8 Liver Cirrhosis Nursing Care Plans

July 15, 2013

Liver cirrhosis, also known as hepatic cirrhosis, is a chronic hepatic disease characterized by diffuse destruction and fibrotic regeneration of hepatic cells. As necrotic tissues yields to fibrosis, the diseases alters the liver structure and normal vasculature, impairs blood and lymph flow, and ultimately causing hepatic insufficiency. 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.

These are the clinical types of cirrhosis:

Laennec’s cirrhosis is the most common type and occurs 30% to 50% of cirrhotic patients. Up to 90% of whom have a history of alcoholism. Liver damage results from malnutrition, especially of dietary protein, and chronic alcohol ingestion. Fibrous tissue forms in portal areas and around central veins.
Biliary cirrhosis occurs in 15% to 20% of patients, and results from injury or prolonged obstruction.
Postnecrotic cirrhosis stems from various types of hepatitis.
Pigment cirrhosis results from disorders such as hemochromatosis.
Idiopathic cirrhosis, has no known cause.
Noncirrhotic fibrosis may results from schistosomiasis or congenital hepatic fibrosis or may be idiopathic.

Nursing Care Plans

Nursing care planning for patients with liver cirrhosis includes promoting rest, providing adequate nutrition, skin care, reducing risk for injury, and monitoring and managing complications.

Here are eight (8) nursing care plans (NCP) and nursing diagnosis for patients with liver cirrhosis:

Imbalanced Nutrition: Less Than Body Requirements

Imbalanced Nutrition: Less Than Body Requirements: Intake of nutrients insufficient to meet metabolic needs.

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
Measure dietary intake by calorie count.	Provides important information about intake, needs and 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 and/or ascites. Skinfold measurements are useful in assessing changes in muscle mass and subcutaneous fat reserves.
Encourage patient to eat; explain reasons for the types of diet. Feed patient if tiring easily, or have SO assist patient. Include patient in meal planning to consider his/her preferences in food choices.	Improved nutrition and 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 including 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.
Give small, frequent meals.	Poor tolerance to larger meals may be due to increased intra-abdominal pressure and ascites (if present).
Provide salt substitutes, if allowed; avoid those containing ammonium.	Salt substitutes enhance the flavor of food 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 and/or diarrhea and abdominal discomfort that may impair oral intake.
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. Provide teaching on the possible negative effects of smoking.	Reduces excessive gastric stimulation and risk of irritation and may lead to bleeding.
Monitor laboratory studies: serum glucose, prealbumin and albumin, total protein, ammonia.	Glucose may be decreased because of impaired gluconeogenesis, 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 and urea in the GI tract.
Refer to dietitian to provide diet 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 (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.