8 Liver Cirrhosis Nursing Care Plans


Discover the nursing diagnoses for liver cirrhosis nursing care plans. Learn effective and evidence-based nursing interventions and nursing care management strategies to improve patient outcomes.

What is Liver Cirrhosis?

Liver cirrhosis, also known as hepatic cirrhosis, is a chronic hepatic disease characterized by diffuse destruction and fibrotic regeneration of hepatic cells. Various insults can injure the liver, including viral infections, toxins, hereditary conditions, or autoimmune processes. With each injury, the liver forms scar tissue or fibrosis, initially without losing its function, After a long-standing injury, most of the liver tissue gets fibrosed, leading to loss of function and the development of cirrhosis (Farci, 2022). As necrotic tissues yield to fibrosis, the disease alters the liver structure and normal vasculature, impairs blood and lymph flow, and ultimately causes hepatic insufficiency. 

Chronic liver disease usually progresses to cirrhosis. The most common causes of cirrhosis in the United States include hepatitis C, alcoholic liver disease, cryptogenic causes, hepatitis B, and other miscellaneous causes (autoimmune hepatitis,  primary biliary cholangitis, Wilson disease, etc.). Cirrhosis is the ninth leading cause of death in the United States and represents a serious threat to long-term health. Worldwide, cirrhosis is the 14th most common cause of death, but in Europe, it is the 4th most common cause of death (Wolf & Anand, 2020).

These are the clinical types of cirrhosis:

  • Laennec’s cirrhosis is the most common type and occurs in 30% to 50% of cirrhotic clients. Up to 90% of them 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 clients 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 result from schistosomiasis, congenital hepatic fibrosis, or idiopathic.

Some clients with cirrhosis are completely asymptomatic and have a reasonably normal life expectancy. Other individuals have a multitude of the most severe symptoms of end-stage liver disease and a limited chance of survival. Common signs and symptoms may include hepatomegaly, abdominal pain, ascites, abdominal distention, bulging flanks, shifting dullness, anorexia, weight loss, fatigue, and muscle wasting. Cutaneous manifestations include jaundice, spider angiomata, skin telangiectasia (“paper money skin”), palmar erythema, white nails, the disappearance of lunulae, and finger clubbing (Wolf & Anand, 2020).

Nursing Care Plans

The nursing care planning goals for patients with liver cirrhosis include managing symptoms such as ascites, jaundice, and encephalopathy, reducing risk for injury, preventing and treating complications such as portal hypertension and variceal bleeding; and promoting self-care management and education to improve overall health outcomes. Moreover, nursing interventions may focus on monitoring and promoting adequate nutrition and fluid balance, as well as addressing the psychological and emotional needs of patients and families.


Here are eight (8) nursing care plans (NCP) and nursing diagnoses for clients with liver cirrhosis:

  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

Imbalanced Nutrition: Less Than Body Requirements

A key aspect of managing clients with liver disease, from the stages of compensated cirrhosis through liver failure, is early recognition and treatment of malnutrition. Given the increasing prevalence of obesity, diabetes, and their association with non-alcoholic fatty liver disease (NAFLD), an imbalance of nutritional intake is becoming increasingly observed in clients with cirrhosis. The resultant combination of adiposity and sarcopenia, termed sarcopenic obesity poses unique nutritional challenges, with regard to optimizing metabolic risk factors and muscle function (Dhaliwal et al., 2020).

Nursing Diagnosis

  • Imbalanced Nutrition: Less Than Body Requirements

May be related to

  • Inadequate diet; inability to process/digest nutrients
  • Anorexia, nausea/vomiting, indigestion, early satiety (ascites)
  • Abnormal bowel function

Possibly evidenced by

  • Weight loss
  • Changes in bowel sounds and function
  • Poor muscle tone/wasting
  • Imbalances in nutritional studies

Desired Outcomes

  • The client will demonstrate progressive weight gain toward a goal with the client-appropriate normalization of laboratory values.
  • The client will experience no further signs of malnutrition.

Nursing Assessment and Rationales

1. Evaluate the client for malnutrition.
80 to 90% of the blood that leaves the stomach and intestines carries nutrients to the liver where they are converted into substances the body can use. The client with liver dysfunction often has malnutrition because of inadequate dietary intake due to poor food choices or preference for alcohol rather than food and may currently have malabsorption syndrome due to the inability to process or digest nutrients, anorexia, nausea or vomiting, indigestion, or early satiety associated with ascites. Additionally, because of the decreased secretion of bile into the gut, the client may have difficulty absorbing fat and fat-soluble vitamins A, D, E, and K.

