Cirrhosis of the liver is caused by long term liver damage that interferes with its functions. Excessive alcohol consumption over 10 years or more is a major risk factor. Symptoms range from mild indigestion to jaundice, abdominal swelling and mental clouding. Treatment focuses on complete alcohol abstinence, dietary changes including fruit and milk, and lifestyle modifications to avoid further liver damage.

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I.INTRODUCTION
Cirrhosis of the liver refers to all forms of liver disease characterised by a significant loss of cells.
It is one ofthe mostserious hepatic diseases. The liver gradually contracts in size and becomes hard and
leathery.
The liver is one ofthe mostimportant glandular organs in the body. Itis located high up on the right side of
the abdomen just under the diaphragm. It is a vast chemical laboratory which performs many important
functions. It produces bile, cholesterol, lecithin, blood albumin vital to the removal of tissue wastes
prothrombin essential to the clotting of blood and numerous enzymes.
It inactivates hormones no longer needed, synthesises many amino acids used in building tissues and
breaks proteins into sugar and fat when required for energy. It stores vitamins and minerals. It also
destroys harmful substances and detoxifies drugs, poisons, chemicals and toxins from bacterial infections.
Liver damage interferes with all of these functions.
In cirrhosis ofthe liver, although regenerative activity continues, the progressive loss ofliver cells exceeds
cell replacement. There is also progressive distortion ofthe vascular system which interferes with the portal
blood flow through the liver. The progressive degeneration of liver structure and function may ultimately
lead to hepatic failure and death.

2. Excessive use of alcohol over a long period is the most potent cause of cirrhosis of the liver. It has been
estimated that one out of 12 chronic alcoholics in the United States develops cirrhosis.
The disease can progress to end-stage of hepatic failure if the person does not abstain from alcohol.
Cirrhosis appears to be related to the duration of alcohol intake and the quantity consumed daily. Recent
researches indicate that the average duration of alcohol intake to produce cirrhosis is 10 years and the
dose is estimated to be in excess of 500 ml of alcohol daily.
Poor nutrition can be another causative factor in the development of cirrhosis and a chronic alcoholic
usually suffers from severe malnutrition as he seldom eats. Other causes of cirrhosis are excessive intake
of highly seasoned food, habitual taking of quinine for a prolonged period in tropical climate, and drug
treatments for syphillis, fever and other diseases. It may also result from a highly toxic condition of the
system in general. In fact, anything which continually overburdens the liver cells and leads to their final
breakdown can be a contributing cause of cirrhosis.
In the early stages of the diseases, there may be nothing more than frequent attacks of gas and
indigestion, with occasional nausea and vomiting. There may be some abdominal pain and loss of weight.
In the advanced stage, the patient develops a low grade fever. He has a foul breath, jaundiced skin and
distended veins in the abdomen. Reddish hair like markings, resembling small spiders, may appear on the
face, neck, arms and trunk. The abdomen becomes bloated and swollen, the mind gets clouded and there
may be considerable bleeding from the stomach.
The patient should be kept in bed. He must abstain completely from alcohol in any form. He should
undergo an initial liver cleaning programme with a juice fast for seven days. Freshly extracted juices from
red beets, lemon, papaya and grapes may be taken during this period. This may be followed by the fruit
and milk diet for two to three weeks.
In this regimen, the patient should have three meals a day, each of fresh juicy fruits and milk.
The fruits may include apples, pears, grapes, grape fruit, oranges, pineapples and peaches. One litre of
milk may be taken on the first day. It should be increased by 250 ml daily up to two to two and a half litres a
day. The milk should be fresh and unboiled, butmay be slightly warmed ifdesired.Itshould be sipped very
slowly.
After the fruit and milk diet, the patient may gradually embark upon a well-balanced diet of three basic food
groups, namely seeds, nuts and grains, vegetables and fruits, with emphasis on raw organically grown
foods.
An adequate high quality protein dietis necessary in cirrhosis. The bestcomplete proteins for liver patients
are obtained from raw goat‘s milk,home-made raw cottage cheese, sprouted seeds and grains and raw
nuts, especially almonds.

3. Vegetables such as beets, squashes, bitter gourd, egg-plant, tomato, carrot, radishes and papaya are
useful in this condition. All fats and oils should be excluded from the diet for several weeks.
The patient should avoid all refined, processed and canned foods, sugar in any form, spices and
condiments, strong tea and coffee, fried foods, all preparations cooked in ghee, oil or butter and all meats
rich in fat. The use ofsalt should be restricted. The patient should also avoid all chemical additives in food
and poisons in air, water and environment.
Warm water enema should be used during the treatment to cleanse the bowels. If constipation is habitual,
all steps should be taken for its eradication. Application of alternate compress to liver area followed by
general wet sheetrub will be beneficial. The morning dry friction and breathing and other exercises should
form a regular daily feature of the treatment.

