Liver Cirrhosis Nursing Care Plan & Management

 Description

  • Is a chronic disease that causes cell destruction and fibrosis (scarring) of hepatic tissue.
  • Fibrosis alters normal liver structure and vasculature, impairing blood and lymph flow and resulting in hepatic insufficiency and hypertension in the portal vein.
  • Complications include hyponatremia, water retention, bleeding esophageal varices, coagulopathy, spontaneous bacterial peritonitis, and hepatic encephalopathy.
    Three major forms:
  1. Laennec’s (alcohol induced) Cirrhosis
    • Fibrosis occurs mainly around central veins and portal areas.
    • This is the most common form of cirrhosis and results from chronic alcoholism and malnutrition.
  2. Postnecrotic (micronodular) Cirrhosis
    • Consist of broad bands of scar tissue and results from previous acute viral hepatitis or drug-induced massive hepatic necrosis.
  3. Biliary Cirrhosis
    • Consist of Scarring of bile ducts and lobes of the liver and results from chronic biliary obstruction and infection (cholangitis), and is much rarer than the preceding forms.
Causes/ Risk Factors
  • Cirrhosis of the liver is a chronic disease that causes cell destruction and fibrosis (scarring) of hepatic tissues. Fibrosis alters normal liver structure and vasculature, impairing blood and lymph flow and resulting in hepatic insufficiency and hypertension in the portal vein. Complications include hyponatremia, water retention, bleeding esophageal varices, coagulopathy, spontaneous bacterial peritonitis, and hepatic encephalopathy.
  • Cirrhosis is known in three major forms. In Laennec’s (alcohol-induced) cirrhosis, fibrosis occurs mainly around central veins and portal areas. This is the most common form of cirrhosis and results from chronic alcoholism and malnutrition. Postnecrotic (micronodular) cirrhosis consist of broad bands of scar tissue and results from previous acute viral hepatitis or drug-induced massive hepatic necrosis. Biliary cirrhosis consists of scarring of bile ducts and lobes of the liver and results from chronic biliary obstruction and infection (cholangitis), and is much rarer than the preceding forms.


Pathophysiology
Assessment
  1. Early complaints including fatigue, anorexia, edema of the ankles in the evening, epistaxis, bleeding gums, and weight loss.
  2. In later disease:
    • Chronic dyspepsia, constipation and diarrhea.
    • Esophageal varices; dilated cutaneous veins around umbilicus (caput medusa); internal hemorrhoids, ascites, splenomegaly.
    • Fatigue, weakness, and wasting caused by anemia and poor nutrition.
    • Deterioration of mental function.
    • Estrogen-androgen imbalance causing spider angioma and palmar erythema; menstrual irregularities in women; testicular and prostatic atrophy, gynecomastia, loss of libido, and impotence in men.
    • Bleeding tendencies and hemorrhage.
  3. Enlarged, nodular liver.
Diagnostic Evaluation
  1. Elevated serum liver enzyme levels, reduced serum albumin.
  2. Liver biopsy detects cell destruction and fibrosis of hepatic disease.
  3. Liver scan shows abnormal thickening and a liver mass.
  4. CT scan determines the size of the liver and its irregular nodular surface.
  5. Esophagoscopy determines the presence of esophageal varices.
  6. Percutaneous transhepatic cholangiography differentiates extrahepatic from intrahepatic obstructive jaundice.
  7. Paracentesis examines ascitic fluid for cell, protein, and bacteria counts.
Primary Nursing Diagnosis
  • Fluid volume excess related to retention