Cirrhosis Nursing Care Plan

What is liver cirrhosis?

Liver cirrhosis or hepatic cirrhosis is a progressive and irreversible condition characterized by the replacement of healthy liver tissue with scar tissue, ultimately leading to impaired liver function. This chronic liver disease often arises from various factors, including excessive alcohol consumption, viral hepatitis, non-alcoholic fatty liver disease, and autoimmune liver diseases (National Institute of Diabetes and Digestive and Kidney Diseases, 2019a; Sharma & John, 2022). As cirrhosis advances, it can culminate in end-stage liver disease, necessitating interventions such as liver transplantation.

One of the hallmarks of liver cirrhosis is portal hypertension. In this condition, elevated pressure within the blood vessels supplying the liver leads to complications such as esophageal varices and ascites or fluid accumulation in the abdomen. Additionally, liver cirrhosis can result in hepatic encephalopathy, which manifests as altered mental status due to the liver's inability to detoxify harmful substances.

Treatment focuses on managing complications, addressing the underlying cause, and preventing further damage to the liver. For those with decompensated cirrhosis, a liver transplant may be the only curative option. Nursing diagnosis for cirrhosis involves vigilant monitoring for signs of liver failure, fluid retention, and mental status changes, as well as providing supportive care to optimize patient outcomes.

Symptoms of cirrhosis

Liver cirrhosis can manifest with a range of symptoms, which may vary in severity and presentation. Recognizing these symptoms is crucial for early detection and intervention. Some common symptoms include (National Health Service, 2020; National Institute of Diabetes and Digestive and Kidney Diseases, 2019b):

• Fatigue
• Weakness
• Jaundice (yellowing of the skin and eyes)
• Loss of appetite
• Weight loss
• Nausea and vomiting
• Abdominal pain or tenderness
• Swelling in the abdomen (ascites)
• Swelling in the legs and ankles (edema)
• Easy bruising and bleeding
• Itchy skin
• Confusion or altered mental status (hepatic encephalopathy)
• Dark urine

These symptoms may develop gradually over time as liver function declines. However, some individuals with cirrhosis may remain asymptomatic until the disease reaches an advanced stage. 

How to use our Cirrhosis Nursing Care Plan template

You can use the Cirrhosis Nursing Care Plan template to streamline patient care and ensure comprehensive management of individuals with liver cirrhosis. Here's how:

Step 1: Download the care plan

Get a copy of this Cirrhosis Nursing Care Plan by clicking the download button on this page. Sign up for a Carepatron account, and you can access it through our templates library and thousands of other templates.

Step 2: Document assessments

Look for common complications of cirrhosis, such as ascites, hepatic encephalopathy, and variceal bleeding. Document assessments of abdominal distention, changes in mental status, and signs of gastrointestinal bleeding. 

Step 3: Formulate cirrhosis nursing diagnosis

Formulate a nursing diagnosis by identifying key health issues related to the patient's liver condition. A precise diagnosis ensures the healthcare team can provide targeted and effective treatment for managing cirrhosis complications.

Step 4: Write down goals and nursing interventions

Example goals include improving liver function through medication adherence and a low-sodium diet, or reducing fluid retention with proper diuretic use and lifestyle changes. Coordination with healthcare providers, including transplant programs, ensures timely care. Use the template to educate patients on medication, diet, lifestyle changes, and the risks of alcoholic liver disease, promoting open communication for informed decisions.

Step 5: Evaluate progress and adjust care plans

Regularly evaluate the effectiveness of nursing interventions documented in the care plan template. Assess changes in symptoms, nutritional state, laboratory values, and overall patient well-being.Modify care plans based on patient responses, condition changes, and evolving treatment goals while collaborating with interdisciplinary teams to provide coordinated, holistic care for liver cirrhosis patients.

