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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:
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- Imbalanced Nutrition: Less Than Body Requirements
- Excess Fluid Volume
- Risk for Impaired Skin Integrity
- Ineffective Breathing Pattern
- Risk for Injury
- Risk for Acute Confusion
- Disturbed Body Image
- Deficient Knowledge
- Other Possible Nursing Care Plans
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Imbalanced Nutrition: Less Than Body Requirements
- Imbalanced Nutrition: Less Than Body Requirements
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. |
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Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use. - Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively. - NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales. - Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates. - Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing. - Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans. - Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you. - Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023. - All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
More nursing care plans related to gastrointestinal disorders:
- Appendectomy | 4 Care Plans
- Cholecystectomy | 12 Care Plans
- Cholecystitis and Cholelithiasis | 4 Care Plans
- Gastroenteritis | 4 Care Plans
- Hemorrhoids | 3 Care Plans
- Hepatitis | 7 Care Plans
- Ileostomy & Colostomy | 10 Care Plans
- Inflammatory Bowel Disease | 7 Care Plans
- Intussusception | 3 Care Plans
- Liver Cirrhosis | 8 Care Plans
- Pancreatitis | 8+ Care Plans
- Peritonitis | 6 Care Plans
- Peptic Ulcer Disease | 5 Care Plans
- Subtotal Gastrectomy | 2 Care Plans
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thank u
Just a question – is this site like Wikipedia where anyone can upload information? its just i would love to be able to reference this for my assignment on adult nursing degree but i don’t know if i am allowed to cite it? please could you let me know or could you let me know where you found your orriginal sources? THanks for your help…
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very informative
Hello! I would like too, to know if i’m allowed to cite your work in my thesis. please let me know your sources and if I can put this in my references
Sure. :)
Very helpful