The document outlines nursing management of patients with cirrhosis of the liver. It discusses the metabolic functions of the liver and alterations that occur with disease. Cirrhosis is a chronic disease characterized by scar tissue replacing normal liver tissue. Nursing interventions focus on promoting rest, improving nutritional status through diet and supplements, providing skin care to prevent injury from scratching, and reducing risks like infection that could further damage the liver.

1.  
Dhuha F Shamsaldeen

2.  Identify the metabolic functions of the liver and the
alterations in these functions that occur with liver
disease.
 Explain liver function tests and the clinical manifestations
of liver dysfunction in relation to pathophysiology
alterations of the liver.
 Describe the medical, surgical, and nursing management
of patients with cirrhosis.
 Use the nursing process as a framework for care of the
patient with cirrhosis of the liver.

3.  The liver, is the largest gland of the body, located behind
the ribs in the upper right portion of the abdominal cavity.

4.  Glucose metabolism.
 Ammonia conversion.
 Protein metabolism.
 Fat metabolism.
 Vitamins and iron storage.
 Bile formation.
 Bilirubin excretion.
 Drug metabolism.

5.  N/V
 Anorexia
 Abdominal distention
 Changes in bowel habits
 Weight loss
 Weakness and fatigue
 Abdominal pain
 Bleeding in ( skin, stool, urine )
 Edema
 Dark urine
 Ascites
 Jaundice

6.  

7.  Is a chronic disease characterized by replacement of
normal liver tissue with diffuse fibrosis that disrupt the
structure and function of the liver.

9. Types of the hepatic
cirrhosis :
Alcoholic cirrhosis
In which the scar tissue
characteristically
surround the portal al
areas .
Biliary cirrhosis
In which scarring occurs
in the liver around the
bile ducts. This type of
cirrhosis usually result
from chronic biliary
obstruction and infection.
Postnecrotic cirrhosis
In which there are broad
bands of scar tissue. This
is a late result of a
previous bout of acute
viral hepatitis.

10. compensated decompensated
Intermittent mild fever
Vascular spiders
Palmar erythema ( reddened palms )
Unexplained epistaxis
ankle edema
Vague morning indigestion
Flatulent dyspepsia
Abdominal pain
Enlarged liver
Splenomegaly
Ascites
Jaundice
Fatigue
Muscle wasting
Weight loss
Continuous of liver
Clubbing of liver
pruritus
Spontaneous bruising
Epistaxis
Hypotension
Spare body hair
White nails
Gonadal atropy

12.  

13.  Autoimmune
 Poor nutrition
 Toxic substances
 Infections

14.  Older adults ( age )

15.  Feeding habits
 Adults circumcision

16.  Direct Bilirubin
 Indirect Bilirubin
 Serum amylase
 Serum lipase
 Ammonia
 AST ( Aspartate Amino Transfers )
 ALT ( Alanine Amino Transfers )
 SGOT ( Serum Glutamic Oxaloacetic Transaminase)
 LDH ( Lactic Acid Dehydrogenase )
 ALP ( Alkaine Phosphatase )
 GGT ( G-Glutamyl Transfers)

17.  CT scan
 MRI
 Liver biopsy

18.  Antacids / Histamine-2 ( H2 ) antagnosis:
To decrease gastric distress and minimize the possibility of
GI bleeding.
 Vitamins and nutritional supplements:
To promote healing of damaged liver cells and improve the
patient`s general nutritional status.
 Potassium-sparing diuretics such as spironolactone or
triamterene ( Dyrenium ):
To decrease ascites and minimize the fluid and electrolyte
changes.

19.  

20. Nursing interventions rationale Expected outcomes
1. Assess level of activity
tolerance and degree of
fatigue when performing
routine activities of daily
living.
2. Assist when activities and
hygiene when fatigued.
3. Encourage rest when
fatigued or when abdominal
pain or discomfort occurs.
4. Assist with selection and
pacing of desired activities
and exercise.
5. Provide diet high in
carbohydrates with protein
intake consistent with liver
function.
6. Administer supplemental
vitamins ( A, B complex, C,
and K ).
1. Provides baseline for future
assessment and criteria for
assessment of effectiveness
of environment.
2. Promotes exercise and
hygiene within pt`s level of
tolerance.
3. Conserves energy to
protects the liver.
4. Stimulates patient`s interest
in selected activities.
5. Provides calories for energy
and protein for healing.
6. Provides additional nutrient.
• Exhibits increased interest in
activity and events.
• Participate in activities and
gradually increases exercise
within physical limits.
• Reports increased in
strength and well-being.
• Reports absence of
abdominal pain and
discomfort.
• Plans activities to allow
ample periods of rest.
• Takes vitamins as
prescribed.

21. Nursing interventions rationale Expected outcomes
1. Assess dietary intake and
nutritional status through diet
history and diary, daily weight
measurements, and laboratory
data.
2. Provide diet high in
carbohydrates with protein
intake consistent with liver
function.
3. Assist pt in identifying low
sodium foods.
4. Elevate the head of the bed
during meals.
5. Provides oral hygiene before
meals and pleasant environment
for meals at meal time.
6. Offer smaller, more frequent
meals.
7. Eliminate alcohol.
8. Apply an ice collar for nausea.
1. Identifies deficits in nutritional
intake and adequacy of
nutritional state.
2. Provides calories for energy,
sparing protein for healing.
3. Reduces edema and ascites
formation.
4. Reduces discomfort from
abdominal distention.
5. Promotes positive environment
and increased appetite; reduced
unpleasant taste.
6. Decrease feeling of fullness and
bloating.
7. Eliminates “empty calories” and
further damage from alcohol.
• Exhibits improved nutritional
status by increased weight (
without fluid retention ) and
improved laboratory data.
• States rationale for dietary
modifications.
• Identifies foods high in
carbohydrates and within protein
requirements ( moderate to high
protein in cirrhosis ).
• Reports improved appetite.
• Participates in oral hygiene
measures.
• Gains weight without increased
edema or ascites formation.