2. Determine interest in eating and ability to chew, swallow, and taste.
These are factors that affect the ingestion and digestion of nutrients. Clients with massive ascites may experience abdominal discomfort, depressed appetite, and decreased oral intake. Many clients complain of anorexia, which may be compounded by the direct compression of ascites on the GI tract (Wolf & Anand, 2020).

3. Utilize nutritional screening tools to assess the client’s nutritional status.
All clients with liver cirrhosis, irrespective of BMI, should be screened and assessed for malnutrition. This can be performed using validated screening tools. Nutritional screening tools available to identify those at risk of malnutrition include the standard Malnutrition Universal Screening Tool (MUST) and the Nutritional Screening Risk-2002 (Dhaliwal et al., 2020). 

4. Assess the client’s functional status.
Functional status can be assessed immediately as the client arrives for a consultation. Do they walk unaided? What is the strength of the client’s handshake? Are they able to rise from a chair? Assess how well a person performs their activities of daily living and their perceived exercise tolerance. Directed, validated measures of functional ability in cirrhosis include short physical performance battery testing, incremental shuttle walk tests, and most recently, the liver frailty index, which incorporates hand grip strength, timed chair stands, and balance (Dhaliwal et al., 2020).

5. Measure dietary intake by calorie count.
This provides important information about intake, needs, and deficiencies. A client with cirrhosis requires a balanced protein diet providing 2,000 to 3,000 calories per day to permit liver cell regeneration. Understanding a client’s energy expenditure is key to accurately calculating their nutritional energy requirements to protect and optimize muscle function. For compensated cirrhosis, recommended energy intake is 25 to 35 kcal/kg/day, while recommended protein intake is 1,2 to 1,5 g/kg/day to maintain muscle mass. For clients with decompensated cirrhosis with sarcopenia recommended energy intake is  30 to 35 kcal/kg/day and recommended protein intake is 1.5 to 2.0 g/kg/day to prevent further loss and reverse sarcopenia (Dhaliwal et al., 2020).

6. Weigh as indicated. Compare changes in fluid status, recent weight history, and skinfold measurements.
It may be difficult to use weight as a direct indicator of nutritional status in view of edema and/or ascites. Skinfold measurements are useful in assessing changes in muscle mass and subcutaneous fat reserves. Dry body weight and BMI should be recorded, using weight following paracentesis or via estimation by subtracting a percentage of body weight based on ascites (mild 5%; moderate 10%, and severe 15%) and peripheral edema (5% if bilateral) (Dhaliwal et al., 2020).

7. Perform anthropometry measurements as indicated.
Anthropometry can be carried out to obtain measures of muscle mass (MAMC) and contractile function (hand grip strength), both of which predict mortality. Hand grip strength should be performed three times in the non-dominant hand and compared with historical ‘normal’ values for women (29 kg) and men (40 kg). MAMC is obtained by measuring the mid-arm circumference (MAC) which incorporates muscle and adipose and tricep skin fold, an estimate of the adipose thickness (Dhaliwal et al., 2020).

8. Assess the severity of cirrhosis.
For many years, the most common prognostic tool used in clients with cirrhosis was the Child-Turcotte-Pugh (CTP) system. Epidemiologic work shows that the CTP score may predict life expectancy in clients with advanced cirrhosis. A CTP score of 10 or greater is associated with a 50% chance of death within 1 year. Since 2002, liver transplant programs in the United States have used the Model for End-stage Liver Disease (MELD) scoring system to assess the relative severity of clients’ liver disease (Wolf & Anand, 2020).

9. Monitor laboratory studies: serum glucose, prealbumin, albumin, total protein, prothrombin time (PT), and ammonia.
Glucose may be decreased because of impaired gluconeogenesis, depleted glycogen stores, or inadequate intake. Protein may be low because of impaired metabolism, decreased hepatic synthesis, or loss of the peritoneal cavity (ascites). Elevation of ammonia level may require a restriction of protein intake to prevent serious complications. PT is elevated due to coagulation factor defects and bilirubin, while albumin is low as it is synthesized by the liver and the liver’s functional capacity goes down. Thus, serum albumin and PT are true indicators of synthetic hepatic function (Farci, 2022).

