The liver plays a vital role in many metabolic functions, but can fail due to disease, toxicity, or other stress factors. Early liver failure involves inflammation and scarring of the liver tissue, while advanced failure occurs when compensatory mechanisms are overwhelmed and toxic substances build up. Acute liver failure has many potential causes including viral hepatitis, toxic drugs, and shock. Medical tests like bloodwork and imaging can help identify the underlying cause and extent of damage. Key nursing priorities include monitoring for complications like fluid imbalance and hepatic encephalopathy. Treatment focuses on supportive care, dietary modifications, and addressing any underlying triggers.

1. LIVER FAILURE

2. The liver plays a vital role by providing multiple functions such as metabolism , carbohydrates, proteins and fats storing fat- soluable vitamins,b12, copper and iron synthesis of blood clotting factors, amino acids, albumin, globulins, detoxification of toxic substance and phagocytosis of microorganisms.

3. It also plays a role in glycolysis and gluconeogenesis. Liver functioning can be which time can no longer perform its normal operation. Liver disease is becoming more common in the elderly because of increased susceptibility to drugs and other toxic substances. The elderly person is unable to compensate for various metabolic ,infectious and immunologic abuse.

4. Early hepatic failure present as a type of cirrosis of the liver. Liver becomes inflamed and obstructed which result damage the cells around the central portal vein. When the inflammation decrease, the lobule regenerates and this replaces healthy normal liver tissue. Advance hepatic failure develops when all compensatory mechanisms fail, causing the serum ammonia level to rise.

5. The already-damaged liver is unable to synthesize normal product, so acidosis, hypoglycemia or blood dyscrasias develop and the patient become comatose. Acute liver failure also known as fulminant hepatic failure, may be precipitated by a stress factor that aggravates a pre-existing chronic liver disease. Some stress factors include alcohol intake, ingestion of amanita mushrooms, large amounts of dietary protein, gastrointestinal bleeding and portcaval shunt surgery.

6. An acute type of liver failure may occur as a result of viral or toxic hepatitis, biliary obstruction, cancer,acute infective, processess, drugs such as acetaminophen, isoniazid and rifamficin, severe –dehydration, reye’s syndrome, or shock states.

7. Medical Care Laboratory: CBC – used to identify anemias and white blood cell counts helps to identify hypersplenism or infection, thrombocytopenia may occur secondary to alcoholic bone marrow suppression.

8. CT SCANS Used to identify biliary obstruction or dilatation of bile ducts, hepatomegaly, intrahepatic tumors and changes or portal hypertension.

9. Liver Scan May be used to detect degenerative cirrhosis changes or to identify focal liver disease.

10. COMMON NURSING DIAGNOSES Deficient Volume related to: Gasrointestinal bleeding, Osmotic changes, Hydrostatic pressure changes, ascites Defining Characteristics: Hypotension, Tachycardia, Decreased Skin Turgor, Weakness, Pallor, Diaphoresis,Decreased Capillary Refill

11. Ineffective Breathing Pattern Related to: Increase pressure from ascites, increased ammonia levels, increased lung expansion, fatique, fear of suffocation. Defining Characteristics: Dypnea, tachypnea, nasal flaring, cyanosis, shallow respiration, pursed-lip breathing, changes in inspiratory/expiratory ratio, use of accesory muscle.

12. Disturbed Thought Process Related to : serum ammonia levels, hepatic encephalopathy Defining Characteristics: Increased ammonia levels, increased BUN, mental status changes, decreasing level of consciousness, changes in personality.

13. OUTCOME CRITERIA Patient will be conscious and stable , with ammonia levels within normal ranges.

14. INTERVENTIONS Monitor patient neurologic status every 1-2 hours and prn. Notify physician abnormalities and/changes. If possible, have patient write name each day and do simple mathematic calculations. Administer cathartics as ordered. Observe for asterixis or other tremors.

15. Provide safe environment for patient, with furniture moved to edges of room, using sufficient lighting, keeping room uncluttered, and so forth. Provide low-protein diet. Avoid sedatives and Narcotics, if at all possible. Instruct patient/family in side effects of drugs used to facilitate decrease in ammonia levels

16. Imbalance Nutrition: Less than Body Requirements Related to: Metabolism changes, increased ammonia levels, encephalopathy, ascites. Defining Characteristics: Anorexia, Nausea, Vomiting, Malabsorption of fats, Malabsorption of vitamins, altered carbohydrate, fat and protein metabolism, malnutrition

17. Outcome Criteria Patient will be able to achieve a positive nitrogen balance and have stable weight.

18. Interventions Provide diet that has protein in ordered amounts, with supplementation of vitamins and other nutrients. Ensure that patient is positioned in upright, sitting position for meals. Avoid sodium intake of amounts greater than ordered. If patient is unable to ingest adequate dietary intake, administer tube feedings of parenteral nutrition as ordered.

19. Weigh patient daily, on same scale at same time if all possible Instruct patient/family regarding need for limitations of protein and sodium. Instruct patient/family regarding need for enteral or parenteral nutrition as warranted