Liver cancer, also known as hepatocellular carcinoma (HCC), is a serious malignancy that requires comprehensive nursing care and management. This nursing diagnosis guide focuses on identifying key symptoms, providing appropriate interventions, and managing complications associated with liver cancer.
Causes (Related to)
Liver cancer development can be influenced by various factors that nurses must consider when developing care plans:
- Chronic viral hepatitis (B or C)
- Cirrhosis of the liver
- Alcohol abuse
- Nonalcoholic fatty liver disease (NAFLD)
- Pre-existing conditions such as:
- Diabetes
- Obesity
- Autoimmune disorders
- Genetic disorders
- Environmental factors including:
- Exposure to aflatoxins
- Chemical toxins
- Excessive alcohol consumption
Signs and Symptoms (As evidenced by)
Understanding the manifestations of liver cancer is crucial for proper nursing assessment and care planning.
Subjective: (Patient reports)
- Right upper quadrant pain
- Loss of appetite
- Unexplained weight loss
- Fatigue and weakness
- Nausea and vomiting
- Early satiety
- Abdominal fullness
Objective: (Nurse assesses)
- Jaundice
- Ascites
- Hepatomegaly
- Portal hypertension
- Abnormal liver function tests
- Elevated alpha-fetoprotein (AFP)
- Peripheral edema
- Cachexia
Expected Outcomes
The following outcomes indicate effective management of liver cancer:
- The patient will report adequate pain control
- The patient will maintain optimal nutritional status
- The patient will demonstrate improved energy levels
- The patient will show no signs of complications
- The patient will understand disease management strategies
- The patient will maintain a quality of life
- The patient will adhere to the treatment plan
Nursing Assessment
Monitor Vital Signs and Physical Status
- Check vital signs regularly
- Assess pain levels
- Monitor weight changes
- Evaluate skin color and condition
- Assess mental status
Evaluate Liver Function
- Monitor liver function tests
- Assess for ascites
- Check for peripheral edema
- Monitor bleeding tendencies
- Document jaundice progression
Assess Nutritional Status
- Track dietary intake
- Monitor weight changes
- Check albumin levels
- Assess for muscle wasting
- Document fluid restrictions
Monitor for Complications
- Check for signs of bleeding
- Assess for hepatic encephalopathy
- Monitor for infection
- Evaluate respiratory status
- Check for portal hypertension
Review Treatment Response
- Monitor treatment side effects
- Assess pain management effectiveness
- Track tumor markers
- Document imaging results
- Evaluate quality of life indicators
Nursing Care Plans
Nursing Care Plan 1: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to tumor mass effect and liver capsule distention as evidenced by reported right upper quadrant pain, guarding behavior, and facial grimacing.
Related Factors:
- Tumor mass effect
- Liver capsule distention
- Metastatic disease
- Inflammation
Nursing Interventions and Rationales:
- Assess pain characteristics regularly
Rationale: Enables appropriate pain management strategies - Administer prescribed pain medications
Rationale: Provides comfort and improves quality of life - Implement non-pharmacological pain management
Rationale: Complements medication therapy and promotes comfort
Desired Outcomes:
- The patient will report decreased pain levels
- The patient will demonstrate improved comfort
- The patient will maintain daily activities with minimal pain interference
Nursing Care Plan 2: Impaired Nutrition
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less than Body Requirements related to decreased appetite and tumor effects as evidenced by weight loss, decreased muscle mass, and reduced intake.
Related Factors:
- Decreased appetite
- Early satiety
- Nausea and vomiting
- Altered metabolism
Nursing Interventions and Rationales:
- Monitor nutritional intake
Rationale: Ensures adequate nutrition for healing - Implement small, frequent meals
Rationale: Promotes better tolerance and intake - Provide nutritional supplements
Rationale: Supplements inadequate oral intake
Desired Outcomes:
- The patient will maintain a stable weight
- The patient will demonstrate an improved appetite
- The patient will meet daily nutritional requirements
Nursing Care Plan 3: Risk for Impaired Skin Integrity
Nursing Diagnosis Statement:
Risk for Impaired Skin Integrity related to ascites, edema, and nutritional deficits as evidenced by skin tension and compromised circulation.
Related Factors:
- Ascites
- Peripheral edema
- Poor nutrition
- Decreased mobility
Nursing Interventions and Rationales:
- Assess skin condition regularly
Rationale: Enables early detection of breakdown - Implement pressure relief measures
Rationale: Prevents skin breakdown - Maintain proper skin hygiene
Rationale: Promotes skin integrity
Desired Outcomes:
- The patient will maintain intact skin
- The patient will demonstrate an understanding of skincare
- The patient will participate in skin protection measures
Nursing Care Plan 4: Fatigue
Nursing Diagnosis Statement:
Fatigue related to disease process and treatment effects as evidenced by decreased energy, increased rest requirements, and reduced activity tolerance.
Related Factors:
- Disease progression
- Treatment side effects
- Nutritional deficits
- Sleep disturbances
Nursing Interventions and Rationales:
- Plan activities during peak energy
Rationale: Maximizes activity participation - Implement energy conservation techniques
Rationale: Preserves energy for essential activities - Promote adequate rest periods
Rationale: Allows for energy restoration
Desired Outcomes:
- The patient will report improved energy levels
- The patient will maintain a balanced activity schedule
- The patient will demonstrate effective energy management
Nursing Care Plan 5: Anxiety
Nursing Diagnosis Statement:
Anxiety related to disease progression and uncertain prognosis as evidenced by expressed concerns, restlessness, and increased tension.
Related Factors:
- Disease uncertainty
- Treatment concerns
- Changed life expectations
- Fear of death
Nursing Interventions and Rationales:
- Provide emotional support
Rationale: Reduces anxiety and promotes coping - Teach relaxation techniques
Rationale: Helps manage anxiety symptoms - Facilitate open communication
Rationale: Allows expression of concerns
Desired Outcomes:
- The patient will demonstrate reduced anxiety levels
- The patient will utilize effective coping strategies
- The patient will verbalize understanding of condition and treatment
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Gou Y, Yi J, Jiang M, Cao C. Analysis on Effects of Comprehensive Nursing Care Applied in Interventional Therapy for Patients with Liver Cirrhosis and Liver Cancer. Iran J Public Health. 2019 Mar;48(3):494-500. PMID: 31223577; PMCID: PMC6570817.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- 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.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Waller LP, Deshpande V, Pyrsopoulos N. Hepatocellular carcinoma: A comprehensive review. World J Hepatol. 2015 Nov 18;7(26):2648-63. doi: 10.4254/wjh.v7.i26.2648. PMID: 26609342; PMCID: PMC4651909.
- Wang H, Liu Y, Shen J, Du T. Personalized nursing improves physical condition and life quality of patients undergoing interventional therapy for liver cancer. Am J Transl Res. 2021 Dec 15;13(12):14220-14228. PMID: 35035768; PMCID: PMC8748081.
