Liver Cancer Nursing Care Plans Diagnosis and Interventions
Liver Cancer NCLEX Review and Nursing Care Plans
Liver cancer is a type of cancer that starts on the liver. It can be classified as either primary or secondary, primary meaning that the cancer originated in the liver itself and secondary meaning that the cancer is due to the metastasis of another cancer.
There are different types of liver cancer, but the primary classifications are:
- Hepatocellular carcinoma. Also known as HCC or hepatoma is a type of liver cancer common to patients who have chronic hepatitis or cirrhosis.
- Cholangiocarcinoma. Also known as bile duct cancer, is another subtype that develops in the bile ducts of the liver.
- Liver angiosarcoma. This is a rare type of liver cancer characterized by the growth of tumors in the blood vessels of the liver.
- Hepatoblastoma. An extremely rare subtype that majorly affects children, especially under the age of 3.
Signs and Symptoms of Liver Cancer
Most people in the early stages of liver cancer oftentimes would not have clinical manifestations of the condition. However, when these symptoms appear, they are usually detected when the cancer has already progressed and worsen. The signs are:
- Unexplained and unnatural weight loss
- Loss of appetite
- Upper abdominal pain
- Nausea and vomiting
- Generalized weakness and fatigue
- Abdominal distention and swelling
- Jaundice, or the yellowish discoloration of the patient’s skin and sclera
- White, chalky stools
- Tea colored or dark urine
- Easy bleeding or bruising
- Feeling full unusually fast when eating
Causes of Liver Cancer
Liver cancer develops when latent cells undergo mutations in their DNA. In review, DNA is the genetic material (i.e., blueprint) present inside cells that direct the function, nature, and total mechanisms and physiology of each cell.
When instructions in the DNA are altered due to various risk factors, aberrant cells grow and proliferate.
Once these aberrant cells have expanded and grown exponentially, tumors start to develop and progress to cancer. The exact cause of liver cancer, like with most cancers, is unknown.
However, certain pre-existing conditions such as chronic hepatitis infection, birth defects, and cirrhosis have been linked to increased liver cancer risks.
Patients with fatty liver and who are obese also has increased links to liver cancer risks.
Risk Factors to Liver Cancer
Risk factors of primary liver cancer include the following conditions and instances:
- Chronic Hepatitis infection. Patients with chronic infection of either Hepatitis B or C have increased liver cancer risks than other patients due to the latent inflammatory process of the disease.
- Cirrhosis. This condition is characterized as a continuing and irrevocable disease of the liver that causes the replacement of healthy liver tissue with the formation of scar tissue.
- Certain inherited liver diseases. Conditions such as hemochromatosis (i.e., build-up of too much iron in the body) and Wilson’s disease (i.e., genetic disorder of excessive build-up of copper in the body) increases the chances of developing liver cancer.
- Diabetes. Patients with diabetes are predisposed to developing liver cancer when compared to patients who have no diabetes.
- Non-alcoholic fatty liver disease. Excessive accumulation of fat in the liver elevates liver cancer risk of the patient.
- Exposure to aflatoxins. Aflatoxins are substances produced by molds on inappropriately stored crops such as rice, corn, and nuts. When these crops become contaminated by this toxin, it can end up in food that when consumed increases cancer risk.
- Excessive alcohol consumption. Taking more than the moderate level of alcohol on a daily basis chronically will lead to irreparable liver damage, thereby increasing liver cancer risk.
- Age. It has been noted that liver cancer is more prevalent in older patients.
- Race and ethnicity. Patients of American Indian or Native Alaskan descent have morbidity rates higher for liver disease when compared to White people.
- Smoking. Tobacco and cigarette smoking has been associated with increasing risk for liver cancer.
Complications of Liver Cancer
Complications of liver cancer involves a variety of conditions, some of which are:
- Anemia. Anemia is common for patients with liver cancer due to a variety of hepatic functions, including the lack of clotting factors, that are compromised with tumor growth.
- Bile duct obstruction. Bile is produced in the liver that is utilized by the body for fat metabolism. In the case of a growing liver cancer, the bile ducts may become blocked or compromised and therefore will not be transported for use.
- Bleeding. The patient with liver cancer is prone to bleeding episodes due to the lack of adequate clotting factors that is primarily produced by the liver.
