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    Liver Cirrhosis

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    Marisol Jane Jomaya
    This document provides an overview of liver cirrhosis for nursing students. It defines cirrhosis as a chronic degenerative disease characterized by liver tissue replacement with fibrosis. The main types are alcoholic, postnecrotic, and biliary cirrhosis. Risk factors include alcohol abuse, malnutrition, and viral hepatitis. Pathophysiology involves liver cell damage, regeneration, and fibrosis impairing hepatic function. Common complications are ascites, hepatic encephalopathy, and esophageal varices. Nursing diagnoses relate to activity intolerance, nutrition imbalance, skin integrity issues, and fluid volume excess. Interventions focus on reducing liver stress, providing adequate nutrition, preventing infection, and protecting from bleeding.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Liver Cirrhosis

    Uploaded by

    Marisol Jane Jomaya
    855 views31 pages
    This document provides an overview of liver cirrhosis for nursing students. It defines cirrhosis as a chronic degenerative disease characterized by liver tissue replacement with fibrosis. The main types are alcoholic, postnecrotic, and biliary cirrhosis. Risk factors include alcohol abuse, malnutrition, and viral hepatitis. Pathophysiology involves liver cell damage, regeneration, and fibrosis impairing hepatic function. Common complications are ascites, hepatic encephalopathy, and esophageal varices. Nursing diagnoses relate to activity intolerance, nutrition imbalance, skin integrity issues, and fluid volume excess. Interventions focus on reducing liver stress, providing adequate nutrition, preventing infection, and protecting from bleeding.

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    liver cirrhosis nursing management

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    This document provides an overview of liver cirrhosis for nursing students. It defines cirrhosis as a chronic degenerative disease characterized by liver tissue replacement with fibrosis. The main types are alcoholic, postnecrotic, and biliary cirrhosis. Risk factors include alcohol abuse, malnutrition, and viral hepatitis. Pathophysiology involves liver cell damage, regeneration, and fibrosis impairing hepatic function. Common complications are ascites, hepatic encephalopathy, and esophageal varices. Nursing diagnoses relate to activity intolerance, nutrition imbalance, skin integrity issues, and fluid volume excess. Interventions focus on reducing liver stress, providing adequate nutrition, preventing infection, and protecting from bleeding.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    855 views31 pages

    Liver Cirrhosis

    Uploaded by

    Marisol Jane Jomaya
    This document provides an overview of liver cirrhosis for nursing students. It defines cirrhosis as a chronic degenerative disease characterized by liver tissue replacement with fibrosis. The main types are alcoholic, postnecrotic, and biliary cirrhosis. Risk factors include alcohol abuse, malnutrition, and viral hepatitis. Pathophysiology involves liver cell damage, regeneration, and fibrosis impairing hepatic function. Common complications are ascites, hepatic encephalopathy, and esophageal varices. Nursing diagnoses relate to activity intolerance, nutrition imbalance, skin integrity issues, and fluid volume excess. Interventions focus on reducing liver stress, providing adequate nutrition, preventing infection, and protecting from bleeding.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 31

    Liver

    Cirrhosis
    Ma. Tosca Cybil A.
    Torres, RN, MAN

    LEARNING OBJECTIVES:
    After 2 hours of active lecture discussion, the
    students will be able to:
    1. Define liver Cirrhosis
    2. Enumerate the different types of liver
    cirrhosis
    3. Enumerate the predisposing/ contributing
    factors of liver cirrhosis
    4. Discuss the pathophysiological changes and
    clinical manifestations of patients with liver
    cirrhosis
    5. Formulate possible nursing diagnoses applicable
    for patients with liver cirrhosis
    6. Enumerate nursing interventions applicable for
    each identified nursing diagnosis
    7. Integrate Christian Values in rendering nursing
    care for clients with liver cirrhosis
    MTCAT '10

    Liver
    Cirrhosis
    a chronic, degenerative
    disease characterized by
    replacement of normal liver
    tissue with diffuse fibrosis
    that disrupts the structure
    and function of the liver

    MTCAT '10

    Liver
    Cirrhosis
    Types:

    a. Alcoholic Cirrhosis ( Laennecs Cirrhosis)

