Impaired liver function encompasses various conditions affecting the liver’s ability to perform its essential roles in metabolism, detoxification, and protein synthesis. This nursing diagnosis focuses on identifying and managing symptoms of liver dysfunction while preventing complications and promoting optimal liver health.
Causes (Related to)
Impaired liver function can result from various factors that impact liver health and function:
- Viral infections (Hepatitis A, B, C)
- Alcohol-induced liver damage
- Drug-induced liver injury
- Medical conditions such as:
- Cirrhosis
- Fatty liver disease
- Autoimmune disorders
- Cancer
- Hemochromatosis
- Contributing factors including:
- Poor nutrition
- Obesity
- Medication toxicity
- Environmental toxins
Signs and Symptoms (As evidenced by)
Impaired liver function presents with distinctive signs and symptoms that nurses must recognize for proper assessment and intervention.
Subjective: (Patient reports)
- Fatigue and weakness
- Nausea and loss of appetite
- Right upper quadrant pain
- Pruritis (itching)
- Dark urine
- Confusion or mental changes
- General malaise
Objective: (Nurse assesses)
- Jaundice (yellowing of skin/sclera)
- Ascites
- Spider angiomas
- Palmar erythema
- Asterixis (flapping tremors)
- Hepatomegaly
- Elevated liver enzymes
- Abnormal coagulation studies
Expected Outcomes
The following outcomes indicate successful management of impaired liver function:
- The patient will demonstrate improved liver function tests
- The patient will maintain an adequate nutrition status
- The patient will show no signs of hepatic encephalopathy
- The patient will demonstrate an understanding of medication management
- The patient will maintain fluid balance
- The patient will avoid complications
- The patient will adhere to prescribed dietary restrictions
Nursing Assessment
Monitor Vital Signs and Mental Status
- Check vital signs every 4 hours
- Assess the level of consciousness
- Monitor for confusion or drowsiness
- Document sleep patterns
- Note any behavioral changes
Assess Physical Signs
- Check for jaundice progression
- Monitor ascites development
- Assess skin integrity
- Document the presence of edema
- Evaluate bleeding tendency
Evaluate Nutritional Status
- Monitor weight changes
- Track dietary intake
- Assess muscle wasting
- Check skin turgor
- Document vitamin deficiency signs
Monitor Laboratory Values
- Track liver function tests
- Check coagulation studies
- Monitor electrolyte levels
- Assess albumin levels
- Review ammonia levels
Evaluate Risk Factors
- Assess alcohol consumption
- Review medication history
- Document exposure to toxins
- Check vaccination status
- Monitor for drug interactions
Nursing Care Plans
Nursing Care Plan 1: Risk for Bleeding
Nursing Diagnosis Statement:
Risk for Bleeding related to decreased clotting factor production as evidenced by elevated PT/INR and the presence of bruising.
Related Factors:
- Impaired clotting factor synthesis
- Portal hypertension
- Thrombocytopenia
- Vitamin K deficiency
Nursing Interventions and Rationales:
- Monitor for bleeding signs\
Rationale: Early detection prevents serious complications - Implement bleeding precautions\
Rationale: Prevents trauma and reduces bleeding risk - Administer prescribed blood products\
Rationale: Corrects coagulation deficiencies
Desired Outcomes:
- The patient will demonstrate no new bleeding episodes
- The patient will maintain stable hemoglobin/hematocrit
- Patient will demonstrate an understanding of bleeding precautions
Nursing Care Plan 2: Impaired Nutrition
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less than Body Requirements related to decreased appetite and impaired protein metabolism as evidenced by weight loss and muscle wasting.
Related Factors:
- Decreased appetite
- Impaired protein synthesis
- Nausea/vomiting
- Altered metabolism
Nursing Interventions and Rationales:
- Monitor nutritional intake\
Rationale: Ensures adequate nutrition for healing - Provide small, frequent meals\
Rationale: Improves nutrient absorption and tolerance - Administer prescribed supplements\
Rationale: Corrects nutritional deficiencies
Desired Outcomes:
- The patient will maintain a stable weight
- The patient will demonstrate an improved appetite
- The patient will show normal protein levels
Nursing Care Plan 3: Risk for Fluid Volume Excess
Nursing Diagnosis Statement:
Risk for Fluid Volume Excess related to decreased plasma protein production and portal hypertension as evidenced by ascites and peripheral edema.
Related Factors:
- Decreased albumin production
- Portal hypertension
- Sodium retention
- Impaired hormone metabolism
Nursing Interventions and Rationales:
- Monitor fluid balance\
Rationale: Prevents fluid overload - Implement sodium restrictions\
Rationale: Reduces fluid retention - Administer diuretics as prescribed\
Rationale: Promotes excess fluid elimination
Desired Outcomes:
- The patient will maintain an appropriate fluid balance
- The patient will demonstrate decreased edema
- The patient will adhere to sodium restrictions
Nursing Care Plan 4: Risk for Confusion
Nursing Diagnosis Statement:
Risk for Acute Confusion related to hepatic encephalopathy as evidenced by altered level of consciousness and asterixis.
Related Factors:
- Elevated ammonia levels
- Metabolic imbalances
- Sleep pattern disturbance
- Medication effects
Nursing Interventions and Rationales:
- Monitor mental status\
Rationale: Detects early signs of encephalopathy - Implement safety measures\
Rationale: Prevents injury during confusion episodes - Administer lactulose as prescribed\
Rationale: Reduces ammonia levels
Desired Outcomes:
- The patient will maintain a normal mental status
- The patient will demonstrate improved cognitive function
- The patient will remain safe from injury
Nursing Care Plan 5: Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for Impaired Skin Integrity related to pruritis and poor nutrition as evidenced by skin excoriations and poor wound healing.
Related Factors:
- Bile salt accumulation
- Nutritional deficiencies
- Edema
- Decreased protein levels
Nursing Interventions and Rationales:
- Assess skin condition\
Rationale: Identifies early skin breakdown - Implement skin care protocol\
Rationale: Maintains skin integrity - Teach anti-pruritic measures\
Rationale: Reduces scratching and skin damage
Desired Outcomes:
- The patient will maintain intact skin
- The patient will demonstrate proper skincare
- The patient will report decreased itching
References
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- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
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