- Portal hypertension. Patients with liver cancer naturally has growing tumors that may block pathways, thereby decreasing blood flow. This will result in elevated pressure in the surrounding blood vessels, that when ruptured may cause bleeding.
- Hypercalcemia. Hypercalcemia may occur for patients with liver cancer due to the compromised metabolic functions. Spilling of excess calcium will go to the bloodstream, causing manifestations such as extreme muscle weakness and confusion, among others.
- Hepatorenal syndrome. In this condition, the liver condition progresses enough to also affect the kidney due to alterations in circulation. This is oftentimes irreversible and would necessitate transplantation.
- Hepatic encephalopathy. Hepatic encephalopathy is a debilitating, but reversible complication of liver cancer wherein the patient suffers from disorientation and severe confusion. This happens because of the free toxins spilling into the blood as a result of compromised liver function.
Diagnosis of Liver Cancer
Diagnosing liver cancer involves a multitude of techniques, some of which are listed below:
- Medical and family history. A comprehensive assessment of the patient’s history will reveal necessary data that can be used to formulate an accurate care plan for the patient.
- Comprehensive physical examination. Conducting a thorough physical assessment of the patient can reveal crucial data that is needed in formulating a definitive patient diagnosis.
- Liver function test. Liver function tests are laboratory works focused in assessing the general liver health of the patient. It seeks to measure the protein, enzymes, and bilirubin levels sensitive to liver health via the testing of the blood.
- Alpha-fetoprotein (AFP) test. The AFP levels are usually elevated on a patient suspected of having liver cancer, although this protein is associated in a developing fetus and stops after birth.
- Imaging tests. Tests such as abdominal ultrasounds, MRI or CT scans can be employed to visualize the abdomen, liver, and surrounding structures to assess for any deviations on the structures. When a tumor is found, these tests can help in recognizing the size, location, and spread of the cancer.
- Liver biopsy. Liver biopsy is a diagnostic test done under sedation in order to collect a sample of the patient’s liver which will be tested under the microscope. Take note that testing of the biopsied liver tissue is the definitive and confirmatory method of determining liver cancer. There are several types of liver biopsy, and they are as follows:
- Needle biopsy. In this procedure, the doctor will insert a thin needle into the abdomen, under ultrasound guidance, to obtain a sample of the patient’s liver for testing.
- Laparoscopic biopsy. In this procedure, the doctor will use a thin, flexible tube (i.e., laparoscope) that is inserted via a small incision in the abdomen to be able to better visualize the liver and to accurately collect a specimen.
- Surgical biopsy. In this procedure, the doctor will perform surgical removal of a part or the entire tumor and after which, a sample will be taken for testing.
Treatment for Liver Cancer
Treatment options for liver cancer will depend on the stage of the disease, age, liver function, presence of cirrhosis, general health, and well-being of the patient. It involves a multitude of ways, and they are enumerated below:
- Surgery. Surgical operation can be done for a patient with liver cancer and it includes:
- Partial hepatectomy – It is the surgical removal of a portion of a patient’s diseased liver. This is usually done for patients on the early stages of the condition. As time passes, the remaining healthy liver tissue will regenerate and replace the removed parts.
- Liver transplant – It is the surgical removal of the entire diseased liver which will be replaced with a healthy tissue from a suitable donor. This is only done if the cancer has not advanced enough to the surrounding tissues.
- Localized treatment. These are specialized treatments directed towards the cancer cells, including the surrounding areas. Options under this method includes:
- Radiofrequency ablation – This method involves the use of electric current to heat the cancer cells that will likewise be destroyed. This is done under the guidance of an imaging test through insertion of small and thin needles in the abdomen. Microwaves or lasers are other sources for this type of ablation.
- Cryoablation – This method uses extreme cold temperatures, via a cryoprobe containing liquid nitrogen, which is applied directly to the cancer cells to be destroyed.
- Ethanol ablation – This method involves directly applying pure alcohol into the tumor cells for it to be destroyed.
- Chemoembolization – This method uses potent chemotherapy drugs directly applied into tumor cells on the liver.
- Radioembolization – This method uses radioactive beads placed directly in the liver that will produce radiation to kill cancer cells.
- Radiation therapy – This method utilizes beams of high-level radiation to target cancer cells and can be done internally or externally.
- Systemic treatment. This method targets and kills cancer cells by infusing special medications through the patient’s circulatory system. Examples of which are:
- Targeted therapy – This therapy involves medications created to reduce tumor growth, including its blood supply. This is given for patients who cannot have hepatectomy or liver transplant.
