Liver Cirrhosis Powerpoint (Week 2) REVISED

NURSING CARE MANAGEMENT
OF AN ADULT CLIENT
DIAGNOSED WITH LIVER
CIRRHOSIS
CACHERO, JUSTIN C.
INTRODUCTION
• With today’s fast-paced world, many people are engrossed to
various unhealthy behaviors and activities which became
habitual and have already been part of their lives.
• Having the role of a filter, the liver does majority of the
cleaning and is very much susceptible to the damage brought
about by different substances and microorganisms
(MedlinePlus, 2011).
• The liver is the largest organ inside the body, and also
one of the most important.
• It is considered as the body’s engine processor which
silently does its work until it manifests symptoms of
damage when the disease is on its advances stage
(MedlinePlus, 2011).
• The World Health
Organization (WHO)
defines cirrhosis as a
process characterized by
fibrosis (scarring) that
changes the architecture
of the normal liver into
one that has structurally
abnormal nodules, or
lumps.
• Cirrhosis is most commonly caused by alcoholism, hepatitis B and C,
and fatty liver disease.
• When complications cannot be controlled by treatment, a liver
transplant is considered. Liver transplantation is a major operation in
which the diseased liver is removed and replaced with a health and
from an organ donor.
• Liver cirrhosis is estimated to kill
about 30,558 people each year,
and 101,000 people diagnosed
with liver cirrhosis in the United
States based from the 2009
statistics of Center for Disease
Control and Prevention
• considered as the seventh most
common cause of death in
adults between the ages of 45 to
65.
• Hepatitis C virus infection is the most prevalent cause in
Japan, accounting for about 60% of all liver cirrhosis cases
and the induction of liver cirrhosis by Hepatitis B virus and
alcohol was similarly prevalent (Japan Etiology of Liver
Cirrhosis Study Group, 2009)
• low serum retinol level was highly prevalent in
cirrhotic patients, and that the Vitamin A level
in the blood could determine the extent of the
liver damage
A study in the year 2010 by the Federal University of Rio de

Janeiro
OBJECTIVES:
• This case study aims to assess the patient’s general health
status, identify the different health needs and plan for
appropriate measures that are necessary in order to bring
change towards the promotion of health of the client.
• This case study also aims to present the disease of the
patient in the most detailed and accurate way possible.
SHORT TERM OBJECTIVES:
• Defined the patient’s condition—liver cirrhosis, and reviewed latest
statistics and current trends.
• Identified the different possible diseases and factors, which could have
led to the development of the disease;
• Recognized the different manifestations of the disease through the
patient;
• Discussed the management and treatment, and provide nursing care
through the utilization of the nursing process.
LONG TERM OBJECTIVES:
• Understood the pathophysiology of the diagnosis of the patient;
• Generate practical nursing interventions to solve the identified
nursing problems;
• Analyzed the different environmental and familial factors in
relation to the cause if illness of the patient.
• Assessed and gained knowledge and skills in intervening to the
patient.
NORMAL PHYSIOLOGIC RESPONSE
• The liver is the largest internal organ in the body, weighing 3 lbs.
(1,200 to 1,600 g) in the average adult. It is also one of the busiest
performing well over 100 separate functions.
• The most important of these are the formation and secretion of
bile; detoxification of harmful substances; storage of vitamins;
metabolism of carbohydrates, fat, and proteins; and production of
plasma proteins (Lippincott Williams & Wilkins, 2009).
• Blood flow
• Metabolic functions -
carbohydrates, fats,
and proteins
• Conversion of bilirubin
• Inactivation of many
drugs
PATHOPHYSIOLOGICAL RESPONSE
Modifiable and Non-modifiable factors cause Hepatocyte
damage  Liver inflammation  Alterations in blood and
lymph flow  Liver necrosis 
1. Biochemical Alterations  Elevated AST and ALT levels,
Elevated Alkaline Phosphatase, Elevated Globulin, Prolonged
Prothrombin time
2. Decreased ADH and aldosterone detoxification  Edema 
Hypertension and Decreased HCT
3. Decreased Androgen and estrogen detoxification 
Palmar Erythema, Testicular Hypertrophy, Spider Angiomas,
Gynecomastia, Loss of Body Hair, Menstrual changes
4. Decreased Metabolism of proteins  Decreased plasma
proteins Decreased capillary oncotic pressure Ascites,
Edema  Hypertension and Decreased HCT
5, Decreased metabolism of carbohydrates 
Hypoglycemia, Malnutrition
6. Decreased Metabolism of fats  Decreased Cholesterol
levels
7. Decreased Vitamin K absorption  Bleeding tendency
8. Decreased Bilirubin metabolism and/or biliary tree
damage or obstruction  Conjugated and unconjugated
hyperbilirubinemia  Jaundice, Icteric sclera; Increased
Urobilinogen  Dark urine; Decreased bile in
gastrointestinal tract  Clay-colored stools
BEHAVIORAL RESPONSE
Assessment:
• Pain Assessment: PQRST scale
• Vital signs (Fever)
• Mental status (GCS Scoring); Orientation/Disorientation
• Cephalocaudal Physical Assessment
• Abdominal girth measurement (Ascites)
• Measurement of Spleen
• Level of edema scoring
• Low hemoglobin level
• Jaundice (yellow discoloration of the skin, mucous
membranes, and sclerae of the eyes [scleral icterus])
• Epistaxis
• Purpura
• Hematuria
• Spider Angiomas
(Telangiectasias)
• Bleeding Gums
EXPERIENTIAL RESPONSE
• Abdominal Discomfort
• Description of flulike symptoms
• Loss of appetite
• Complaints of dyspnea
• Complaints of Pruritus
• Nausea and vomiting
• General weakness
• Fatigue
• Indigestion
• Abnormal bowel function (either constipation or diarrhea)
• Flatulence
FACTOR: PERSONAL/INTERNAL ENVIRONMENT
Non-Modifiable factors
1.Familial predisposition
2.Age
3.Gender (Men)
4.Race (Non-whites)
Modifiable Factors
1.Post-acute viral (types B and C hepatitis)
2.Post intoxication with industrial chemicals
3.Intrahepatic cholestasis/obstruction of bile ducts
4.Alcohol abuse
5.Poor nutritional state
6.Obesity
7. Use of Drugs (Acetaminophen, Methotrexate, Isoniazid)
8. Right-sided heart failure
9. Constrictive pericarditis
10. Valvular heart diseases
11. Alpha1-antitrypsin deficiency
12. Amyloidosis
13. Glycogen-storage disease
14. Galactosemia
FACTOR: EXTERNAL ENVIRONMENT
Assessment:
• Knowledge and skills required of nursing staff
• Understanding of patient and family of the importance of continual
health care and medical supervision
• Measures to achieve and maintain remission. These include proper
diet, rest, avoidance of potentially hepatotoxic over-the-counter drugs
(e.g., acetaminophen [Tylenol]), and abstinence from alcohol.
• Availability of community support programs, such as Alcoholics
Anonymous, for help with alcohol abuse.
IMPLICATIONS TO PRACTICE
• Effective dissemination of information and preventive measures

