8 Liver Cirrhosis Nursing Care Plans

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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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  1. Imbalanced Nutrition: Less Than Body Requirements
  2. Excess Fluid Volume
  3. Risk for Impaired Skin Integrity
  4. Ineffective Breathing Pattern
  5. Risk for Injury
  6. Risk for Acute Confusion
  7. Disturbed Body Image
  8. Deficient Knowledge
  9. Other Possible Nursing Care Plans
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Excess Fluid Volume

Nursing Diagnosis

May be related to

  • Compromised regulatory mechanism (e.g., syndrome of inappropriate antidiuretic hormone [SIADH], decreased plasma proteins, malnutrition)
  • Excess sodium/fluid intake

Possibly evidenced by

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  • Edema, anasarca, weight gain
  • Intake greater than output, oliguria, changes in urine specific gravity
  • Dyspnea, adventitious breath sounds, pleural effusion
  • BP changes, altered CVP
  • JVD, positive hepatojugular reflex
  • Altered electrolyte levels
  • Change in mental status

Desired Outcomes

  • Demonstrate stabilized fluid volume, with balanced I&O, stable weight, vital signs within patient’s normal range, and absence of edema.
Nursing InterventionsRationale
Measure I&O, weigh daily, and note gain of more than 0.5 kg/day.To assess circulating volume status, developing or resolution of fluid shifts, and response to therapeutic regimen. Positive balance/weight gain often reflects continuing fluid retention. Note: Decreased circulating volume (fluid shifts) may directly affect renal function and urine output, resulting in hepatorenal syndrome.
Monitor BP (and CVP if available). Note JVD and abdominal vein distension.BP elevations are usually associated with fluid volume excess but may not occur because of fluid shifts out of the vascular space. Distension of external jugular and abdominal veins is associated with vascular congestion.
Assess respiratory status, noting increased respiratory rate, dyspnea.Indicative of pulmonary congestion.
Auscultate lungs, noting diminished breath sounds and developing adventitious sounds.Increasing pulmonary congestion may result in consolidation, impaired gas exchange, and complications.
Monitor for cardiac dysrhythmias. Auscultate heart sounds, noting development of S3/S4 gallop rhythm.May be caused by HF, decreased coronary arterial perfusion, and electrolyte imbalance.
Assess degree of peripheral edema.Fluids shift into tissues as a result of sodium and water retention, decreased albumin, and increased antidiuretic hormone (ADH).
Measure abdominal girth.Reflects accumulation of fluid (ascites) resulting from loss of plasma proteins/fluid into peritoneal space. Note: Excessive fluid accumulation can reduce circulating volume, creating a deficit (signs of dehydration).
Encourage bedrest when ascites is present.May promote recumbency induced diuresis.
Provide frequent mouth care; occasional ice chips (if NPO).Decreases sensation of thirst.
Monitor serum albumin and electrolytes (particularly potassium and sodium).Decreased serum albumin affects plasma colloid osmotic pressure, resulting in edema formation. Reduced renal blood flow accompanied by elevated ADH and aldosterone levels and the use of diuretics (to reduce total body water) may cause various electrolyte shifts/imbalances.
Monitor serial chest x-rays.Vascular congestion, pulmonary edema, and pleural effusions frequently occur.
Restrict sodium and fluids as indicated.Sodium may be restricted to minimize fluid retention in extravascular spaces. Fluid restriction may be necessary to correct dilutional hyponatremia.
Administer salt-free albumin/plasma expanders as indicated.Albumin may be used to increase the colloid osmotic pressure in the vascular compartment (pulling fluid into vascular space), thereby increasing effective circulating volume and decreasing formation of ascites.
Administer medications as indicated:
  • Diuretics: spironolactone (Aldactone), furosemide (Lasix)
Used with caution to control edema and ascites, block effect of aldosterone, and increase water excretion while sparing potassium when conservative therapy with bedrest and sodium restriction does not alleviate problem.
  • Potassium
Serum and cellular potassium are usually depleted because of liver disease and urinary losses.
Positive inotropic drugs and arterial vasodilators.Given to increase cardiac output/improve renal blood flow and function, thereby reducing excess fluid.
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Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

More nursing care plans related to gastrointestinal disorders:

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
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