- Chemotherapy – This therapy involves administration of potent drugs that kill both cancer and healthy cells.
- Immunotherapy – This method treats cancer by supplementing the body’s own immune system to attack cancer cells.
Liver Cancer Nursing Diagnosis
Nursing Care Plan for Liver Cancer 1
Nursing Diagnosis: Acute Pain related to side effects of chemotherapeutic drugs secondary to liver cancer treatment as evidenced by reports of pain at a 9/10 pain scale and restlessness.
- The patient will be able to verbalize relief of pain at a tolerable pain scale of 4/10.
- The patient will be able to perform activities of daily living without being restless.
- The patient will be able to perform relaxation and diversional activities as instructed.
Nursing Care Plan for Liver Cancer 2
Nursing Diagnosis: Risk for Infection related to immunosuppressive effects of chemotherapy secondary to liver cancer treatment.
- The patient will have a reduced risk of developing an infection.
- The patient will verbalize knowledge about the signs and symptoms of infection to watch out for.
- The patient will be knowledgeable about infection control measures.
|Liver Cancer Nursing Interventions||Rationale|
|Assess and monitor vital signs frequently. Routinely check laboratory values such as WBC count, serum protein, and albumin.||Elevation of body temperature can be an early sign of an infection. WBC count is the basis for the patient’s immune function. Serum protein and albumin are linked to the patient’s nutritional status.|
|Assess the patient for any skin breakdown or any possible entry of infection.||Chemotherapy can cause skin changes, ranging from redness to skin breakdown, especially on the punctured site.|
|Educate and encourage the patient and significant others about frequent and proper hand washing techniques.||Handwashing significantly reduced the transmission and acquisition of infection.|
|Educate the patient and significant others about proper cleaning and disinfection of the administration site. Use clean water and iodine for disinfecting. Cover the site with a sterile dressing.||It is important to clean the site after therapy to prevent skin breakdown. Sterile dressing prevents infection on the site.|
|Educate the patient about the importance of limiting visitors and exposure to others.||Patients who undergo chemotherapy have weak immune function. Exposure to others can cause infection and cross-contamination.|
|Encourage an increase in fluid intake if not contraindicated. Eating fruits, protein-rich, and fiber-rich foods.||Maintains adequate blood flow and prevents dehydration from the side effects of chemotherapy. Fruits, fibers, and increased protein intake support healing and liver function.|
|Demonstrate and stress the importance of using personal protective equipment (PPE) such as facemasks and gloves when in contact with the patient.||Personal protective equipment gives extra protection from possible health and safety risks, minimizing transmission and spread of infection.|
|Encourage adequate sleep and rest periods between activities.||The immune system works during sleep and rest.|
Nursing Care Plan for Liver Cancer 3
Risk for Fluid Volume Deficit
Nursing Diagnosis: Risk for Fluid Volume Deficit related to excessive losses through vomiting secondary to liver cancer treatment.
- The patient will be able to have adequate fluid balance as evidenced by adequate skin perfusion, stable vital signs, moist mucus membranes, and adequate urinary output.
- The patient will be able to recognize signs and symptoms of dehydration.
- The patient will be able to verbalize methods to reduce the risk of fluid volume deficit.
|Liver Cancer Nursing Interventions||Rationale|
|Assess and monitor the patient’s vital signs, including the skin, turgor, mucous membranes, capillary refill, and peripheral pulses.||An increase in heart rate and temperature with decreased blood pressure signifies reduced circulating blood volume. Checking of skin turgor, mucus membranes, peripheral pulses, and capillary refill is used to determine adequate perfusion.|
|Document and monitor intake and output, including all sources of fluid input and output such as IV fluids, gavage, lavage, vomitus, etc. Weigh the patient same time each day with light-weight clothing.||Wight, intake, and output records will show if the patient is retaining fluid or losing more than the expected amount.|
|Implement appropriate dietary measures such as nothing per orem or NPO status for several hours, gradual introduction of food, bland diet, or small frequent feeding.||NPO status will give enough time for the stomach to rest. Bland diets are easy-to-digest foods. A gradual introduction of food allows the stomach to adjust, and small portions of food allow easier digestion.|
|Encourage ice chips or sips of cold water and dry foods such as crackers when nauseous.||Decrease discomfort and relieve nausea.|
|Encourage increased fluid intake as tolerated. IV fluids can be used for patients who cannot tolerate oral fluid.||Increasing fluid intake is the best way to restore adequate fluid balance along with renal and cardiovascular functions.|
|Monitor laboratory values such as CBC, electrolytes, and serum albumin.||These laboratory values can determine the hydration status of the patient.|
|Educate the patient and significant others about the signs and symptoms of dehydration.||Awareness can lead to early detection and prompt intervention.|
Nursing Care Plan for Liver Cancer 4
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to hypermetabolic state secondary to liver cancer as evidenced by muscle wasting.