should be implemented through detailed health teachings.
• Awareness must be inculcated to as many people as possible,
using mass media to promptly disseminate the information.
• Implementation and provision of appropriate management in
treating and managing the patient’s condition shall be rendered
accordingly by the team
• They must be able to strictly adhere to the therapeutic
management advised to them by the healthcare team
POSSIBLE NURSING DIAGNOSIS
• Acute Pain
• Impaired Breathing Pattern
• Ineffective Tissue Perfusion
• Imbalanced Nutrition: Less than Body
Requirements
• Excess Fluid Volume
• Acute Confusion
• Risk for Impaired Skin Integrity
• Risk for Injury
GENERAL NURSING INTERVENTIONS:
• Monitor patient for signs of bleeding in the gums and injection

sties, decrease in blood pressure, increase in pulse, hematemesis,
and melena
• Monitor hemoglobin, hematocrit, prothrombin time, and INR.
• Monitor parenteral fluids and blood transfusions.
• Administer Vitamin K and neomycin as ordered.
• Instruct patient to avoid straining with stools and to avoid vigorous
tooth brushing
• Monitor gastric output (color and consistency)
• Observe frequently for changes in mental status, such as lethargy,
drowsiness, and confusion.
• Monitor neurologic status for decreased monitor ability
• Give lactulose as ordered to decrease production of ammonia
• Provide a safe environment: side rails up, bed in low
position.
• Avoid use of sedatives, tranquilizers, and opioids.
• Monitor daily weight
• Offer support and understanding
• Promote adequate rest.
BIBLIOGRAPHY
Book Sources:
• Caldwell S.H., Battle E.H. Ascites and Spontaneous bacterial peritonitis. In: Schiff E.R., Sorrell M.F., Maddrey W.C., eds. Schiff’s Diseases of the Liver. 8th ed.
Philadelphia, Pa: Lippincott-Raven; 2009: 371-85.
• Carey W.D. How should a patient with an isolated GGT be evaluated? Cleve Clin J Med. 2002, 67: 315-316.
• Fonda M.L., Brown S.G., et al. Concentration of Vitamin B6 and activities of enzymes of B6 metabolism in the blood of alcoholic and nonalcoholic men. Alcohol
Clin Exp Res. 2005 Dec; 13(6): 804-9.
• Joel J. Heidelbaugh, M.D., and Maryann Sherbondy, M.D., University of Michigan Medical School, Ann Arbor, Michigan Am Fam Physician. 2006 Sep 1; 74(5):
767-776.
• Joyce M. Black, Jane Hokanson Hawks, Medical-Surgical Nursing: clinical management for positive outcomes, Volume 1 and 2 Edition 8. Saunders, 2009 ISBN
1416046879, 9781416046875.
• Lillian Sholtis Brunner, Suzanne C. Smeltzer, Brenda G. Bare, Janice L. Hinkle, Kerry H. Cheever, Brunner and Suddarth’s textbook of Medical-Surgical Nursing
Volume 1 of Brunner and Suddarth’s textbook Medical-Surgical Nursing Edition 12. Lippincott Williams and Wilkins, 2009, ISBN 0781785898, 9780781785891.
• Melissa Palmer, Doctor Melissa Palmer’s guide to hepatitis and liver disease revised edition. Penguin, 2004 ISBN 1583331883, 9781583331880.
• Ramzi Cotran, M.D., Vinay Kumar, M.D., Stanley Robbins, M.D., “Robbins Pathologic Basis of Disease”; 2011.

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NURSING CARE MANAGEMENT

A study in the year 2010 by the Federal University of Rio de

• Effective dissemination of information and preventive measures

• Monitor patient for signs of bleeding in the gums and injection

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