4. II.OBJECTIVES
General Objective:
The study aims is to test the knowledge ofthe studentnurses by practicing what they have learned
on school on caring and management of patient with liver cirrhosis. The study was guided by the following
specific objectives:
Specific Objectives:
 To obtain more knowledge about the actual hospital setting.
 To gain knowledge about the disease Liver Cirrhosis
 To be able to formulate effective nursing care plan for patient with Liver Cirrhosis.
 To be able to perform different nursing interventions to the patient with liver cirrhosis
 To be able to assist the patient’s recovery
 To be able to practice the nursing skills effectively.
 To establish rapport to the patient.
 To practice proper nurse-patient relationship
 To show good learning relationship with the clinical instructor and fellow nursing students

5. III. Nursing History
Personal Data
D.P is a woman who lives in west rainbow Block 21 R. Mabini. She is 66 years old and a certified Filipino.
She is also a Roman Catholic. She is a plain housewife and a widow for about 8 years. Her husband died
due to heart attack. She have 3 children and all of them are professionals as now.
Past History
She do nothave a past hospital history according to her and to her children. But she have an IUD for about
11 years without being check- up by the hospital.
Present History
She is confined last Thursday July 15, 2010. With the reason ofabdominal pain. She is now undergone on
the different laboratory procedure to make sure of her true condition. Her confinement diagnosis is liver
cirrhosis to consider hepatocellular cancer. This is not the final diagnosis notatleast it is being prove by the
laboratory result.
Family or Familial History
Her mother died due to lung cancer and her father died due to liver cancer.
Environmental History
She lives in the side of the road of Mabini. Her house is located near in the road where the vehicles are
passing which give her a smoke and dust in her own house.
Nutritional History
Her diet is high in salt and high in fat. She is fun of eating fried chicken, pork chop and other foods which
are cooked by means of frying. She also eat tuyo and tinapa that are too salty.

6. IV. Physical Assessment:
General survey: asleep in bed. Have an ongoing oxygen inhalation via nasal cannula regulated at 3
lpm
Ares to be assess 1st day FINDINGS 2nd day FINDINGS
Vital signs BP:100/80
RR:16 bpm
PR:75 bpm
T:36.0 C
BP:100/90
RR:17 bpm
PR:60 bpm
T:36.0 C
SKIN No lesion, normal skin turgor,
have a dry skin
No lesion, normal skin turgor,
have a dry skin
HEAD Rounded, have a even
distribution of air in scalp
Rounded, have a even
distribution of air in scalp
EYES Black color ofthe pupil, shiny,
smooth and pale conjunctiva,
yellowish sclera, pupil
constrict when looking near
objectand dilate when looking
for object, pupil also convenge
when the objectis move
toward the nose
Black color ofthe pupil, shiny,
smooth and pale conjunctiva,
yellowish sclera, pupil constrict
when looking near objectand
dilate when looking for object,
pupil also convenge when the
objectis move toward the nose
EARS Auricle are symmetrical, have
color as the facial skin, Pinna
soft and recoil after folding
forward
Auricle are symmetrical, have
color as the facial skin, Pinna
soft and recoil after folding
forward
NOSE Uniform color, there is no
discharge presentin the nose
Uniform color, there is no
discharge presentin the nose
MOUTH Absence ofinflammation, no
oral trash,have pink buccal
mucosa, moist, smooth, soft
mucosa
Absence ofinflammation, no
oral trash,have pink buccal
mucosa, moist, smooth, soft
mucosa

7. NECK No swelling, no enlargement
of thyroid, no distention, no
neck masses
No swelling, no enlargement
of thyroid, no distention, no
neck masses
CHEST AND LUNGS Presences ofwheezing
sound, irregular breathing
pattern, regular breathing rate.
Presences ofwheezing sound,
irregular breathing pattern,
regular breathing rate.
ABDOMEN Uniform color like the other
part of the body, have a large
abdomen that is not
proportionate to the size ofher
body, she also have a caput
medusea in her abdomen
Uniform color like the other
part of the body, have a large
abdomen that is not
proportionate to the size ofher
body, she also have a caput
medusea in her abdomen
LOWER
EXTREMITIES
Uniform color as the body,
Capillary refill comes back
within 3 seconds, pinkish nail
bed
Uniform color as the body,
Capillary refill comes back
within 3 seconds, pinkish nail
bed
UPPER
EXTREMITIES
Uniform color like the other
parts ofthe body, symmetrical
to the other upper extremities,
have some bruises because of
dislodging IV.
Uniform color like the other
parts ofthe body, symmetrical
to the other upper extremities,
have some bruises because of
dislodging IV.