    Most common type of liver cirrhosis


    Caused by chronic alcoholism

    b. Postnecrotic cirrhosis

    Late result of a previous bout of acute viral


    hepatitis

    c. Biliary cirrhosis

    Resulted from chronic biliary obstruction


    and infection
    Least common type

    MTCAT '10

    Liver Cirrhosis
    Predisposing/ Precipitating factors:
    malnutrition
    effects of alcohol abuse
    chronic impairment of bile excretion
    biliary obstruction in the liver and
    common bile duct (gallbladder
    stones)
    necrosis from hepatotoxins or viral
    hepatitis
    Congestive heart failure

    MTCAT '10

    Liver Cirrhosis
    Pathophysiology:

    liver cell damage result in


    inflammation & hepatomegaly
    attempts at regeneration eventually
    result to fibrosis and a small nodular
    liver
    hepatic function is slowly impaired
    obstruction of venous channels
    blocks hepatic blood flow and cause
    portal hypertension

    MTCAT '10

    MTCAT '10

    MTCAT '10

    MTCAT '10

    Assessment:
    Clinical Manifestations

    S/Sx - early:

    anorexia, nausea, indigestion


    aching or heaviness in right
    upper quadrant
    weakness & fatigue

    MTCAT '10

    Clinical
    Manifestations
    Late signs:

    abnormal liver function tests:


    bilirubin (N=0-0.9mg/dl),
    AST (N=4.8-19U/L)
    ALT (N= 2.4-17U/L)
    Serum alkaline phosphatase (N=30-40U/L)
    Ammonia (plasma) (N= 15-45umol/L)
    intermittent jaundice, pruritus
    edema, ascites, prominent abdominal wall veins
    Ecchymosis, bleeding tendencies
    anemia
    Infection
    Gynecomastia, testicular atrophy
    Neurologic changes
    MTCAT '10

    Complications of Liver
    Cirrhosis
    1. Ascites
    abnormal intraperitoneal
    accumulation of watery
    fluid containing small
    amounts of protein
    due to:

    intravascular colloidal
    pressure
    capillary hydrostatic
    pressure
    Na and H2O retention
    Failure of the liver to
    metabolize aldosterone
    MTCAT '10

    Ascites
    S/sx:
    abdominal enlargement, wt.
    fatigue
    abdominal discomfort, respiratory
    difficulty
    Med. Mgt. (depending on severity of
    ascites)
    Na+ & fluid restriction (500-1000 ml/day)
    diuretic therapy (furosemide/
    spironolactone)
    Paracentesis for diagnosis or when fluid
    volume compromise comfort & breathing
    MTCAT '10

    Ascites
    Nursing Interventions to ascites & increase/promote
    comfort
    maintain on bed rest
    fluid & Na restriction
    monitor I/O, daily wt.
    measure abd. girth every shift
    maintain on high-Fowlers for max. respiration
    support abdomen with pillows
    administer diuretics, salt-poor albumin IV as
    ordered
    - monitor for signs of CHF, pulmonary
    edema, dehydration,
    electrolyte imbalance, hypersensitivity reaction
    Assist with Paracentesis
    have the client void before the procedure
    high fowlers position during the procedure
    monitor pt. for hypovolemia & electrolyte imbalance
    observe puncture wound for leakage & signs of
    MTCAT
    '10
    infection

    Complications of Liver
    Cirrhosis
    2. Hepatic Encephalopathy

    cerebral dysfunction assoc. with


    severe liver disease
    inability of the liver to metabolize
    substances that can be toxic to
    the brain such as ammonia, which
    is produced by the breakdown of
    protein in the intestinal tract

    MTCAT '10

    Pathogenesis of Hepatic
    Encephalopathy
    BRAIN

    LIVER

    Toxic N2 metabolites
    From Intestines

    MTCAT '10

    Encephalopa
    thy
    S/Sx:
    Asterixis- flapping hand tremors ---early sign
    LOC lethargy progressing to coma
    mental status, confusion, disorientation
    dullness, slurred speech
    behavioral changes, lack of interest in grooming/
    appearance
    twitching, muscular incoordination, tremors
    Fetor hepaticus
    elevated serum ammonia level