How nurses assess and diagnose cirrhosis

Diagnosing liver cirrhosis typically involves a combination of clinical assessment, imaging studies, and liver biopsy to confirm the presence of scar tissue in liver cells. Elevated liver enzymes and imaging findings indicative of damage are common indicators. Nurses play a crucial role in assessing liver cirrhosis nursing, employing a multifaceted approach to gather information and identify potential signs and symptoms of liver disease. 

Review the patient's medical history

Nurses begin by reviewing the patient's medical history, paying close attention to factors such as alcohol consumption, previous liver medical history, exposure to hepatotoxic substances, and family history of liver disease. This information provides valuable insights into potential risk factors and underlying conditions contributing to liver cirrhosis.

Physical examination

A comprehensive physical examination follows, focusing on signs indicative of liver dysfunction, such as jaundice, abdominal tenderness, ascites, spider angiomas, and hepatic encephalopathy. Nurses also assess for complications of cirrhosis, including signs of gastrointestinal bleeding, hepatorenal syndrome, and hepatopulmonary syndrome.

Diagnostic evaluations

Diagnostic evaluations are essential for confirming the diagnosis of cirrhosis and assessing the severity of liver damage. This often involves blood tests to measure liver function, including liver enzymes, bilirubin levels, and clotting factors.

Imaging studies such as ultrasound, CT scan, or MRI may be performed to visualize liver abnormalities, assess blood flow, and detect abdominal fluid accumulation (ascites). In some cases, a liver biopsy may be necessary to evaluate the extent of liver damage and determine the need for further management, such as a liver transplant.

Next steps after diagnosis

Once cirrhosis is diagnosed, nurses collaborate with healthcare providers to develop a comprehensive care plan tailored to the patient's needs. This may include interventions to relieve abdominal pressure, prevent skin breakdown, manage symptoms, and address complications of liver cirrhosis.

Education and support empower patients and their families to manage their conditions and promote optimal health outcomes. In cases of end-stage liver disease, nurses play a pivotal role in facilitating access to liver transplant evaluation and supportive care services.

Common nursing interventions for cirrhosis

Nurses play a crucial role in the management of cirrhosis patients, employing a variety of interventions to address symptoms, prevent complications, and promote overall well-being.

Monitoring and managing nutritional status

Assessing and optimizing nutritional status is vital for cirrhotic patients, as malnutrition is common due to decreased oral intake, metabolic abnormalities, and hepatic insufficiency. Nurses monitor dietary intake, provide education on nutritionally dense foods, and collaborate with dietitians to develop individualized meal plans. In cases of fluid restriction, nurses implement strategies to ensure adequate nutrient intake while managing fluid balance.

Monitoring for complications

Regular assessment for complications such as ascites, hepatic encephalopathy, and variceal bleeding is essential in cirrhotic patients. Nurses monitor signs of abdominal distention, changes in mental status, and signs of gastrointestinal bleeding. Prompt intervention and collaboration with healthcare providers are crucial to prevent further liver damage and manage complications effectively.

Medication administration and management

Nurses are essential in administering medications to manage symptoms, prevent complications, and support liver function in cirrhosis patients, including diuretics, lactulose, and beta-blockers. They also educate patients on medication adherence, side effects, and the importance of follow-up care.

Providing emotional support and education

Living with cirrhosis can be emotionally challenging for patients and their families. Nurses offer emotional support, address concerns, and provide education on the disease process, treatment options, and lifestyle modifications.

Coordinating care and referrals

Nurses work with doctors, dietitians, social workers, and transplant coordinators to provide comprehensive care for cirrhosis patients. They also coordinate referrals for liver transplant programs, palliative care, and support groups.

References

National Health Service. (2020). Cirrhosis. https://www.nhs.uk/conditions/Cirrhosis/

National Institute of Diabetes and Digestive and Kidney Diseases. (2019a, June 10). Cirrhosis. https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis

National Institute of Diabetes and Digestive and Kidney Diseases. (2019b, October 22). Symptoms & causes of cirrhosis. https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis/symptoms-causes

Sharma, B., & John, S. (2022). Hepatic cirrhosis. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482419/