Cirrhosis Nursing Diagnosis and Nursing Care Plan

Cirrhosis Nursing Care Plans Diagnosis and Interventions

Cirrhosis NCLEX Review and Nursing Care Plans

What is Cirrhosis?

Cirrhosis is described as a chronic disease of the liver wherein there is destruction of hepatic tissues with accompanied regeneration of liver cells, albeit fibrotic in nature. Because of the necrotic tissues being replaced with fibrosis, this ultimately changes the liver structure and the blood and lymphatic pathways resulting in chronic damage.

Types of Cirrhosis

The different types of cirrhosis are correlated with regards to their etiologies:

  • Laennec’s cirrhosis – The most common type and is associated with alcoholism. It occurs to 30-50% of patients.
  • Biliary cirrhosis – This is due to blockages in the bile pathways with an incidence rate of 15-20% of patients.
  • Postnecrotic cirrhosis – A subtype associated with hepatitis infections with an incidence rate of 10-30% of patients.
  • Pigment cirrhosis – A subtype associated with hemochromatosis which occurs to 5-10% of patients.
  • Cardiac cirrhosis – This is a rare subtype due to right-sided heart failure.
  • Idiopathic cirrhosis – This subtype has no known cause and could make up about 10% of patients with cirrhosis.

Liver Cirrhosis Symptoms

Clinical manifestations of Cirrhosis, despite having different types, almost same similar traits and are discussed below as they affect each organ system.:

  • Gastrointestinal system – Early signs include anorexia, indigestion, nausea, vomiting, constipation or diarrhea.
  • Respiratory system – Manifestations occur as the disease worsens due to accompanying liver structure changes (e.g., pleural effusion) or due to limited expansion of the chest (e.g., abdominal ascites) that leads to hypoxia.
  • Central nervous system – Hepatic encephalopathy is a sign of late onset and is accompanied by mental changes (i.e. lethargy), slurred speech, flapping tremors, hallucinations, obtundation, and ultimately coma.
  • Hematologic – The patient is prone to develop anemia and bleeding episodes due to the compromised state of the liver.
  • Endocrine system – For the males, testicular atrophies may occur. For women, there will be irregularities in menses, alopecia, loss of hair, etc.
  • Skin – Signs include pruritus, extreme skin dryness, poor skin turgor, hyperpigmentation, and in late stages, jaundice.
  • Hepatic – Because of cirrhosis, it will cause other symptoms specifically jaundice, ascites, hepatomegaly (liver enlargement) and ultimately hepatic renal syndrome.

What Causes Cirrhosis

There are different causes of cirrhosis per classification, but the most common causes are discussed below:

  • Chronic alcohol abuse
  • Viral hepatitis, usually chronic (Hep A, B, C and D)
  • Abnormal fat in the liver (nonalcoholic fatty liver disease)
  • Hemochromatosis – abnormal iron buildup in the body
  • Cystic fibrosis
  • Wilson’s disease – abnormal accumulation of copper in the liver
  • Biliary atresia – abnormality arising from poorly formed bile ducts
  • Alpha-1 antitrypsin deficiency
  • Inherited sugar metabolism deficiency ( galactosemia, glycogen storage disease)
  • Genetic digestive disorder (i.e., Alagille syndrome)
  • Liver dysfunction associated with the immune system (i.e., autoimmune hepatitis)
  • Primary sclerosing cholangitis – abnormal hardening of the bile ducts
  • Other infections such as syphilis, brucellosis
  • Other medications such as methotrexate, isoniazid

Related Factors to Cirrhosis

Related factors to Cirrhosis include the following:

  • Excessive alcohol consumption – Long-term excessive alcohol consumption is the most common reason for the development of cirrhosis, and therefore liver damage.
  • Being overweight – Excesses in weight (i.e. obesity) increases the risk of conditions such as nonalcoholic fatty liver disease, which ultimately results in cirrhosis.
  • Having viral hepatitis – Hepatitis infection causes inflammation and damage to hepatic cells thereby making patients prone to develop post necrotic cirrhosis.

Nursing Diagnosis of Cirrhosis

Nursing Care Plan for Cirrhosis 1

Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to abnormal bowel functions secondary to cirrhosis as evidenced by changes in bowel functions and imbalances in nutritional studies.

Desired Outcome: The patient will be able to regain patient-appropriate normalization of laboratory results with no further observed signs of malnutrition.

