Nursing Care Plans for Liver Cirrhosis – Best Nursing Care Plans(2022)

This article discusses Nursing Care Plans for Liver Cirrhosis‘ plus its causes, symptoms, preventions, treatments, and interventions.

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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students for learning purposes only and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.

Introduction

Cirrhosis is a late stage of liver scarring (fibrosis) caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism.

Each time the liver is injured, whether by disease, excessive alcohol consumption, or another cause, it tries to repair itself. In the process, scar tissue forms. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function. Advanced cirrhosis is life-threatening.

The liver damage done by cirrhosis generally can’t be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited.

Symptoms of Liver Cirrhosis

1. Fatigue and weakness
2. Lack of appetite and weight loss
3. Nausea
4. Bleed or bruise easily and have swelling legs or belly.
5. Changes in your skin, such as:
6. Jaundice (when your skin and eyes turn yellow)
7. Intense itching
8. Spider web-like blood vessels in your skin
9. Redness in the palms of your hands or whitening of your nails

Some other symptoms might include:

• Vomiting blood
• Severe muscle cramps
• Brownish urine
• Fever
• Enlarged spleen
• Bone disease, causing bones to break more easily

Causes of Liver Cirrhosis

Cirrhosis always develops because of another liver problem or disease. If the cause of liver cirrhosis is not treated, it’ll worsen, and the healthy liver cells won’t be able to keep up over time. A patient might start to get tired, feel like they don’t want to eat, and lose weight without trying. After a while, the liver may not be able to work well or at all.

It’s important to know the cause of liver cirrhosis so it can get the right treatment and keep it from getting worse. The most common causes are:

1. Alcohol abuse
2. Nonalcoholic fatty liver disease – Obesity raises the chances of this condition. If this disease causes liver cirrhosis, liver health can be improved by losing weight and controlling blood sugar levels, preventing further damage.
3. Hepatitis B or hepatitis C – Medicines for these diseases can stop more damage from happening to the liver.
4. Other conditions that can lead to cirrhosis include:
5. Cystic fibrosis
6. Diseases that make it hard for the body to process sugars
7. Too much iron buildup in the body
8. Wilson’s disease, where too much copper is stored in the liver
9. Autoimmune diseases that cause the body to attack liver cells
10. Blockage of the bile duct, which carries digestive enzymes from the liver into the intestines
11. Certain genetic digestive disorders
12. Some infections, including syphilis and brucellosis
13. Bad reactions to certain medications

Diagnosis of Liver Cirrhosis

A doctor will examine the patient and feel around the liver area to determine whether it is enlarged. The patient will be asked about their medical history and lifestyle, including drinking.

The following tests may also be ordered:

Blood tests – These measures how well the liver is functioning. If levels of alanine transaminase (ALT) and aspartate transaminase (AST) are high, the patient may have hepatitis.

Imaging tests – Ultrasound, CT, or MRI scans can be used to see whether the liver is enlarged and detect any scarring or nodules.

Biopsy – A small sample of liver cells is extracted and examined under a microscope. The biopsy can confirm cirrhosis and its cause.

Endoscopy – The doctor inserts a long, thin tube with a light and video camera at the end that goes through the esophagus and into the stomach. The doctor looks out for swollen blood vessels called varices that can signify cirrhosis.

Complications of Liver Cirrhosis

High blood pressure in the veins that supply the liver (portal hypertension). Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood to the liver from the intestines and spleen.

Swelling in the legs and abdomen. The increased pressure in the portal vein can cause fluid to accumulate in the legs (edema) and in the abdomen (ascites). Edema and ascites also may result from the inability of the liver to make enough of certain blood proteins, such as albumin.

Enlargement of the spleen (splenomegaly). Portal hypertension can also cause changes to and swelling of the spleen and trapping of white blood cells and platelets. Decreased white blood cells and platelets in your blood can be the first sign of cirrhosis.

Bleeding. Portal hypertension can cause blood to be redirected to smaller veins. Strained by the extra pressure, these smaller veins can burst, causing serious bleeding. Portal hypertension may cause enlarged veins (varices) in the esophagus (esophageal varices) or the stomach (gastric varices) and lead to life-threatening bleeding. If the liver can’t make enough clotting factors, this also can contribute to continued bleeding.

