Liver Cirrhosis Case Pres

Liver Cirrhos is

Objectives This case study aims to come up with a more in-depth understanding of the disease, Liver Cirrhosis for us (and other nursing students) to be able to come up with the best nursing care plan in the care of patients with the said disease.

Cirrhosis of the Liver The liver, the largest organ in the body, is essential in keeping the body functioning properly. It removes or neutralizes poisons from the blood, produces immune agents to control infection, and removes germs and bacteria from the blood. It makes proteins that regulate blood clotting and produces bile to help absorb fats and fat-soluble vitamins. You cannot live without a functioning liver.

Cirrhosis of the Liver Cirrhosis is a potentially lifethreatening condition that occurs when scarring damages the liver. This scarring replaces healthy tissue and prevents the liver from working normally. Cirrhosis usually develops after years of liver inflammation. When chronic diseases cause the liver to become permanently injured and scarred, the condition is called Cirrhosis.

Three major forms Laennec’s (alcohol induced) Cirrhosis

Three major forms Postnecrotic (micronodular) Cirrhosis

Three major forms Biliary Cirrhosis

Patient’s Profile

ETIOLO GY

Chronic alcoholism

Chronic Hepatitis C, B and D

Autoimmune Hepatitis

Inherited Diseases

Nonalcoholic Steatohepatitis

Blocked Bile Ducts

Drugs, toxins and infections

Clinical Manifestations

Weakness, fatigue

Anorexia

Stomatitis

Tea colored Urine

Clay colored Stool

Amenorrhea

Decrease sexual urge

Loss of pubic/axilla hair

Hepatomegaly

Jaundice

Pruritus or Urticaria

Hematological Changes

Endocrine Changes

GIT Changes

Neurological Changes

Complic ations

Edema and Ascites

Bruising and Bleeding

Jaundice

Itching

Gallstones

Toxins in the blood or brain

Sensitivity to medication

Portal

Hypertension

Varices

Insulin resistance and type 2 DM

Liver Cancer

Problems in other organs

Pathophysiolo gy

Persistent Fibrotic changes Injury toor Fibrosis will the liver occur Drugs alcoholis syste toxins infectio virus mic m ns

Alteration in physiologic function Nutritional metabolism

Fibrosis

Increase Portal Pressure

Without adequate Process can and proper be arrested regeneration with adequate liver regeneratio n

Deat

Diagnostic Evaluation

Ultrasound of Whole Abdomen The liver is unenlarge exhibiting smooth contour and heterogenous parenchymal echopatter. There is no focal mass. Undilated bile canaliculi, portal and systemic vessels. There is no free peritoneal fluid. The Gallbladder is undilated with even, unthickened wall. No luminal shadowing calculus or focal mass is seen.

IMPRESSION: Mild liver parenchymal changes

Vitros Clinical Chem. Report

HEMATOLOGY Hemoglobin: 147 g/1; normal: M = 140-170g/1 WBC: 12.8 x 109/1; nomarl: 5-10 x 109/1 Hematocrit: 45vo1%; normal: M = 4050 vo1/%

Other Diagnostic Procedures for Liver Liver biopsy - detects destruction and fibrosis of hepatic tissue.

Other Diagnostic Procedures for Liver Liver scan- shows abdominal thickening and liver mass

Other Diagnostic Procedures for Liver CT scan- determines the size of the liver and its irregular nodular surface.

Other Diagnostic Procedures for Liver Esophagoscopy – to determine esophageal varices.

Other Diagnostic Procedures for Liver Paracentesis – to examine ascetic fluid for cell, protein and bacterial count.

Other Diagnostic Procedures for Liver Laparoscopy – permits direct visualization of the liver.

Other Diagnostic Procedures for Liver Serum liver function test – results are elevated.

Medical Management Pharmacologic Interventions: 2. Provide asymptomatic relief measures such as pain medications and antiemetics. 3. Diuretic therapy, frequently with spironolactone, a potassium-sparing diuretic that inhibits the action of aldosteroe on the kidneys. 4. I.V albumin to maintain osmotic pressure and reduce ascites. 5. Administration of lactulose or neomycin through a nasogastric tube or retention enema to reduce ammonia levels during periods of hepatic encephalopathy.

Medical Management Surgical Interventions:

2. Transjugular intrahepatic portosystemic shunt may be performed in patients whose ascites prove resistant. This percutaneous procedure creates a shunt from the portal to systemic circulation to reduce portal pressure and relieve ascites. 3. Orthotopic liver transplantation may be necessary.

Nursing Intervention Promoting Activity Tolerance 3. Encourage alternating periods of rest and ambulation. 4. Maintain some periods of bed rest with legs elevated to mobilize edema and ascites. 5. Encourage and assist with gradually increasing periods of exercise.

Nursing Intervention Improving Nutritional Status 3. Encourage patient to eat high calorie, moderate protein meal and to have supplementary feedings. 4. Suggest small, frequent feedings and attractive meals in an aesthetically pleasing setting at meal time. 5. Encourage and assist with gradually increasing periods of

Nursing Intervention Protecting Skin Integrity 3. Note and record degree of jaundice of skin and sclera and scratches on the body. 4. Encourage frequent skin care, bathing without soap, and massage with emollient lotions. 5. Advise patient to keep fingernails short.

Nursing Intervention Patient Education and Health Maintenance Ø Stress the necessity of giving up alcohol completely. Ø Urge acceptance of assistance from a substance abuse program. Ø Provide written dietary instructions. Ø Encourage daily weighing for selfmonitoring of fluid retention depletion. Ø Discuss adverse effects of diuretic

Nursing Intervention Patient Education and Health Maintenance

Ø Emphasize the importance of rest, a sensible lifestyle, and an adequate, well-balanced diet. Ø Involve the person closest to the patient because recovery usually is not easy and relapses are common. Ø Stress the importance of continued follow –up for laboratory test and evaluation by a health care provider

Nursing Care Plan

Evaluation Achievement of outcomes is successful if the patient with cirrhosis:

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Has clear breath sounds throughout lung fields and normal percussion results from thoracic cavity. Increases involvement in daily self-care activities and ambulation in hospital hallways. Loses 1 to 2 lb/day until dry weight is reached; has decreasing edema, decreasing abdominal girth, and urine output of 500 to 1000 ml greater than intake until dry weight is reached. Has normal body temperature and no indications of infections.

Evaluation Achievement of outcomes is successful if the patient with cirrhosis:

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Shows normal prothrombin time and hematocrit; hemoglobin levels that are increasing; no orthostatic vital sign changes; and no falls, cuts, or other injuries. Maintains adequate food intake to regain or keep weight as appropriate with incorporation of foods from all food groups and restriction of sodium and protein as necessary. Shows no evidence of scratching and states that itching is decreased and controlled. Makes positive statements about self and realistic statements about future goals. Maintains intact skin and appropriate healing

Recommendation •

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Avoid further hepatic damage: abstain from alcohol; abstain from any drugs not prescribe by physician, including over-the-counter drugs, such as analgesics or cold remedies; avoid exposure to hepatotoxins in the work and home environments. Dietary regimen (may include sodium and/or protein restrictions) should be well balanced and include sources high in protein such as milk, eggs, fish, and poultry. Fluid restriction if required; how to incorporate

Recommendation •

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Signs and symptoms requiring immediate follow-up: weight gain; increased abdominal girth; recurrence of edema, fever, or bleeding (blood in urine, stool, or vomitus; epistaxis; cuts that continue to bleed); change in metal function or behavior. Measures that lessen chance of bleeding. Activity plan than promotes adequate rest. Care measures that help to control prurirus.