10. Review the client’s glycemic control.
It is important to review the client’s glycemic control, particularly in the presence of diabetes and subsequent anti-diabetic medications. Hemoglobin (HbA1c) as a direct marker of glycemic control should be used in the clinical context, as it can be falsely reassuring in the context of anemia (Dhaliwal et al., 2020).

Nursing Interventions and Rationales

1. Encourage the client to eat; explain reasons for the types of diet. Feed the client if tiring easily, or have a family caregiver assist the client. Include the client in meal planning to consider his/her preferences in food choices.
Improved nutrition and diet are vital to recovery. The client may eat better if the family is involved and preferred foods are included as much as possible. A regular eating pattern of 2 to 3 hourly meals and snacks, including a bedtime snack, should be encouraged with the aim of reducing starvation time and minimizing the breakdown of muscle and fat stores for use as a metabolic fuel (Dhaliwal et al., 2020).

2. Encourage the client to eat all meals including supplementary feedings.
The client may pick at food or eat only a few bites because of a loss of interest in food or because of nausea, generalized weakness, or malaise. The 2010 practice guidelines for alcoholic liver disease published by the American Association for the Study of Liver Disease and the American College of Gastroenterology recommend aggressive treatment of protein-calorie malnutrition in clients with alcoholic cirrhosis. Multiple feedings per day, including breakfast and a snack at night, are specified (Wolf & Anand, 2020).

3. Give small, frequent meals.
Poor tolerance to larger meals may be due to increased intra-abdominal pressure and ascites (if present). For energy malnutrition, divided meals and late evening snacks, such as rice balls, liquid nutrients, and branch chain amino acids (BCAA) enriched supplementation are recommended. Approximately 200 kcal is divided from the target total daily calories and taken as a snack or energy before going to bed to improve nighttime starvation. These divided meals or late-evening snacks should be easy to prepare and ingest (Dhaliwal et al., 2020).

4. Provide salt substitutes, if allowed; avoid those containing ammonium.
Salt substitutes enhance the flavor of food and aid in increasing appetite; ammonia potentiates the risk of encephalopathy. Salt restriction is the first line of therapy. In general, clients begin with a diet containing less than 2000 mg of sodium daily. Some clients with refractory ascites require a diet containing less than 500 mg of sodium daily. However, ensuring that clients do not construct diets that might place them at risk for calorie-protein malnutrition is important (Wolf & Anand, 2020).

5. Restrict intake of alcohol, raw or uncooked food, and excessively fatty foods.
Any amount of alcohol is considered unsafe for anyone with cirrhosis because it is a potential cause of more liver damage and liver failure. Drinking alcoholic substances can also contribute to malnutrition, as some people addicted to alcohol may prefer drinking than eating and choosing nutritious foods. When the liver is damaged, the production and supply of bile may be affected, leading to an inability to process a high-fat meal effectively. Clients with liver cirrhosis also have impaired immune function, resulting in bacteria and viruses being harbored through raw or uncooked foods (Daniel, 2022).

6. Encourage frequent mouth care, especially before meals.
The client is prone to sore and/or bleeding gums and a bad taste in the mouth, which contributes to anorexia. Fetor hepaticus, also known as ‘breath of the dead’ is a condition in which the breath of the client is sweet, musty, and occasionally fecal in nature. It is associated with portal hypertension with portosystemic shunts (Thomas, 2021).

7. Promote undisturbed rest periods, especially before meals.
Conserving energy reduces metabolic demands on the liver and promotes cellular regeneration. The energy supply must balance total energy expenditure (TEE) to maintain nutritional equilibrium. TEE includes a combination of resting energy expenditure, physical activity expenditure, and food-related thermogenesis. Even though physical activity is reduced in many clients with cirrhosis, the TEE ranges from 28 to 37.5 kcal/kg body weight per day (Dhaliwal et al., 2020).

8. Recommend cessation of smoking. Provide teaching on the possible negative effects of smoking.
This reduces excessive gastric stimulation and the risk of irritation and may lead to bleeding. Smoking appears to have adverse effects on the liver via three separate mechanisms: toxic (both direct and indirect), immunologic, and oncogenic. Cigarette smoking has an important negative effect on a multitude of liver diseases via various mechanisms, therefore, smoking cessation must be prioritized (Rutledge & Asgharpour, 2020).

