Nursing care Plans for Cirrhosis, Cirrhosis is a chronic hepatic disease that is characterized by destruction of the functional liver cells, which leads to cellular death. In cirrhosis, the damaged liver cells regenerate as fibrosis areas instead of functional cells, causing alterations in liver structure, function, blood circulation, and lymph damage. The major cellular changes include irreversible chronic injury of the functional liver tissue and the formation of regenerative nodules. These changes result in liver cell necrosis, collapse of liver support networks, distortion of the vascular bed, and nodular regeneration of the remaining liver cells. This disease alters liver structure and normal vasculature, impairs blood and lymph flow, and ultimately causes hepatic insufficiency.
Pathophysiology of Cirrhosis
Nursing care Plans for Cirrhosis
Treatment of Cirrhosis The goal of Cirrhosis therapy is to remove or alleviate the underlying cause of cirrhosis, prevent further liver damage, and prevent or treat complications:
- Vitamins and nutritional supplements promote healing of damaged hepatic cells and improve the patient's nutritional status.
- Sodium consumption is usually restricted, and liquid intake is limited to or reduce to help manage ascites and edema.
- Drug therapy requires special caution detoxify harmful substances efficiently.
- Antacids may be prescribed to reduce gastric distress and decrease the potential for GI bleeding.
- Potassium-sparing diuretics, such as furosemide, may be used to reduce ascites and edema.
- Alcohol is restricted /prohibited,.
- Sedatives should be avoided. Acetaminophen is especially hepatotoxic, particularly when combined with alcohol.
- In patients with ascites, paracentesis may be used as a palliative treatment to relieve abdominal pressure.
- Surgical intervention may be required to divert ascites
- To control bleeding from esophageal varices or other GI hemorrhage, nonsurgical measures are attempted first. These include gastric intubation and esophageal balloon tamponade. In gastric intubation, a tube is inserted and the stomach is lavaged until the contents are clear. If the bleeding is assessed as a gastric ulcer, antacids and histamine antagonists are administered.
- Emphasize to the patient with alcoholic liver cirrhosis that continued alcohol use exacerbates the Cirrhosis disease.
- Emphasize to the patient that alcoholic liver disease in its early stages is reversible when the patient abstains from alcohol. but on further stage can be irreversible
- To minimize the risk of bleeding, warn the patient against taking non-steroidal anti-inflammatory drugs, straining to defecate, and blowing his nose or sneezing too vigorously. Suggest using an electric razor and a soft toothbrush.
- Advise the patient that rest and good nutrition conserve energy and decrease metabolic demands on the liver.
- Teach the patient to have frequent, small meals. Teach him to alternate periods of rest and activity to reduce oxygen demand and prevent fatigue.
- Tell the patient how he can conserve energy while performing activities of daily living. For example, suggest that he sit on a bench while bathing or dressing.
- Stress the need to avoid infections and abstain from alcohol. Refer the patient to Alcoholics Anonymous, if appropriate
- Encourage the patient to seek frequent medical follow-up. Visits from a community health nurse to monitor the patient’s progress and to help with any questions or problems at home.
- Refer the patient to an alcohol support group or liver transplant support group
Cirrhosis is a chronic hepatic disease that is characterized by destruction of the functional liver cells, which leads to cellular death. In cirrhosis, the damaged liver cells regenerate as fibrosis areas instead of functional cells, causing alterations in liver structure, function, blood circulation, and lymph damage. The major cellular changes include irreversible chronic injury of the functional liver tissue and the formation of regenerative nodules. These changes result in liver cell necrosis, collapse of liver support networks, distortion of the vascular bed, and nodular regeneration of the remaining liver cells. This disease alters liver structure and normal vasculature, impairs blood and lymph flow, and ultimately causes hepatic insufficiency.
Causes for Cirrhosis depending on the type for Cirrhosis
Hepatocellular disease, Postnecrotic cirrhosis called portal, nutritional, or alcoholic cirrhosis stems from various types of hepatitis e.g. A, B, C, or D viral hepatitis or toxic exposures. Damage of the Livver results from malnutrition and overuse of alcohol. Fibrous tissue forms in portal areas and around central veins. Autoimmune disease, such as sarcoidosis and chronic inflammatory bowel disease, may result in cirrhosis.
Cholestatic diseases, Cholestatic diseases include diseases of the biliary tree and sclerosing cholangitis.
Metabolic diseases, metabolic diseases include disorders such as Wilson's disease, alpha1- antitrypsin deficiency, and hemochromatosis.
