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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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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 Interventions | Rationale |
|---|---|
| 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 | |
| Promotes prothrombin synthesis and coagulation if liver is functional. Vitamin C deficiencies increase susceptibility of GI system to irritation and/or bleeding. |
| 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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- 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, 2021-2023Â (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
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
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…
U HAVE DEDICATED YOUR SELF TO SERVE THE WORLD.THANK U
thank U
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