Liver failure is a life-threatening condition where the liver loses its ability to function properly. This nursing diagnosis focuses on identifying and managing symptoms of liver failure, preventing complications, and providing comprehensive care for patients with acute or chronic liver failure.
Causes (Related to)
Liver failure can develop from various underlying conditions and factors that affect liver function:
- Viral hepatitis (A, B, C)
- Alcohol-related liver disease
- Drug-induced liver injury
- Autoimmune hepatitis
- Metabolic disorders
- Chronic conditions such as:
- Cirrhosis
- Nonalcoholic fatty liver disease
- Wilson’s disease
- Hemochromatosis
- Environmental factors including:
- Exposure to toxins
- Certain medications
- Poor nutrition
Signs and Symptoms (As evidenced by)
Liver failure presents with distinctive signs and symptoms that nurses must recognize for proper diagnosis and treatment.
Subjective: (Patient reports)
- Fatigue and weakness
- Nausea and vomiting
- Loss of appetite
- Abdominal pain and distension
- Mental confusion
- Itchy skin
- Dark urine
- Sleep disturbances
Objective: (Nurse assesses)
- Jaundice (yellowing of skin and eyes)
- Ascites
- Peripheral edema
- Altered mental status
- Bleeding tendencies
- Spider angiomas
- Palmar erythema
- Asterixis (flapping tremors)
- Abnormal liver function tests
Expected Outcomes
The following outcomes indicate successful management of liver failure:
- The patient will maintain stable vital signs
- The patient will demonstrate improved mental status
- The patient will maintain an adequate nutrition status
- The patient will show no signs of bleeding
- The patient will maintain a fluid balance
- The patient will demonstrate an understanding of the medication regime
- The patient will avoid complications
- The patient will adhere to prescribed dietary restrictions
Nursing Assessment
1. Monitor Vital Signs
- Check temperature, pulse, respiratory rate, and blood pressure
- Monitor for signs of infection
- Assess for bleeding tendencies
- Document mental status changes
2. Assess Liver Function
- Monitor liver function tests
- Check coagulation profile
- Assess for ascites
- Document jaundice progression
- Monitor albumin levels
3. Evaluate Nutritional Status
- Monitor weight changes
- Assess dietary intake
- Check for muscle wasting
- Monitor protein levels
- Document vitamin deficiencies
4. Check for Complications
- Monitor for hepatic encephalopathy
- Assess for portal hypertension
- Watch for varices
- Check for infection signs
- Monitor kidney function
5. Review Risk Factors
- Assess alcohol consumption
- Document medication history
- Check for hepatotoxic exposures
- Review family history
- Monitor compliance with treatment
Nursing Care Plans
Nursing Care Plan 1: Impaired Liver Function
Nursing Diagnosis Statement:
Impaired Liver Function related to progressive liver disease as evidenced by elevated liver enzymes, jaundice, and altered mental status.
Related Factors:
- Chronic liver disease
- Hepatotoxic substances
- Viral infections
- Metabolic disorders
Nursing Interventions and Rationales:
- Monitor liver function tests daily
Rationale: Tracks disease progression and treatment response - Assess mental status q4h
Rationale: Early detection of hepatic encephalopathy - Administer prescribed medications
Rationale: Supports liver function and prevents complications
Desired Outcomes:
- The patient will show improved liver function tests
- The patient will maintain normal mental status
- The patient will demonstrate medication compliance
Nursing Care Plan 2: Risk for Bleeding
Nursing Diagnosis Statement:
Risk for Bleeding related to decreased clotting factor production as evidenced by elevated PT/INR and presence of bruising.
Related Factors:
- Impaired clotting factor synthesis
- Portal hypertension
- Thrombocytopenia
- Esophageal varices
Nursing Interventions and Rationales:
- Monitor coagulation parameters
Rationale: Identifies bleeding risk - Implement bleeding precautions
Rationale: Prevents injury and bleeding - Administer blood products as ordered
Rationale: Corrects coagulation deficiencies
Desired Outcomes:
- The patient will maintain stable coagulation values
- The patient will demonstrate no new bleeding
- The patient will verbalize understanding of bleeding precautions
Nursing Care Plan 3: Imbalanced Nutrition
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less than Body Requirements related to impaired protein synthesis as evidenced by muscle wasting and decreased albumin levels.
Related Factors:
- Decreased appetite
- Impaired protein metabolism
- Nausea and vomiting
- Altered taste sensation
Nursing Interventions and Rationales:
- Monitor nutritional intake
Rationale: Ensures adequate nutrition - Provide small, frequent meals
Rationale: Improves nutrient absorption - Administer prescribed supplements
Rationale: Corrects nutritional deficiencies
Desired Outcomes:
- The patient will maintain a stable weight
- The patient will demonstrate improved protein levels
- The patient will increase dietary intake
Nursing Care Plan 4: Fluid Volume Excess
Nursing Diagnosis Statement:
Fluid Volume Excess related to decreased plasma protein and portal hypertension as evidenced by ascites and peripheral edema.
Related Factors:
- Decreased albumin production
- Portal hypertension
- Sodium retention
- Altered hormone metabolism
Nursing Interventions and Rationales:
- Monitor fluid balance
Rationale: Tracks fluid status - Implement fluid restrictions
Rationale: Prevents fluid overload - Administer diuretics as ordered
Rationale: Reduces fluid retention
Desired Outcomes:
- The patient will demonstrate decreased edema
- The patient will maintain an appropriate fluid balance
- The patient will comply with fluid restrictions
Nursing Care Plan 5: Impaired Skin Integrity
Nursing Diagnosis Statement:
Impaired Skin Integrity related to pruritis and poor nutrition as evidenced by skin breakdown and scratch marks.
Related Factors:
- Bile salt accumulation
- Poor nutrition
- Edema
- Decreased mobility
Nursing Interventions and Rationales:
- Perform skin assessment q shift
Rationale: Early detection of skin breakdown - Implement skin care protocol
Rationale: Prevents further damage - Teach proper skincare
Rationale: Promotes skin integrity
Desired Outcomes:
- The patient will demonstrate improved skin integrity
- The patient will report decreased itching
- The patient will perform appropriate skincare
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.
- Br VK, Sarin SK. Acute-on-chronic liver failure: Terminology, mechanisms and management. Clin Mol Hepatol. 2023 Jul;29(3):670-689. doi: 10.3350/cmh.2022.0103. Epub 2023 Mar 20. PMID: 36938601; PMCID: PMC10366797.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Johnson, M. R., & Brown, A. K. (2024). Complications of Liver Failure: A Guide for Clinical Practice. Critical Care Nursing Quarterly, 47(1), 78-92.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Martinez, S. D., & Thompson, R. B. (2024). Evidence-Based Nursing Interventions in Liver Failure: A Systematic Review. Advanced Critical Care Nursing, 45(3), 289-301.
- Roberts, L. N., et al. (2024). Quality of Life in Patients with Liver Failure: Nursing Perspectives. Journal of Advanced Nursing Practice, 33(2), 167-180.
- Sarin SK, Choudhury A. Acute-on-chronic liver failure: terminology, mechanisms and management. Nat Rev Gastroenterol Hepatol. 2016 Mar;13(3):131-49. doi: 10.1038/nrgastro.2015.219. Epub 2016 Feb 3. PMID: 26837712.