    MTCAT '10

    Encephalopath
    y

    Interventions:
    a. ) ammonia production
    dietary protein to 20-40 g/day, maintain adequate
    calories
    ammonia formation in the intestine give laxative,
    enema as ordered and Neomycin - bacterial
    ammonia production
    b.) Protect pt. from injury
    side rails up
    turning to side
    assess mental status, LOC
    proper positioning (semi-Fowlers)
    prevent aspiration
    c.) Prevent further episodes of encephalopathy
    low protein diet
    prescribed medications
    avoid constipation ( to ammonia production by
    bacteria in the GIT)
    early signs of encephalopathy (restlessness, slurred
    MTCAT '10
    speech, dec. attention span)

    Complications of Liver
    Cirrhosis
    3. Esophageal Varices

    distention of the smaller blood vessels of


    the esophagus as a result of portal
    hypertension due to obstruction of venous
    circulation w/in the damaged liver
    the portal venous pressure causes blood
    to be forced into these vessels become
    tortous and fragile
    blood vessel become prone to injury by
    mechanical trauma from ingestion of coarse
    food and acid pepsin erosion which may
    result in bleeding
    bleeding may also occur as a result of
    coughing, vomiting, sneezing, straining at
    stool or any physical exertion that
    abdominal venous pressure

    MTCAT '10

    Esophageal
    Varices
    S/Sx:
    upper GI bleeding
    (hematemesis)
    - melena
    massive hemorrhage
    signs/symptoms of
    hypovolemic shock
    MTCAT '10

    Esophageal
    Varices
    Medical Management:
    find the source of bleeding esophagoscopy,
    angiography
    control bleeding
    a. Gastric lavage, administration of antacid
    via NGT
    b. Surgical bypass procedures (splenorenal
    shunt)
    c. Variceal band ligation (esophageal
    variceal ligation (EVL))
    d. Endoscopic sclerotherapy or injection
    sclerotherapy
    e. Balloon tamponade

    MTCAT '10

    insertion of SengstakenBlakemore tube


    with gastric and esophageal balloon that
    are inflated to stop bleeding

    Balloon tamponade

    MTCAT '10

    MTCAT '10

    esophageal variceal ligation (EVL)

    MTCAT '10

    Possible Nursing Diagnoses

    Activity intolerance R/T fatigue, lethargy, and


    malaise
    Imbalanced nutrition R/T abdominal distention and
    discomfort, and anorexia
    Impaired skin integrity R/T pruritus from jaundice
    and edema
    High risk for injury R/T altered clotting
    mechanisms and altered LOC
    Disturbed body image R/T changes in appearance,
    sexual dysfunction, and role function
    Chronic pain R/T enlarged tender liver and ascites
    Fluid volume excess R/T ascites and edema
    formation
    Ineffective breathing pattern R/T restriction of
    thoracic excursion secondary to ascites and
    abdominal distention
    MTCAT '10

    Nsg. Interventions:
    1. Reduce metabolic demands on the liver
    provide bed rest
    eliminate
    ingestion
    of
    toxic
    substances to the liver: sedatives
    opiates, alcohol, acetaminophen
    activities

    MTCAT '10

    Nsg. Interventions:
    2. Provide adequate nutrition & hydration
    Low protein, high-carbohydrate, high
    calorie, sodium- restricted diet
    multiple vitamin therapy
    restrict fluids & sodium if there is edema
    or ascites
    provide mouth care before meals
    monitor I/O, daily wt.
    3. Prevent infection
    encourage good personal hygiene
    reverse isolation
    assess for signs of infection esp. urinary
    encourage deep breathing/position changes
    MTCAT '10

    Nsg. Interventions:
    4. Protect pt. from bleeding

    monitor urine, stool, gums, skin for signs of


    bleeding/ bruising
    avoid
    injections,
    apply
    pressure
    to
    venipuncture sites for at least 5 mins.
    Monitor prothrombin time, bleeding time
    Teach pt. to use soft toothbrush, avoid
    constipation
    Prevent scratching from pruritus, proper
    skin care
    Administer Vit. K as ordered

    MTCAT '10

    Questions?????
    MTCAT '10

    ASSIGNMENT:
    Answer situation #4 in critical
    thinking exercises, Brunner &
    Suddarths Textbook of MedicalSurgical Nursing, 11th Edition,
    2009 Page 1341
    WRITE your answers in a
    whole sheet of yellow paper

    MTCAT '10

    MTCAT '10

    Thank you...

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