
- Inspect stools for amount, color, and consistency.
- Increase the patient’s exercise tolerance by decreasing fluid volumes and providing rest periods before exercise.
- Use appropriate safety measures to protect the patient from injury.
- Watch for signs of anxiety , epigastric fullness, restlessness, and weakness.
- Observe closely for signs of behavioral or personality changes.
- Observe Report increasing stupor, lethargy, hallucinations, or neuromuscular dysfunction. Arouse the patient periodically to determine level of consciousness. Watch for asterixis, a sign of developing encephalopathy.
- Allow the patient to express his feelings about having cirrhosis.
- Provide psychological support and encouragement, when appropriate.
Patient teaching nursing care Plans for Cirrhosis
- Warn the patient against taking nonsteroidal anti-inflammatory drugs, straining to defecate, and blowing his nose or sneezing too vigorously. To minimize the risk of bleeding.
- Suggest using a soft toothbrush and a electric razor
- Advise the patient that rest and good nutrition conserve energy and decrease metabolic demands on the liver.
- Suggest the patient to eat frequent, small meals. Teach him to alternate periods of rest and activity to reduce oxygen demand and prevent fatigue.
- Tell the patient how he can conserve energy while performing activities of daily living. For example, suggest that he sit on a bench while bathing or dressing.
- Stress the need to avoid infections and abstain from alcohol. Refer the patient to alcohol abuse treatment Anonymous, if appropriate
- Alcohol abuse treatment. Emphasize to the patient with alcoholic liver cirrhosis that continued alcohol use exacerbates the disease. Stress that alcoholic liver disease in its early stages is reversible when the patient abstains from alcohol. Encourage family involvement in. Assist the patient in obtaining counseling or support for her or his alcoholism.
- Encourage the patient to seek frequent medical follow-up and Refer the patient to an alcohol support group or liver transplant support group.