Infections. If you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to bacterial peritonitis, a serious infection.

Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.

Buildup of toxins in the brain (hepatic encephalopathy). A liver damaged by cirrhosis isn’t able to clear toxins from the blood as well as a healthy liver can. These toxins can then build up in the brain and cause mental confusion and difficulty concentrating. With time, hepatic encephalopathy can progress to unresponsiveness or coma.

Jaundice. Jaundice occurs when the diseased liver doesn’t remove enough bilirubin, a blood waste product, from your blood. Jaundice causes yellowing of the skin and whites of the eyes, and darkening of urine.

Bone disease. Some people with cirrhosis lose bone strength and are at greater risk of fractures.

Increased risk of liver cancer. A large proportion of people who develop liver cancer have pre-existing cirrhosis.

Acute-on-chronic cirrhosis. Some people end up experiencing multiorgan failure. Researchers now believe this is a distinct complication in some people with cirrhosis, but they don’t fully understand its causes.

Treatment of Liver Cirrhosis

If cirrhosis is diagnosed early enough, damage can be minimized by treating the underlying cause or the various complications that arise.

Treatment for alcohol dependency: The patient needs to stop drinking if their cirrhosis is caused by long-term, regular heavy alcohol consumption. The doctor will recommend a treatment program for treating alcohol dependency in many cases.

Medications: The patient may be prescribed drugs to control liver cell damage caused by hepatitis B or C.

Controlling pressure in the portal vein: Blood can “back up” in the portal vein that supplies the liver with blood, causing high blood pressure in the portal vein. Drugs are usually prescribed to control the increasing pressure in other blood vessels. The aim is to prevent severe bleeding. Signs of bleeding can be detected via an endoscopy.

Note: If the patient vomits blood or passes bloody stools, they probably have esophageal varices. Urgent medical attention is required. The following procedures may help:

Banding: A small band is placed around the base of the varices to control bleeding.

Injection sclerotherapy: After an endoscopy, a substance is injected into the varices, which triggers a blood clot and scar tissue to form. This helps stem the bleeding.

A Sengstaken-Blakemore tube with a balloon: A balloon is placed at the end of the tube. If endoscopy does not stop the bleeding, the tube goes down the patient’s throat and into their stomach. The balloon is inflated. This places pressure on the varices and stops the bleeding.

Transjugular intrahepatic portosystemic stent shunt (TIPSS): If the therapies mentioned above do not stem the bleeding, a metal tube is passed across the liver to join the portal and hepatic veins, creating a new route for the blood to flow through. This reduces the pressure that was causing the varices.

Other complications are handled in different ways:

Infections: The patient will be given antibiotics for any infections that arise.

Screening for liver cancer: Patients with cirrhosis have a much higher risk of developing liver cancer. The doctor may recommend regular blood tests and imaging scans.

Hepatic encephalopathy, or high blood toxin levels: Drugs can help treat excessive blood toxin levels.

In some cases, the damage caused by cirrhosis covers most of the liver and cannot be reversed. In these cases, the person may need a new, transplanted liver. It can take time to find a suitable donor, and this procedure is often advised only as a last resort.

Prevention of Liver Cirrhosis

Reduce the risk of cirrhosis by taking these steps to care for the liver:

Do not drink alcohol if you have cirrhosis. If you have liver disease, you should avoid alcohol.

Eat a healthy diet. Choose a plant-based diet that’s full of fruits and vegetables. Select whole grains and lean sources of protein. Reduce the amount of fatty and fried foods you eat.

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Maintain a healthy weight. An excess amount of body fat can damage your liver. Talk to your doctor about a weight-loss plan if you are obese or overweight.

Reduce your risk of hepatitis. Sharing needles and having unprotected sex can increase your risk of hepatitis B and C. Ask your doctor about hepatitis vaccinations.

Nursing Care Plans for Liver Cirrhosis Based on Diagnosis

Nursing Care Plans for Liver Cirrhosis – Nursing Care Plan 1: Diagnosis – Imbalanced Nutrition: Less than Body Requirements

It is related to abnormal bowel functions secondary to cirrhosis. 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.

