Nursing Guide to Cirrhosis: Nursing Diagnosis, Interventions, & Care Plans

Cirrhosis Etiology and Epidemiology

Cirrhosis is also called chronic liver failure or end-stage liver disease. It may be caused by many different types of liver diseases and conditions which results in fibrous tissue and nodules. Each time the liver is injured, it tries to repair itself, which results in scar tissue and fibrosis. As more scar tissue forms, the liver has difficulty functioning (Mayo Clinic, 2021).

Common causes of cirrhosis include:

• Alcohol abuse
• Hepatitis B and C
• Nonalcoholic fatty liver disease
• Bile duct disease
• Genetic diseases
• Some prescribed and over-the-counter medicines
• Environmental poisons

Cirrhosis Diagnosis

Cirrhosis is diagnosed by symptoms, physical exam, and blood tests. Radiology exams such as ultrasound, CT, MRI, or transient elastography may be performed. A liver biopsy may also be performed to see how much of the liver is damaged (American Liver Foundation, 2021).

During the early stages of cirrhosis there may not be any symptoms. This is called compensated cirrhosis. As more liver damage occurs, the individual may experience decompensated cirrhosis including symptoms such as:

• Nausea
• Weight loss
• Loss of appetite
• Weakness and lethargy
• Red patches on the palms
• Spider-like blood vessels above waist level
• Jaundice
• Itchy skin
• Ascites
• Edema in the legs
• Dark urine
• Pale bowel movements
• Vomiting blood
• Bruising and bleeding easily
• Encephalopathy

Portal hypertension is a complication of cirrhosis of the liver. The increased pressure in the portal vein causes the development of varices or large veins across the esophagus and stomach. These veins bleed easily (Cleveland Clinic, 2021).

Another complication of cirrhosis may be liver cancer. The complication of liver cancer can occur in both the compensated and decompensated stages (Department of Veteran Affairs, 2018).

Management

There is no cure for cirrhosis. Treatment focuses on managing symptoms and treating the problem that led to cirrhosis in order to slow its progression. If the individual is experiencing decompensated cirrhosis, they may be a candidate for a liver transplant.

Medication may be given to treat symptoms such as edema, itching or nausea. Medication to reduce ammonia buildup such as lactulose (Enulose®) or to treat mental changes due to encephalopathy may also be given. Beta blockers or nitrates are given to reduce the pressure in varices. For portal hypertension isosorbide (Imdur®) and propranolol (Inderal®) may be prescribed to lower the pressure in the portal vein (Cleveland Clinic, 2021).

Follow up with the healthcare provider is an important part in the management of cirrhosis. The individual should have periodic upper endoscopies to assess for varices. Screening for ascites and liver cancer should also be completed.

Cirrhosis Nursing Care Plan

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for cirrhosis are listed below.

Assessment

When assessing an individual with cirrhosis, the primary focus should be on complications. Abdominal girth should be measured to assess for an increase in ascites. Daily weights should also be performed. The individual’s mental status should be assessed for changes due to encephalopathy. Observation for signs of abnormal bleeding should be part of the assessment process.

Nursing Diagnosis/Risk For

There are many appropriate nursing diagnoses for the individual with cirrhosis. Some possible nursing diagnoses include:

• Nutritional deficit, less than body requirements, related to abdominal distention, discomfort, and anorexia
• Activity intolerance related to lethargy and fatigue
• Disturbed thought process related to increased ammonia levels
• Pain related to ascites
• High risk for injury related to altered clotting and confusion
• Fluid volume excess related to edema and ascites
• Ineffective breathing pattern related to ascites
• Impaired skin integrity related to edema, pruritus, and jaundice

Interventions

Nursing intervention will vary based on an individual’s symptoms. Some of the most common nursing interventions include:

• Promote rest.
• Provide oxygen, if needed.
• Consult with a dietitian.
• Provide and encourage small frequent meals.
• Explain all procedures to minimize agitation.
• Instruct individual to ask for assistance before getting up.
• Evaluate all injuries for signs of internal bleeding.
• Provide electric razor to prevent cuts.
• Provide soft toothbrush for safety.
• Monitor for bleeding or hemorrhage.
• Monitor labs, as ordered.
• Report changes in mental status promptly.
• Monitor intake and output.
• Administer medications, as ordered.
• Assess cardiovascular and respiratory status.
• Provide protective skin care.
• Provide IV fluids, as ordered.

Expected Outcomes

• Maintains normal fluid balance
• Performs activities of daily living
• Verbalizes fears and anxieties
• Experiences no signs or symptoms of bleeding

Patient/Caregiver Education

• Condition, treatment, and expected outcomes
• Dietitian recommendations, including fluid and sodium restriction
• Medications, as ordered
• Importance of avoiding alcohol
• Referral to Alcoholics Anonymous or counseling, as needed
• Recommended follow-up with healthcare providers

Content Release Date

4/1/2022

Content Expiration

12/31/2024

Course Contributor

The content for this course was created/revised by Kim Matthews, RN. Ms. Matthews obtained a nursing degree from Western Kentucky University in 1998. Ms. Matthews possesses over 20 years of nursing experience with over 17 of those in the Skilled Nursing industry. Ms. Matthews has extensive experience in MDS, restorative nursing programs, and nursing management. Ms. Matthews is currently Post-Acute Care Content writer and subject matter expert for MDS.

References

• American Liver Foundation. (2021). Cirrhosis of the Liver. https://liverfoundation.org/for- patients/about-the-liver/diseases-of-the-liver/cirrhosis/#information-for-the-newly-diagnosed
• Cleveland Clinic. (2021). Portal hypertension. https://my.clevelandclinic.org/health/diseases/4912-portal-hypertension
• Department of Veteran Affairs. (2018). What are the symptoms of cirrhosis? https://www.hepatitis.va.gov/cirrhosis/patient/symptoms.asp
• Mayo Clinic. (2021). Cirrhosis. https://www.mayoclinic.org/diseases-conditions/cirrhosis/symptoms-causes/syc-20351487