8. V. Anatomy and Physiology
The liver is a vital organ presentin vertebrates and some other animals;ithas a wide range of functions,a
few of which are detoxification, protein synthesis,and production ofbiochemicals necessaryfor digestion.The liver
is necessaryfor survival; there is currently no way to compensate for the absence ofliver function. The liver plays a
major role in metabolism and has a number offunctions in the body, including glycogen storage,decomposition of
red blood cells,plasma protein synthesis,hormone production,and detoxification.The liver is also the largestgland
in the human body. It lies below the diaphragm in the thoracic region of the abdomen.It produces bile,an alkaline
compound which aids in digestion,via the emulsification oflipids.Italso performs and regulates a wide variety of
high-volume biochemical reactions requiring highlyspecialized tissues.
Medical terms related to the liver often start in hepato- or hepatic from the Greek word for liver, hēpar
(ήπαρ). An adult human liver normallyweighs between 1.4-1.6 kg (3.1-3.5 lb), and is a soft, pinkish-brown,
triangular organ.Averaging about the size of an American football in adults,it is both the largestinternal organ and
the largestgland in the human body(not considering the skin).
It is located in the rightupper quadrantof the abdominal cavity, resting just below the diaphragm.The liver
lies to the rightof the stomach and overlies the gallbladder.
The various functions of the liver are carried out by the liver cells or hepatocytes.Currently, there is no
artificial organ or device capable of emulating all the functions ofthe liver. Some functions can be emulated by
liver dialysis,an experimental treatmentfor liver failure.

9. VI. Pathophysiology ofPneumonia
Predisposing Factor:
Age: 5 months
Sex: Female
Sedentary Factor:
Environment: smoking of
parents, hot surrounding
Inhalation of the smoke of
the cigarettes.
Dry perspiration in the back.
The air sacs in the lungs fill
with pus and other liquid.
Oxygen has trouble
reaching your blood. If there
is too little oxygen in your
blood, your body cells can’t
work properly.
Spreading infection through
the body pneumonia can
cause death.
Signs and Symtoms:
Fever, chill, chest pain,
difficulty of breathing
Pneumonia

10. VII. Diagnostic Procedure and Laboratory Results
Name: D.P Age: 66 years old
Date: 07-18-2010
Hematology Result Form
Prothormbin Time
Patient 20.5 secs. (11.5-15.5 secs.)
Control 15.5 secs.
Activity 44.3 %
INR 1.75
Examined By: Ma. Cecilia C. Amaro Reviewed By: Noel C. Santos MD
Date: 07-18-2010 Date: 07-18-2010

11. Diagnostic Procedure and LaboratoryResults
Name: F.A. Age: 5 months
Referred by Dr. A.P. Yanga Date: 08-04-09
Hematology
SCHILLINGS
EOS MYELO JUV STAB JEG LYMPHO MONO BAYE
3-5 0 0-1 3-6 43-76 17-48 4.0-10.0
REMARKS 13.9 2.8 83.3
Marilou M. Alcantara Bernadette Espiritu MD,
Examiner FPSP Pathologist
Normal Values Results
RBC F 4.5 – 5.5 mm
Hgb F 120-140 g/l 136gl
Hematocrit F 0.40-0.42 l 0.140
WBC F 5.0-10.0x 10^ 9/l 14.0 x 10^ 9/l
Platelets 150- 390x10g^12/l 300 x10g^12/l
E.SED. Rate F 0-20mm/hr
BleedingTime 1-5 mins.
Coagulation Time 5-6 mins.
Blood Type
RBC Morpoly

12. IX. Nursing Care Plan
Name: D. P.
Age: 66 yrs. Old
Assessment Planning Intervention Rationale Evaluation
Subjective:
“hind naman ako mlakas
kuamain pero mataba ako”
as patient verbalized
Objective:
Edema in upper extremities
Changes in respiratory
pattern
Restlessness
Dypnea
Nursing Diagnosis
Excess Fluid Volume
related to compromised
regulatory mechanism like
organ failure
Partially Compensator
Long Term Goal
After 1 shift of nursing
intervention the pt will
reduce the excess fluid in
the body
Facilitate measuring of abd.
grin.
Facilitate appropriate rate
of fluid intake.
Facilitate weighing ofthe
pt.
Facilitate elevation of
ematous extremities
frequently
Facilitate use of lip balm &
frequent oral intake
For changes that may
indicate inc fluid retention
To preventpeaks/ valleys
in fluid level & thirst
To provide comparative
baseline
To reduce tissue pressure
& risk of skin breakdown
To reduce discomfortof
fluid restriction
Pt. reduce the excess fluid
in the body

