nursing care for liver cirrhosis

• Complete vitals and  respiratory assessment Note impaired gas exchange and compromised respiratory function Assess for decreased or labored breathing

• Monitor fluid and electrolyte balance  ( Daily weights   /   Assess for JVD )

• Liver impairment may also affect renal function. Ascites and dependent edema may be indicators of hyponatremia.

• Increasing weight and blood pressure may indicate vascular congestion

• The decrease in weight and blood pressure may indicate the effectiveness of interventions

• Promote rest to conserve energy (  Impaired liver function can cause the patient to be easily fatigued. Encourage rest periods and cluster care to conserve energy for nutrition and self-care ) .

• Assist with paracentesis as necessary ( If ascites progresses, it may be necessary to perform paracentesis to drain the abdominal fluid. Assist with set-up and positioning of patient, post-procedure site assessments, and monitoring ) .

• Diuretics- are often given to manage the accumulation of fluid and edema

• Lactulose- a man-made sugar that is given to help reduce the amount of ammonia in the blood and prevent hepatic encephalopathy

• Analgesics- given to manage pain; avoid acetaminophen

• Blood products- excessive bleeding and complications following surgery may require blood transfusions

• Vitamin K- helps to promote clotting and avoid complications from bleeding

• Provide adequate nutrition and education, encourage lifestyle changes.

• Administer medications appropriately : 

1.  Diuretics
2.  Lactulose  Analgesics
3.  Blood products
4.  Vitamin K

• Observe stools and emesis for color, consistency, and amount, and test each one for occult blood.

• Monitor fluid intake and output and serum electrolyte levels to prevent dehydration and hypokalemia, which may precipitate hepatic encephalopathy.

• Maintain some periods of rest with legs elevated to mobilize edema and ascites. Alternate rest periods with ambulation.

• Encourage and assist with gradually increasing periods of exercise.

• Encourage the patient to eat high-calorie, moderate protein meals and supplementary feedings. Suggest small, frequent feedings.

• Encourage oral hygiene before meals.

• Administer or teach self-administration of medications for nausea, vomiting, diarrhea or constipation.

• Encourage frequent skin care, bathing with soap, and massage with emollient lotions.

• Keep the patient’s finger nails short to prevent scratching from pruritus.

• Keep the patient quiet and limit activity if signs of bleeding are evident.

• Encourage the patient to eat foods high vitamin C content.

• Use small gauge needles for injections and maintain pressure over injection site until bleeding stops.

• Protect from sepsis through good handwashing and prompt recognition and management of infection.

• Pad side rails and provide careful nursing surveillance to ensure the patient’s safety.

• Stress the importance of giving up alcohol completely.

• Involve the person closest to the patient, because recovery usually is not easy and relapses are common.