Cirrhosis of the Liver

  1. General information
    1. Chronic, progressive disease characterized by inflammation, fibrosis, and degeneration of the liver parenchymal cells
    2. Destroyed liver cells are replaced by scar tissue, resulting in architectural changes and malfunction of the liver
    3. Types
      1. Laennec's cirrhosis: associated with alcohol abuse and malnutrition; characterized by an accumulation of fat in the liver cells, progressing to widespread scar formation.
      2. Postnecrotic cirrhosis: results in severe inflammation with massive necrosis as a complication of viral hepatitis.
      3. Cardiac cirrhosis: occurs as a consequence of right-sided heart failure; manifested by hepatomegaly with some fibrosis.
      4. Biliary cirrhosis: associated with biliary obstruction, usually in the common bile duct; results in chronic impairment of bile excretion.
    4. Occurs twice as often in men as in women; ages 40-60
  2. Assessment findings
    1. Fatigue, anorexia, nausea and vomiting, indigestion, weight loss, flatulence, irregular bowel habits
    2. Hepatomegaly (early): pain located in the right upper quadrant; atrophy of liver (later); hard, nodular liver upon palpation; increased abdominal girth
    3. Changes in mood, alertness, and mental ability; sensory deficits; gynecomastia, decreased axillary and pubic hair in males; amenorrhea in young females
    4. Jaundice of the skin, sclera, and mucous membranes; pruritus
    5. Easy bruising, spider angiomas, palmar erythema
    6. Muscle atrophy
    7. Diagnostic tests
      1. SGOT (AST), SGPT (ALT), LDH alkaline phosphatase increased
      2. Serum bilirubin increased
      3. PT prolonged
      4. Serum albumin decreased
      5. Hgb and hct decreased
  3. Nursing interventions
    1. Provide sufficient rest and comfort.
      1. Provide bed rest with bathroom privileges.
      2. Encourage gradual, progressive, increasing activity with planned rest periods.
      3. Institute measures to relieve pruritus.
        1. do not use soaps and detergents
        2. bathe in tepid water followed by application of an emollient lotion.
        3. provide cool, light, nonrestrictive clothing.
        4. keep nails short to avoid skin excoriation from scratching.
        5. apply cool, moist compresses to pruritic areas.
    2. Promote nutritional intake.
      1. Encourage small frequent feedings.
      2. Promote a high-calorie, low- to moderate-protein, high-carbohydrate, low-fat diet, with supplemental vitamin therapy (vitamins A, B-complex, C, D, K, and folic acid)
    3. Prevent infection.
      1. Prevent skin breakdown by frequent turning and skin care.
      2. Provide reverse isolation for clients with severe leukopenia; pay special attention to hand-washing technique.
      3. Monitor WBC.
    4. Monitor/prevent bleeding.
    5. Administer diuretics as ordered.
    6. Provide client teaching and discharge planning concerning
      1. Avoidance of agents that may be hepatotoxic (sedatives, opiates, or OTC drugs detoxified by the liver)
      2. How to assess for weight gain and increased abdominal girth
      3. Avoidance of persons with upper respiratory infections
      4. Recognition and reporting of signs of recurring illness (liver tenderness, increased jaundice, increased fatigue, anorexia)
      5. Avoidance of all alcohol
      6. Avoidance of straining at stool, vigorous blowing of nose and coughing, to decrease the incidence of bleeding