9. Maintain NPO status when indicated.
Initially, GI rest may be required in acutely ill clients to reduce demands on the liver and the production of ammonia and urea in the GI tract. When this is the case, nutrition must be supplied by another method- enteral or parenteral feedings. Individuals with cirrhosis are commonly kept NPO in the hospital for a variety of reasons and frequently fail to meet caloric goals. Practitioners should prioritize advancing their diet as early as possible, avoiding prolonged fasting, and placing an NG tube for enteral nutrition at the time of intubation (Martin & Stotts, 2020).

10. Refer to a dietitian to provide a diet high in calories and simple carbohydrates, low in fat, and moderate to high in protein; limit sodium and fluid as necessary. Provide liquid supplements as indicated.
High-calorie foods are desired inasmuch as client intake is usually limited. Carbohydrates supply readily available energy. Fats are poorly absorbed because of liver dysfunction and may contribute to abdominal discomfort. Proteins are needed to improve serum protein levels to reduce edema and promote liver cell regeneration. Protein and foods high in ammonia (gelatin) are restricted if the ammonia level is elevated or if the client has clinical signs of hepatic encephalopathy. In addition, these individuals may tolerate vegetable protein better than meat protein.

11. Provide tube feedings, TPN, and lipids if indicated.
This may be required to supplement diet or to provide nutrients when the client is too nauseated or anorexic to eat or when esophageal varices interfere with oral intake. For clients who do not have evidence of gastrointestinal (GI) bleeding, naso- or orogastric tube placement should occur immediately after intubation and can be considered safe regardless of variceal history. Parenteral feeding should only be used when enteral feeding cannot meet the client’s energy demands or is contraindicated (Martin & Stotts, 2020).

12. Optimize protein intake as indicated.
Optimizing protein intake is also essential due to an increased total body protein breakdown and reduced muscle protein synthesis. A minimum of 3 to 4 sources of high-protein foods a day should be recommended including eggs and lean meat (Dhaliwal et al., 2020).

13. Provide nutritional oral supplements as prescribed.
An adequate calorie and protein intake can be difficult to achieve, particularly for clients who have sarcopenia, and nutritional supplements are often required. This typically involves the use of low-volume, high-protein sip feeds, tailored to each client’s individual needs (Dhaliwal et al., 2020). It is reasonable to recommend a daily multivitamin (without manganese, as elevated levels observed in clients with cirrhosis may be associated with hepatic encephalopathy), and to consider individual vitamin and mineral deficiencies in the presence of malnourishment or decompensation (Martin & Stotts, 2020).

14. Encourage physical activities as tolerated.
Physical activity and exercise should be encouraged to support weight management and to improve muscle mass and strength; it should be individually tailored. A structured exercise program including a warm-up, a mixture of both aerobic and resistance exercises followed by a cool down for balance and flexibility training is beneficial at a moderate intensity, in which the client can still speak a two-word or three-word sentence (Dhaliwal et al., 2020).

15. Provide oral branch chain amino acids (BCAA) preparations as indicated.
To improve hypoalbuminemia and amino acid imbalance, oral BCAA preparations are useful. Although oral BCAA preparations include BCAA granules and enteral nutrients for liver failure, they need to be properly used depending on the energy malnutrition state or the presence of hepatic encephalopathy. While supplemental administration of BCAA granular preparation maintains or increases the serum albumin concentration in decompensated liver cirrhosis clients, it prevents adverse events of liver cirrhosis and improves vital prognosis as well as the quality of life (Yoshiji & Kaji, 2019).


Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.

NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses is reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care 
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health 
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

See also

Other recommended site resources for this nursing care plan:

More nursing care plans related to gastrointestinal disorders:

References and Sources

Here are the references and sources for this Liver Cirrhosis Nursing Care Plan:


Matt Vera, a registered nurse since 2009, leverages his experiences as a former student struggling with complex nursing topics to help aspiring nurses as a full-time writer and editor for Nurseslabs, simplifying the learning process, breaking down complicated subjects, and finding innovative ways to assist students in reaching their full potential as future healthcare providers.

8 thoughts on “8 Liver Cirrhosis Nursing Care Plans”

  1. 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…

  2. 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


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