22. Nursing interventions Rationale Expected outcomes
1. Assess degree of
discomfort r/t pruritus and
edema.
2. Note and record degree of
jaundice and extent of
edema.
3. Keep patient`s fingernails
short and smooth.
4. Provide frequent skin care;
avoid use of soaps and
alcohol-based lotions.
5. Massage every 2 h with
emollients; turn every 2 h.
6. Recommend avoiding use
of harsh detergents.
7. Assess skin integrity every
4-8 hrs.
1. Assists in determining
appropriate interventions.
2. Provides baseline for
detecting changes and
evaluating effectiveness of
interventions.
3. Prevents skin excoriation
and infection from
scratching.
4. Removes waste products
from skin while preventing
dryness of skin.
5. Promotes mobilization of
edema.
• Exhibits intact skin without
redness, excoriation, or
breakdown.
• Reports relief from pruritus.
• Exhibits no skin excoriation
from scratching.
• Uses nondrying soaps and
lotions.
• Turns self periodically,
exhibits reduced edema of
dependent parts of the body.
• Exhibits decreased edema;
normal skin turgor.

23. Nursing interventions rationale Expected outcomes
1. Maintain bed rest within
pt experiences
abdominal discomfort.
2. Administer
antispasmodic and
analgesic agents as
prescribed.
3. Observe, record, and
report presence and
character of pain and
discomfort.
4. Reduce fluid and
sodium intake if
prescribed.
5. Encourage the use of
distracting activities
such as music, reading,
or meditation.
1. Reduces metabolic
demands and protects
the liver.
2. Reduces irritability of
the GI tract and
decrease abdominal
pain and discomfort.
3. Provides baseline to
detect further
deterioration of status
and to evaluate
interventions.
4. Removal of a ascites
fluid may decrease
abdominal discomfort.
5. Distraction may limit the
perception of pain.
• Reports pain and
discomfort if present.
• Maintains bed rest and
decrease activity in
presence of pain.
• Takes antispasmodic
and analgesics as
indicated and as
prescribed.
• Reports decreased pain
and abdominal
discomfort.
• Reduce sodium and fluid
intake to prescribed
levels if indicated to treat
ascites.
• Exhibits decreased
abdominal girth and
appropriate weight
changes.

24. Nursing interventions rationale Expected outcomes
1. Restrict sodium and
fluid intake if prescribed.
2. Administer diuretics,
potassium, and protein
supplements as
prescribed.
3. Record intake and
output every 1-8 h
depending on response
to interventions and on
pt acuity.
4. Measure and record
abdominal girth and
weight daily.
5. Explain rationale for
sodium and fluid
restrictions.
1. Minimize formation of
ascites and edema.
2. Promotes excretion of
fluid through the kidneys
and maintenance of
normal fluid and
electrolyte balance.
3. Indicates effectiveness
of treatment and
adequacy of fluid intake.
4. Monitors change in
ascites formation and
fluid accumulation.
5. Promotes pt`s
understanding of
restriction and
cooperation with it.
• Consumes diet low
sodium and within
prescribed fluid
restriction.
• Takes diuretics,
potassium, and protein
supplement as indicated
without experiencing
side effects.
• Exhibits increased urine
output.
• Exhibits decreasing
abdominal girth.
• Shows a decrease in
ascites with decrease
weight .

25. Nursing interventions rationale Expected outcomes
1. Record temperature
regularly.
2. Encourage fluid intake.
3. Apply cool sponges or
ice bag for elevated
temperature.
4. Administer antibiotics as
prescribed.
5. Avoid exposure to
infections.
6. Keep pt at rest while
temperature is
evaluated.
7. Assess for abdominal
pain, tenderness.
8. Use sterile technique for
all invasive procedures.
1. Provides baseline to
detect fever and to
evaluate interventions.
2. Corrects fluid less from
perspiration and fever
and increases patient's
level of comfort.
3. Minimize risk of further
infection and further
increase in body
temperature.
4. Reduce metabolic rate.
• Exhibits normal
temperature and reports
absence of chills or
sweating.
• Demonstrates adequate
intake of fluid.
• Exhibits no evidence of
local or systemic
infection.

26.  Promoting rest
 Improving nutritional status
 Providing skin care
 Reducing risk of injury

27.  www.cirrhosisoftheliver.us
 http://www.nlm.nih.gov/medlineplus/ency/article/000255.
htm
 Kluwer, W., Williams, L., & Wilkins, L. (2010).
Assessment and Management of Patient With Hepatic
Disorders. In Smeltzer S.C., Bare B.G., Hinkle J.L., &
Cheever K.H. (eds), Medical-Surgical Nursing (pp 1116-
1168) (12th ed.). New York: Lippincott-Raven.