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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Risk for Injury

Nursing Diagnosis

  • Risk for Injury

Risk factors may include

  • Abnormal blood profile; altered clotting factors (decreased production of prothrombin, fibrinogen, and factors VIII, IX, and X; impaired vitamin K absorption; and release of thromboplastin)
  • Portal hypertension, development of esophageal varices

Desired Outcomes

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  • Maintain homeostasis with absence of bleeding
  • Demonstrate behaviors to reduce risk of bleeding.
Nursing InterventionsRationale
Closely assess for signs and symptoms of GI bleeding: check all secretions for frank or occult blood. Observe color and consistency of stools, NG drainage, or vomitus.The esophagus and rectum are the most usual sources of bleeding because of their mucosal fragility and alterations in hemostasis associated with cirrhosis.
Observe for presence of petechiae, ecchymosis, bleeding from one or more sites.Subacute disseminated intravascular coagulation (DIC) may develop secondary to altered clotting factors.
Monitor pulse, BP (and CVP if available).An increased pulse with decreased BP and CVP can indicate loss of circulating blood volume, requiring further evaluation.
Note changes in mentation and LOC.Changes may indicate decreased cerebral perfusion secondary to hypovolemia, hypoxemia.
Avoid rectal temperature; be gentle with GI tube insertions.Rectal and esophageal vessels are most vulnerable to rupture.
Encourage use of soft toothbrush, electric razor, avoiding straining for stool, vigorous nose blowing, and so forth.In the presence of clotting factor disturbances, minimal trauma can cause mucosal bleeding.
Use small needles for injections. Apply pressure to small bleeding and venipuncture sites for longer than usual.Minimizes damage to tissues, reducing risk of bleeding and hematoma.
Advice to avoid aspiring-containing products.Prolongs coagulation, potentiating risk of hemorrhage.
Monitor Hb/Hct and clotting factors.Indicators of anemia, active bleeding, or impending complications.
Administer medications as indicated
  • Supplemental vitamins: vitamin K, D, and C.
Promotes prothrombin synthesis and coagulation if liver is functional. Vitamin C deficiencies increase susceptibility of GI system to irritation and/or bleeding.
  • Stool softeners
Prevents straining for stool with resultant increase in intra-abdominal pressure and risk of vascular rupture and hemorrhage.
Provide gastric lavage with room temperature and cool saline solution or water as indicated.In presence of acute bleeding, evacuation of blood from GI tract reduces ammonia production and risk of hepatic encephalopathy.
Assist with insertion and maintenance of GI tube.Temporarily controls bleeding of esophageal varices when control by other means (e.g., lavage) and hemodynamic stability cannot be achieved.
Prepare for surgical procedures: direct ligation (banding) or varices, esophagogastric resection, splenorenal-portacaval anastomosis.May be needed to control active hemorrhage or to decrease portal and collateral blood vessel pressure to minimize risk of recurrence of bleeding.
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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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