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
May be related to
- Lack of exposure/recall; information misinterpretation
- Unfamiliarity with information resources
Possibly evidenced by
- Questions; request for information, statement of misconception
- Inaccurate follow-through of instructions/development of preventable complications
- Verbalize understanding of disease process/prognosis, potential complications.
- Correlate symptoms with causative factors.
- Identify/initiate necessary lifestyle changes and participate in care.
|Review disease process and prognosis and future expectations.||Provides knowledge base from which patient can make informed choices.|
|Refer to dietitian or nutritionist.||Patients with cirrhosis needs close observation and sound nutritional counseling.|
|Stress importance of avoiding alcohol. Give information about community services available to aid in alcohol rehabilitation if indicated.||Alcohol is the leading cause in the development of cirrhosis.|
|Inform patient of altered effects of medications with cirrhosis and the importance of using only drugs prescribed or cleared by a healthcare provider who is familiar with patient’s history.||Some drugs are hepatotoxic (especially narcotics, sedatives, and hypnotics). In addition, the damaged liver has a decreased ability to metabolize all drugs, potentiating cumulative effect and/or aggravation of bleeding tendencies.|
|Review procedure for maintaining function of peritoneovenous shunt when present.||Insertion of a Denver shunt requires patient to periodically pump the chamber to maintain patency of the device. Patients with a LeVeen shunt may wear an abdominal binder and/or engage in a Valsalva maneuver to maintain shunt function.|
|Assist patient identifying support person(s).||Because of length of recovery, potential for relapses, and slow convalescence, support systems are extremely important in maintaining behavior modifications.|
|Emphasize the importance of good nutrition. Recommend avoidance of high-protein/salty foods, onions, and strong cheeses. Provide written dietary instructions.||Proper dietary maintenance and avoidance of foods high in sodium and protein aid in remission of symptoms and help prevent ammonia buildup and further liver damage. Written instructions are helpful for patient to refer to at home.|
|Stress necessity of follow-up care and adherence to therapeutic regimen.||Chronic nature of disease has potential for life-threatening complications. Provides opportunity for evaluation of effectiveness of regimen, including patency of shunt if used.|
|Discuss sodium and salt substitute restrictions and necessity of reading labels on food and OTC drugs.||Minimizes ascites and edema formation. Overuse of substitutes may result in other electrolyte imbalances. Food, OTC and/or personal care products (antacids, some mouthwashes) may contain sodium or alcohol.|
|Encourage scheduling activities with adequate rest periods.||Adequate rest decreases metabolic demands on the body and increases energy available for tissue regeneration.|
|Promote diversional activities that are enjoyable to patient.||Prevents boredom and minimizes anxiety and depression.|
|Recommend avoidance of persons with infections, especially URI.||Decreased resistance, altered nutritional status, and immune response (leukopenia may occur with splenomegaly) potentiate risk of infection.|
|Identify environmental dangers: exposure to hepatitis.||Can precipitate recurrence.|
|Instruct patient/SO of signs and symptoms that warrant notification of health care provider: increased abdominal girth; rapid weight loss/gain; increased peripheral edema; increased dyspnea, fever; blood in stool or urine; excess bleeding of any kind; jaundice.||Prompt reporting of symptoms reduces risk of further hepatic damage and provides opportunity to treat complications before they become life-threatening.|
|Instruct SO to notify health care providers of any confusion, untidiness, night wandering, tremors, or personality change.||Changes (reflecting deterioration) may be more apparent to SO, although insidious changes may be noted by others with less frequent contact with patient.|
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