Nursing Interventions	Rationale
Measure the patient’s daily calorie intake.	Observing and recording the patient’s food intake will help the healthcare providers assess 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 daily patient weighing is limited in assessing for malnutrition (due to edema or ascites), it is still necessary to allow for proper assessment. Skinfold measurement allows the healthcare provider to assess for latent fat reserves of the patient and detect 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 to reduce metabolic demands to the liver and reduce ammonia and urea levels in the body.

Nursing Care Plans for Liver Cirrhosis – Nursing Care Plan 2: Diagnosis – Fluid Volume Excess

Related to compromised regulatory mechanism secondary to decreased plasma proteins in cirrhosis. 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.

Nursing Interventions	Rationale
Ensure the measurement of the patient’s daily weight, 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 fluid retention.
Ensure daily abdominal girth measurement.	Daily abdomen measurement helps assess 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 plasma colloid osmotic pressure effects. Treatment regimens such as the 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, including 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.

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Nursing Care Plans for Liver Cirrhosis – Nursing Care Plan 3: Diagnosis – Ineffective Breathing Pattern

Related to the accumulation of intra-abdominal fluid. 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.

Nursing Interventions	Rationale
Monitor respirations, taking note of the patient’s rate, depth, and effort.	Irregularities in respirations such as dyspnea or shallow patterns may appear due to the accumulation of fluid in the abdomen, thereby reducing effective lung expansion.
Auscultate breath sounds, taking note of the presence of adventitious sounds such as crackles, rhonchi, wheezes.	The occurrence of adventitious breath sounds usually indicates developing complications. Diminished, even absent, breath sounds may indicate lung atelectasis.
Maintain the head of the 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 in proper and adequate lung expansion and the mobilization of secretions to allow expectoration.
Monitor arterial blood gas vital signs, including oxygen saturation.	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 relieve 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 Plans for Liver Cirrhosis – Nursing Care Plan 4: Diagnosis – Disturbed Body Image 

Related to biophysical changes. Evidenced by verbalization of changes in lifestyle and negative feelings about the body.

Desired Outcome

The patient will verbalize understanding and acceptance of biophysical changes and address these changes through acceptable coping mechanisms.

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. Adopt a friendly and positive attitude when caring for the patient.	The caregiver should focus mainly on the patient’s needs so as to allow the patient to feel valued. Avoid judgmental statements because the patient is very sensitive to these issues.
Encourage the family or significant others in active participation in the patient’s care.	The family may sometimes have the guilt of the current condition and fear of the patient’s eventual death. Because of this, the family would need continuous access to the patient as much as necessary. Participation of relatives in the patient’s care 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. Providing psychological support can allow 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 services, 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 to the condition.

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Nursing Care Plans for Liver Cirrhosis – Nursing Care Plan 5: Diagnosis –Risk for Impaired Skin Integrity

Related to altered metabolic state. 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.

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 with 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 skin circulation. 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 the 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.

Related FAQs

1. What is the main nursing diagnosis for patient with liver cirrhosis?

Based on the assessment data, the major nursing diagnosis for the patient are: Activity intolerance related to fatigue, lethargy, and malaise. Imbalanced nutrition: less than body requirements related to abdominal distention and discomfort and anorexia.

2. How do you care for someone with cirrhosis of the liver?

If you have cirrhosis, be careful to limit additional liver damage:

1. Don’t drink alcohol. Whether your cirrhosis was caused by chronic alcohol use or another disease, avoid alcohol.
2. Eat a low-sodium diet.
3. Eat a healthy diet.
4. Avoid infections.
5. Use over-the-counter medications carefully.

3. What is the principal goal of cirrhosis therapy?

Doctors have two main goals in treating this disease: Stop the damage to your liver, and prevent complications. Alcohol abuse, hepatitis, and fatty liver disease are some of the main causes. Your doctor will personalize your treatment based on what caused your cirrhosis, and the amount of liver damage you have.

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4. What does a liver nurse do?

The nurse specialist in liver diseases provides coordination of care, support, and guidance to the patient not only during the initial phase of addiction treatment but also during follow-up, so that sustained sobriety can be achieved.

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