Liver Cirrhosis Case Study

8. Symptoms of Encephalopathy. Early symptoms of hepatic encephalopathy include forgetfulness, unresponsiveness, and trouble concentrating. Sudden changes in the patient’s mental state, including agitation or confusion, may indicate an emergency condition. Other symptoms include bad fruity-smelling breath and tremor. Late stage symptoms of encephalopathy are stupor and eventually coma.

9. Hepatorenal Syndrome

Hepatorenal syndrome occurs if the kidneys drastically reduce their own blood flow in response to the altered blood flow in the liver. It is a life-threatening complication of late-stage liver disease that occurs in patients with ascites. Symptoms include dark colored urine and a reduction in volume, yellowish skin, abdominal swelling, mental changes (delirium, confusion), jerking or coarse muscle movement, nausea, and vomiting.

10. Liver Cancer

Cirrhosis greatly increases the risk for liver cancer, regardless of the cause of cirrhosis. Although few studies have been conducted on the risk for liver cancer in patients with primary biliary cirrhosis, one study reported an incidence of 2.3%. About 4% of patients with cirrhosis caused by hepatitis C develop liver cancer. In Asia about 15% of people who have chronic hepatitis B develop liver cancer, but this high rate is not seen in other parts of the world. (One Italian study that followed a group of hepatitis B patients for 11 years found no liver cancer over that period of time.)

11. Osteoporosis

About 30% of patients with chronic liver disease develop osteoporosis (loss of bone density), which is twice the usual incidence. Patients with primary biliary cirrhosis have a particularly high risk for osteoporosis. Treating osteoporosis in patients with cirrhosis can be complicated. One study found that calcitriol (a form of vitamin D) is especially helpful in preventing bone loss in patients with cirrhosis.

Osteoporosis is a condition characterized by progressive loss of bone density, thinning of bone tissue, and increased vulnerability to fractures. Osteoporosis may result from disease, dietary or hormonal deficiency, or advanced age. Regular exercise and vitamin and mineral supplements may reduce and even reverse loss of bone density.

12. Insulin Resistance

Nearly all patients with cirrhosis are insulin resistant. Insulin resistance is a primary feature in type 2 diabetes and occurs when the body is unable to use insulin. This hormone is important for delivering blood sugar and amino acids into cells and helps determine whether these nutrients will be burned for energy or stored for future use.

DIAGNOSTIC EVALUATION:

• Liver biopsy – detects destruction and fibrosis of hepatic tissue.
• Liver scan – shows abdominal thickening and a liver mass.
• CT scan – determines the size of the liver and its irregular nodular surface.
• Esophagoscopy – to determine esophageal varices.
• Paracentesis – to examine ascetic fluid for cell, protein, and bacterial counts.
• PTC – differentiates extrahepatic from intrahepatic obstructive jaundice.
• Laparoscopy and liver biopsy – permit direct visualization of the liver.
• Serum liver function test – results are elevated

NURSING INTERVENTIONS:

Promoting Activity Tolerance

• Encourage alternating periods of rest and ambulation.
• Maintain some periods of bed rest with legs elevated to mobilize edema and ascites.
• Encourage and assist with gradually increasing periods of exercise.

Improving Nutritional Status

• Encourage patient to eat high calorie, moderate protein meal and to have supplementary feedings.
• Suggest small, frequent feedings and attractive meals in an aesthetically pleasing setting at meal time.
• Encourage and assist withgradually increasing periods of exercise.

Protecting Skin Integrity

• Note and record degree of jaundice of skin and sclerae and scratches on the body.
• Encourage frequent skin care, bathing without soap, and massage with emollient lotions.
• Advise patient to keep fingernails short.

Patient Education and Health Maintenance

• Stress the necessity of giving up alcohol completely.
• Urge acceptance of assistance from a substance abuse program.
• Provide written dietary instructions.
• Encourage daily weighing for self-monitoring of fluid retention depletion.
• Discuss adverse effects of diuretic therapy.
• Emphasize the importance of rest, a sensible lifestyle, and an adequate, well-balanced diet.
• Involve the person closest to the patient because recovery usually is not easy and relapses are common.
• Stress the importance of continued follow –up for laboratory test and evaluation by a health care provider

Nursing Care Plan – Liver Cirrhosis

More information about Liver Cirrhosis

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