Other types of cirrhosis, other types of cirrhosis include Budd-Chiari syndrome, cardiac cirrhosis, and cryptogenic cirrhosis. Cardiac cirrhosis is rare; the liver damage results from rightsided heart failure. Cryptogenic refers to cirrhosis of unknown cause
Complications for Cirrhosis
- Portal hypertension,
- Bleeding esophageal varices
- Hepatic encephalopathy
- Hepatorenal syndrome.
- Liver biopsy
- Abdominal X-rays
- Computed tomography and liver scans
- Esophagogastroduodenoscopy
- Blood and Urine and stool studies disclose increased urine levels of bilirubin and urobilinogen; fecal urobilinogen levels decrease
- Activity intolerance
- Disturbed thought processes
- Excess fluid volume
- Hopelessness
- Imbalanced nutrition: Less than body requirements
- Risk for deficient fluid volume
- Risk for impaired skin integrity
- Risk for injury Cirrhosis:
Nursing Outcomes, Nursing Interventions, and Patient Teaching
Cirrhosis is a chronic hepatic disease that is characterized by destruction of the functional liver
cells, which leads to cellular death. In cirrhosis, the damaged liver cells regenerate as fibrosis
areas instead of functional cells, causing alterations in liver structure, function, blood circulation,
and lymph damage. The major cellular changes include irreversible chronic injury of the
functional liver tissue and the formation of regenerative nodules. These changes result in liver
cell necrosis, collapse of liver support networks, distortion of the vascular bed, and nodular
regeneration of the remaining liver cells. This disease alters liver structure and normal
vasculature, impairs blood and lymph flow, and ultimately causes hepatic insufficiency.
Nursing Key outcomes nursing care Plans for Cirrhosis
The patient will:
- Perform ADL activities of daily living without excessive fatigue or exhaustion.
- Remain oriented to his environment.
- Show no signs of circulatory overload.
- Participate in decisions about care.
- Maintain adequate caloric intake.
- Patient's fluid volume will remain within normal parameters.
- Patient's skin integrity will remain intact.
- Avoid or minimize complications.
Nursing interventions nursing care Plans for Cirrhosis
- Monitor vital signs, intake and output, and electrolyte levels to determine fluid volume status.
- Assess fluid retention
- Weigh the patient daily and document his weight.
- Administer diuretics, potassium, and protein or vitamin supplements as ordered.
- Restrict sodium and fluid intake as ordered.
- Assist and provide oral hygiene before and after meals.
- Determine food preferences and provide them within the patient's prescribed diet limitations.
- Provide frequent, small meals.
- Observe and document the degree of sclera and skin jaundice.
- Give the patient frequent skin care.
- Observe for bleeding gums, ecchymosed, epitasis, and petechiae.
- Inspect stools for amount, color, and consistency.
- Increase the patient's exercise tolerance by decreasing fluid volumes and providing rest periods before exercise.
- Use appropriate safety measures to protect the patient from injury.
- Watch for signs of anxiety, epigastric fullness, restlessness, and weakness.
- Observe closely for signs of behavioral or personality changes.
- Observe Report increasing stupor, lethargy, hallucinations, or neuromuscular dysfunction. Arouse the patient periodically to determine level of consciousness. Watch for asterixis, a sign of developing encephalopathy.
- Allow the patient to express his feelings about having cirrhosis.
- Provide psychological support and encouragement, when appropriate.
Patient teaching nursing care Plans for Cirrhosis
- Warn the patient against taking nonsteroidal anti-inflammatory drugs, straining to defecate, and blowing his nose or sneezing too vigorously. To minimize the risk of bleeding,
- Suggest using a soft toothbrush and a electric razor
- Advise the patient that rest and good nutrition conserve energy and decrease metabolic demands on the liver.
- Suggest the patient to eat frequent, small meals. Teach him to alternate periods of rest and activity to reduce oxygen demand and prevent fatigue.
- Tell the patient how he can conserve energy while performing activities of daily living. For example, suggest that he sit on a bench while bathing or dressing.
- Stress the need to avoid infections and abstain from alcohol. Refer the patient to alcohol abuse treatment Anonymous, if appropriate
- Alcohol abuse treatment. Emphasize to the patient with alcoholic liver cirrhosis that continued alcohol use exacerbates the disease. Stress that alcoholic liver disease in its early stages is reversible when the patient abstains from alcohol. Encourage family involvement in. Assist the patient in obtaining counseling or support for her or his alcoholism.
- Encourage the patient to seek frequent medical follow-up
- Refer the patient to an alcohol support group or liver transplant support group.
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