- The patient will have a stable weight within 2weeks of nursing intervention.
- The patient will have normal laboratory values without the signs of malnutrition.
- The patient will be knowledgeable about adequate dietary intake and ways to increase appetite.
|Liver Cancer Nursing Interventions||Rationale|
|1. Assess and monitor the patient’s daily nutritional intake and food habits. Make a food diary as indicated.||To check the patient’s nutritional status and preferences.|
|Assess and measure the patient’s height, weight, fluid intake, skin folds, and other body measurements.||Serve as a basis for comparison of treatment effectiveness. Hypermetabolic state affects all systems of the body including muscles, fats, and skin resulting in decreased body mass and wasting.|
|Monitor laboratory values including serum glucose, serum urea, and creatinine. Check dietary parameters such as calorie and protein intake.||These laboratory values and dietary parameters are associated with energy expenditure in a hypermetabolic state.|
|Assist the patient in the planning of weight goals, short-term and long-term nutrition goals.||This will serve as the determinants and motivation of the patient while engaging in the planning to gain a sense of control over the situation.|
|Encourage the patient to eat foods rich in vitamins A, C, and E, omega-3 fatty acids, amino acids, and proteins.||These foods help in the acute phase of hepatic response and hypermetabolic state. Protein-rich foods improve muscle mass.|
|Educate about alternative dietary measures such as small frequent feeding of a balanced meal.||Small frequent meals allow all the food to be digested properly, to reduce GI symptoms, and to promote high energy intake.|
|Encourage an increase in fluid intake if not contraindicated.||Maintains adequate blood flow and keeps the patient hydrated.|
|Referral to a nutritionist or dietitian.||Provides a more special dietary plan with an adequate amount of nutrition needed.|
Nursing Care Plan for Liver Cancer 5
Risk for Altered Family Process
Nursing Diagnosis: Risk for Altered Family Process related to long-term illness secondary to liver cancer.
- The patient will verbalize feelings about the changes in the family process.
- The patient will participate in planning interventions to resolve family conflicts and issues.
- The patient will be able to develop methods to cope and adjust to the situation.
|Liver Cancer Nursing Interventions||Rationale|
|1. Assess the usual family dynamics between the patient, families, and significant others. Determine the components of the family, their roles, and extended family including friends and neighbors.||This will help the nurse identify an available person to support each other. Their family dynamics will reflect their current situation as a family and how the disease process affects all of them.|
|Identify the usual pattern of communication and interaction among family members.||Problems with communication will interfere with their ability to assist one another.|
|Establish a quiet and trusting environment. Allow verbalization of feelings about the diagnosis of liver cancer and how it affects them.||A quiet and trusting environment promotes openness during the conversation. Expression of their feelings will help the nurse identify specific issues and how it affects the family.|
|Acknowledge their feelings and the difficulty of the situation, especially the treatment for liver cancer, financial problems, and possible death.||Acknowledgment means acceptance of reality and giving them assurance that it is normal to feel that way.|
|Educate the patient about the appropriate expression of anger (i.e., brisk walking, running, etc.) without reacting negatively.||Anger is the second stage of the grieving process; it is normal, especially among chronically ill individuals. Appropriate expression of anger allows progression to the next stage of the grieving process which is bargaining.|
|Educate the patient and family members about effective coping skills like meditation, relaxation techniques, etc.||Energy can be used for other activities rather than focusing on the illness. Most people develop this into a habit that can greatly affect the patient and family.|
|Encourage continuous support and open communication among family members.||Two heads are better than one which resolves problems effectively.|
|Referral to support groups, family therapy, or spiritual groups as indicated.||Additional support can also be beneficial so that they can learn from others who has been through the same situations as them.|
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. (2022). 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. (2020). 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
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