13. Assessment Planning Intervention Rationale Evaluation
Subjective:
“hindako makakain” as
patient verbalized
Objective:
Loss ofappetite
Weakness
Capillary fragility
Dec. albumin: 23.2
Dec.total protein: 47.4
Nursing Diagnosis
Imbalnced Nutrition less
than body requirement
related to inability to absorb
nutrients
Partially Compensator
Long Term Goal
After 3 days ofnursing
intervention the pt will
increase her appetite
Facilitate discussion of
eating habits.
Facilitate weighing ofthe
pt.
Facilitate promotion of
pleasant, relaxing
environment.
Facilitate prevention of
unpleasant odors / sights
Inhibit fluid intake at least1
hr before meals
To appeal clients like and
dislikes
To provide comparative
baseline
To enhance intake
May have a negative effect
on the pt. appetite
To reduce possibility of
early satiety.
Pt. increase her appetite

14. X. Health Teachings
M ·Medication may prescribe to facilitate normal breathing.
· Patient and significant others must be familiar with the medication the patient is
receiving, also in its action, side effects, & proper administration.
E · Facilitate proper ventilation
T · Assess breathe sound & air movement.
H · Identify factors that cause allergic reaction &avertit from the patient. Prevention must
be encouraged.
O · Advise the patientfor a regular check- up for evaluation & reassessmentofthe
condition
D · Identify the food that she needs for age.
·Encourage & well balance diet.
S ·Instruct patient to always bring the medication prescribe by the physician for her
condition

15. VIII. DRUG STUDY
PatientName:EDC Age:71 yrs. Old Diagnosis:LiverCirrhosis
Genericname Brand
name
Classification Dosage Mechanismofaction Indication Contra
indication
Sideeffect Nursing
management
Propanolol Inderal beta-
adrenergic
receptor-
blocking agen
10mg Propranolol is a
beta-blocker drug. It
acts by blocking the
beta-1 and beta-2
receptors presentin
heart and blood
vessels.It
decreases the
action ofpacemaker
cells and slowing
certain impulses in
the heart, thus it
control irregular
heartbeat.
Used for
treating high blood
pressure, heart
pain
(angina), abnormal
rhythms of the
heart, and some
neurologic
conditions.
Allergy to any of
the ingredients
of Propranolol.
If you are
suffering forom
asthma or
Raynaud
syndrome.
fast, slow, or
uneven
heartbeats;
feeling light-
headed,
fainting;
feeling short
of breath,
even with mild
exertion;
swelling of
your ankles or
feet;
hould not
use this
medication if
you are
allergic to
propranolol,
or if you have
asthma or
certain heart
conditions,
especially
second or
third degree
heart block.
Furosemide Lasix Diuretic 20mg Furosemide is a
potent diuretic
(water pill) that is
used to eliminate
water and salt from
the body. In the
kidneys, salt water,
and other small
molecules normally
are filtered out of
the blood and into
the tubules of the
kidney
edema associated
with congestive heart
failure, cirrhosis,
renal disease,and
other edematous
states
acute pulmonary or
cerebral edema
hypercalcemia
Contraindicated
inpatient
hypersensitive
to drug andin
fluidswith
anuria
-Use cautiously
patientwith
hepaticarrhosis
inthor allergic
to sulfonamides
anorexia oral
and gastric
irritation
cramping
diarrhea
constipation
nausea
vomiting
monitor
weight,blood
pressure,and
pulse rate
routinelywith
longtermuse
and during
rapiddiuresis.
Use can leadto
profound
waterand
electrolyte
depletion

17. XI. Evaluation
The student can understand the deeper side ofthe disease this is pneumonia. The patient knows relevant
information ofpneumonia. The readers learn the different nursing intervention for the disease.
 Obtained more knowledge about the actual hospital setting.
 Gained knowledge about the disease Liver Cirrhosis
 Formulate effective nursing care plan for patient with Liver Cirrhosis.
 Perform different nursing interventions to the patient with liver cirrhosis
 Assist the patient’s recovery
 Practice the nursing skills effectively.
 Establish rapport to the patient.
 Practice proper nurse-patient relationship
 Show good learning relationship with the clinical instructor and fellow nursing students

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