8 Liver Cirrhosis Nursing Care Plans

By
Matt Vera
-
Jul 15, 2013

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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:

Laennecs 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 8 liver cirrhosis nursing care plans (NCP):

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
9. Other Possible Nursing Care Plans

Next

Imbalanced Nutrition: Less Than Body Requirements

Imbalanced Nutrition: Less Than Body Requirements: Intake of nutrients insufficient to meet
metabolic needs.
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

Demonstrate progressive weight gain toward goal with patient-appropriate normalization

of laboratory values.
Experience no further signs of malnutrition.

Nursing Interventions Rationale

Measure dietary intake by calorie count.
Weigh as indicated. Compare changes in fluid
status, recent weight history, skinfold
measurements.
Encourage patient to eat; explain reasons for the
types of diet. Feed patient if tiring easily, or
have SO assist patient. Include patient in meal
planning to consider his/her preferences in food
choices.
Encourage patient to eat all meals including
supplementary feedings.
Give small, frequent meals.
Provide salt substitutes, if allowed; avoid those
containing ammonium.
Restrict intake of caffeine, gas-producing or
spicy and excessively hot or cold foods.
Provides important information about intake,
needs and deficiencies.
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.
Improved nutrition and diet is vital to recovery.
Patient may eat better if family is involved and
preferred foods are included as much as
possible.
Patient may pick at food or eat only a few bites
because of loss of interest in food or because of
nausea, generalized weakness, malaise.
Poor tolerance to larger meals may be due to
increased intra-abdominal pressure and ascites
(if present).
Salt substitutes enhance the flavor of food and
aid in increasing appetite; ammonia potentiates
risk of encephalopathy.
Aids in reducing gastric irritation and/or
diarrhea and abdominal discomfort that may
impair oral intake.
 Nursing Interventions
Suggest soft foods, avoiding roughage if
indicated.
Encourage frequent mouth care, especially
before meals.
Promote undisturbed rest periods, especially
before meals.
Recommend cessation of smoking. Provide
teaching on the possible negative effects of
smoking.
Monitor laboratory studies: serum glucose,
prealbumin and albumin, total protein,
ammonia.
Maintain NPO status when indicated.
Refer to dietitian to provide diet high in calories contribute to abdominal discomfort. Proteins
and simple carbohydrates, low in fat, and
moderate to high in protein; limit sodium and reduce edema and to promote liver cell
fluid as necessary. Provide liquid supplements regeneration. Note: Protein and foods high in
as indicated.
Provide tube feedings, TPN, lipids if indicated.
Rationale
Hemorrhage from esophageal varices may
occur in advanced cirrhosis.
Patient is prone to sore and/or bleeding gums
and bad taste in mouth, which contributes to
anorexia.
Conserving energy reduces metabolic demands
on the liver and promotes cellular regeneration.
Reduces excessive gastric stimulation and risk
of irritation and may lead to bleeding.
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 into peritoneal cavity
(ascites). Elevation of ammonia level may
require restriction of protein intake to prevent
serious complications.
Initially, GI rest may be required in acutely ill
patients to reduce demands on the liver and
production of ammonia and urea in the GI tract.
High-calorie foods are desired inasmuch as
patient intake is usually limited. Carbohydrates
supply readily available energy. Fats are poorly
absorbed because of liver dysfunction and may
are needed to improve serum protein levels to
ammonia (gelatin) are restricted if ammonia
level is elevated or if patient has clinical signs
of hepatic encephalopathy. In addition, these
individuals may tolerate vegetable protein better
than meat protein.
May be required to supplement diet or to
provide nutrients when patient is too nauseated
or anorexic to eat or when esophageal varices
interfere with oral intake.