Cirrhosis Nursing InterventionsRationale
Measure the patient’s daily calorie intake.Observing and recording the patient’s food intake will help the healthcare providers in assessing preferences, needs, deficiencies and other nutritional patterns that are otherwise vital for proper management.
Weigh the patient daily. Ensure recording of changes such as fluid status, weight history and skinfold measurements.Although patient daily weighing is limited in assessing for malnutrition (due to edema or ascites), it is still necessary to allow for proper assessment. Skinfold measurement allows for the healthcare provider to assess for latent fat reserves of the patient and in detection of muscle or fat wasting.
Encourage the patient to eat small, frequent meals as tolerated.Because of signs of cirrhosis, (e.g., nausea, malaise), eating for the patient could be difficult. Having the patient eat small, frequent meals ensures that the patient receives nutrition continuously.
Monitor laboratory studies, especially serum glucose, albumin, total protein and ammonia levels.Glucose levels may be depressed due to depleted stores in the liver, poor nutritional intake, or impaired gluconeogenesis (synthesis of glucose from other sources). Protein reserves in the body may also be decreased due to impaired metabolism, decreased synthesis in the liver, or wastage into the peritoneal cavity (i.e. ascites). Ammonia levels may become elevated and would cause complications if left untreated.
Maintain nil by mouth/ nothing per orem (NBM/ NPO) status as indicated.Resting the GI tract would be beneficial to acutely ill patients so as to reduce metabolic demands to the liver and reduction of ammonia and urea levels in the body.

Nursing Care Plan for Cirrhosis 2

Nursing Diagnosis: Fluid Volume Excess related to compromised regulatory mechanism secondary to decreased plasma proteins in cirrhosis as evidenced by edema, weight gain, and altered electrolyte levels.

Desired Outcome: The patient will be able to regain patient-appropriate normalization of laboratory results with no further observed edema and abnormal weight gain.

Cirrhosis Nursing Interventions Rationale
Ensure the measurement of patient’s daily weight, and intake and output.This is done to assess the patient’s volume status, development or resolution of third space shifting of body fluids and response to therapeutic management. Increases in weight and positive balances in I&O may mean abnormal retention of fluid.
Ensure daily abdominal girth measurement.Daily measurement of the abdomen helps in assessing ascites, the accumulation of unwanted fluid in the abdomen due to the loss of protein into the peritoneal space. Note that excessive accumulation reduces circulating fluid volume in the body, thereby inducing signs of dehydration.
Monitor serum albumin and electrolytes.Depressed albumin levels result in edema formation due to effects to plasma colloid osmotic pressure. Treatment regimens such as use of diuretics to reduce latent edema, may cause significant electrolyte changes.
Administer albumin (salt-free) or plasma expanders as indicated.Albumin and/or plasma expanders are beneficial in pulling out unwanted fluid by increasing osmotic pressure, thereby increasing circulating volume and reducing ascites.
Administer medications as ordered, which may include: loop-diuretics and aldosterone receptor antagonists.         Potassium       Positive inotropic drugs and arterial vasodilators    This is indicated to control edema and ascites formation and increase elimination of water while sparing potassium. Given when conservative management (e.g., sodium restriction) does not address the condition.   Potassium replacement is always given due to them being depleted in instances of liver disease and urinary elimination.   Administered to support cardiac function and blood flow, consequently decreasing excess fluid accumulation.

Nursing Care Plan for Cirrhosis 3

Nursing Diagnosis: Ineffective Breathing Pattern related to the accumulation of intra-abdominal fluid as evidenced by increasing abdominal girth, presence of edema and adventitious breath sounds.

Desired Outcome: The patient will be able to maintain an effective respiratory pattern, normal arterial blood gasses (ABGs), and vital signs within acceptable normal limits.

Cirrhosis Nursing Interventions Rationale
Monitor respirations, taking note of rate, depth, and effort taken by the patient.Irregularities in respirations such as dyspnea or shallow patterns may appear due to accumulation of fluid in the abdomen and thereby reducing effective lung expansion.
Auscultate breath sounds taking note of the presence of adventitious sounds such as crackles, rhonchi, wheezes.Occurrence of adventitious breath sounds usually indicate developing complications. Diminished, even absent, breath sounds may indicate lung atelectasis.
Maintain the head of bed elevated at least 30 degrees.This facilitates adequate breathing through the reduction of pressure in the diaphragm and aspiration risks of the patient.
Allow for frequent changes in position, deep breathing and coughing exercises.This method aids the patient to proper and adequate lung expansion and the mobilization of secretions to allow for expectoration.
Monitor arterial blood gas, vital signs including oxygen saturations.This allows for monitoring of patient status and addressing complications as soon as it happens.
Provide supplemental oxygen as ordered.Oxygen supplementation addresses or prevents hypoxia.
Assist for procedures necessary to alleviate edema such as:
Paracentesis    
Peritoneovenous shunt         
Paracentesis is done to remove ascites, and thereby relieving abdominal pressure once other interventions are unsuccessful.  

