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
- 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
Risk for Acute Confusion
- Risk for Acute Confusion
Risk factors may include
- Alcohol abuse
- Inability of liver to detoxify certain enzymes/drugs
- Maintain usual level of mentation/reality orientation.
- Initiate behaviors/lifestyle changes to prevent or minimize recurrence of problem.
|Observe for signs and symptoms of behavioral change and mentation: lethargy, confusion, drowsiness, slurring of speech, and irritability. Around patient at intervals as indicated.||Ongoing assessment of behavior and mental status is important because of fluctuating nature of impending hepatic coma.|
|Review current medication regimen. Note adverse drug reactions and effects of medication to the patient.||Adverse drug reactions or interactions (e.g., cimetidine plus antacids) may potentiate and/or exacerbate confusion.|
|Evaluate sleep and rest schedule.||Difficulty falling or staying asleep leads to sleep deprivation, resulting in diminished cognition and lethargy.|
|Note development and/or presence of asterixis, fetor hepaticus, seizure activity.||Suggests elevating serum ammonia levels; increased risk of progression to encephalopathy.|
|Consult with SO about patient’s usual behavior and mentation.||Provides baseline for comparison of current status.|
|Have patient write name periodically and keep this record for comparison. Report deterioration of ability. Have patient do simple arithmetic computations.||Easy test of neurological status and muscle coordination.|
|Reorient to time, place, person as needed.||Assists in maintaining reality orientation, reducing confusion and anxiety.|
|Maintain a pleasant, quiet environment and approach in a slow, calm manner. Encourage uninterrupted rest periods.||Reduces excessive stimulation and sensory overload, promotes relaxation, and may enhance coping.|
|Provide continuity of care. If possible, assign same nurse over a period of time.||Familiarity provides reassurance, aids in reducing anxiety, and provides a more accurate documentation of subtle changes.|
|Reduce provocative stimuli, confrontation. Refrain from forcing activities. Assess potential for violent behavior.||Avoids triggering agitated, violent responses; promotes patient safety.|
|Discuss current situation, future expectation.||Patient/SO may be reassured that intellectual (as well as emotional) function may improve as liver involvement resolves.|
|Maintain bedrest, assist with self-care activities.||Reduces metabolic demands on liver, prevents fatigue, and promotes healing, lowering risk of ammonia buildup.|
|Identify and provide safety needs. Supervise during smoking, put bed in low position, raise side rails and pad if necessary.||Reduces risk of injury when confusion, seizures, or violent behavior occurs.|
|Investigate temperature elevations. Monitor for signs of infection.||Infection may precipitate hepatic encephalopathy caused by tissue catabolism and release of nitrogen.|
|Recommend avoidance of narcotics or sedatives, anti anxiety agents, and limiting or restricting use of medications metabolized by the liver.||Certain drugs are toxic to the liver, whereas other drugs may not be metabolized because of cirrhosis, causing cumulative effects that affect mentation, mask signs of developing encephalopathy, or precipitate coma.|
|Eliminate or restrict protein in diet. Provide glucose supplements, adequate hydration.||Ammonia (product of the breakdown of protein in the GI tract) is responsible for mental changes in hepatic encephalopathy. Dietary changes may result in constipation, which also increases bacterial action and formation of ammonia. Glucose provides a source of energy, reducing need for protein catabolism. Note: Vegetable protein may be better tolerated than meat protein.|
|Assist with procedures as indicated: dialysis, plasmapheresis, or extracorporeal liver perfusion.||May be used to reduce serum ammonia levels if encephalopathy develops and other measures are not successful.|
Recommended nursing diagnosis and nursing care plan books and resources.
- 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.
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