Peritoneovenous shunt involves a surgically implanted catheter made to drain accumulated fluid in the abdomen back to the vena cava for elimination. This provides long term relief of ascites of the patient.

Nursing Care Plan for Cirrhosis 4

Nursing Diagnosis: Disturbed Body Image related to biophysical changes as possibly evidenced by verbalization of changes in lifestyle and negative feelings about the body.

Desired Outcome: The patient will be able to verbalize understanding and acceptance of biophysical changes, and to address these changes through acceptable coping mechanisms.

Cirrhosis Nursing Interventions Rationale
Discuss with the patient his current situation and encourage verbalization of issues regarding current health status. Explain the symptoms of the disease with its etiology.The patient would be sensitive regarding body issues and may oftentimes have guilt feelings especially if alcoholism or drug use is the cause of his condition.
Encourage the patient. Provide professional and emotional support as needed. Adapt a friendly and positive attitude when caring for the patient.The caregiver should focus mainly on the needs of the patient so as to allow for the patient to feel valued. Avoid judgmental statements because the patient is very sensitive to these issues.
Encourage the family or significant others in the active participation for the care of the patient.The family may sometimes have guilt of the current condition and fear of eventual death of the patient. Because of this, the family would need continuous access to the patient as much as necessary. Participation of relatives in the care of the patient allows for feelings of usefulness and therefore promotes trust between the staff, patient and family.
Assist the patient and his family on how to cope with biophysical changes. Suggest clothing choices that do not focus on the current altered appearance.The patient may have feelings of dissatisfaction brought about by signs of cirrhosis, such as jaundice, ascites, etc. By providing psychological support, this can allow for the patient to regain his self-esteem and self-respect despite the limitations of the disease.
Refer to appropriate support services such as counselors, psychiatric agencies, social service among others.The patient is already in a vulnerable state because of the condition. Because of this, the patient would need further professional services in order for him to adapt with the condition.

Nursing Care Plan for Cirrhosis 5

Nursing Diagnosis: Risk for Impaired Skin Integrity related to altered metabolic state as evidenced by poor skin turgor, presence of edema and ascites.

Desired Outcome: The patient will be able to maintain his skin free from breakdown and demonstrate techniques to maintain epidermal integrity.

Cirrhosis Nursing Interventions Rationale
Inspect the patient’s skin thoroughly, taking note of pressure points. Use emollient lotions to massage bony prominences as gently as possible. Avoid the use of soap when cleansing the skin.Fluid-filled tissues are more prone to skin breakdown and consequently wounds. Ascites may stretch the skin excessively, therefore losing skin integrity. The use of soap removes latent skin moisturizer and can cause skin drying.
Assist the patient to frequent repositioning, typically following a turning schedule as needed. Assist with a range of motion exercises, either in the passive or active form.Frequent repositioning allows for the relief of the pressure points and thereby improving circulation of the skin. Exercises promote circulation and retention of musculoskeletal function and range of motion.
Recommend elevation of lower extremities as indicated.This position promotes venous blood flow return and the reduction of edema of the lower extremities.
Utilize alternating mattresses, waterbed, egg-crate mattresses, as ordered.The use of these devices helps in reducing stress to the skin, especially the bony prominences; Further, this increases proper circulation and decreases tissue injury.
Utilize calamine lotion and baking soda baths. Administer medications such as antihistamines as needed.Calamine lotion and baking soda baths may be soothing for patients with cirrhosis. Antihistamines help control itchiness brought about by jaundice and presence of bile salts in the skin.
Encourage the patient to keep his or her fingernails short. Suggest the use of mittens or gloves as indicated.Short nails prevent skin breakdown and injury from inadvertent scratching of the skin due to the presence of bile salts in the skin.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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4 thoughts on “Cirrhosis Nursing Diagnosis and Nursing Care Plan”

  1. This was real of great help for my assessment thank you.

    Reply

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