Cirrhosis Nursing Process PDF

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This gives a summary of the nursing process for cirrhosis....

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Running head: CIRRHOSIS 1

Cirrhosis Stephanie Hyacinth Bowie State University N315: Pathophysiology Denise Jarboe August 2019

CIRRHOSIS 2 Cirrhosis Cirrhosis is an irreversible, inflammatory, fibrolytic liver disease (Huether, McCance, Brashers, & Rote, 2017). It is characterized by the replacement of normal liver tissue with diffuse fibrosis that disrupts the structure and function of the liver and is usually the end stage of chronic liver disease. (“Handbook for Brunner”, 2010, p. 235). Pathophysiology Cirrhosis is often precipitated by fibrosis. Injury to the cells of the liver occurs due to exposure to toxic agents such as alcohol, infectious agents such as the hepatitis virus, an autoimmune or vascular process, or an inborn error of metabolism. Cell injury causes inflammation, after which liver tissue is replaced by fibrous scar tissue, and repetitive cell injury leads to a buildup of scar tissue, which is known as fibrosis. Fibrosis alters or obstructs biliary channels and blood flow and causes irreversible damage in the liver, and this leads to the development of symptoms that characterize cirrhosis (Huether et al., 2017). Cirrhosis is categorized into four types according to its different etiologies: alcoholic cirrhosis, nonalcoholic steatohepatitis (NASH), postnecrotic cirrhosis, and biliary cirrhosis. Alcoholic cirrhosis is the most common type and is usually due to chronic alcoholism. It progresses from fatty liver (steatosis) which is reversible with the cessation of alcohol consumption to steatohepatitis and ends with cirrhosis. Like in alcoholic cirrhosis, liver damage in nonalcoholic steatohepatitis begins with a fatty liver and progresses to cirrhosis; however, it is caused by high levels of cholesterol and triglycerides such as in obesity and metabolic syndrome. Postnecrotic cirrhosis is the late result of a previous acute viral hepatitis. Biliary cirrhosis, the least common type, is a result of chronic biliary obstruction and infection. Primary biliary cirrhosis is an autoimmune disorder that destroys intrahepatic bile ducts, while secondary biliary cirrhosis occurs secondary to conditions that partially or completely obstruct the common bile

CIRRHOSIS 3 duct or branches such as gallstones, tumors, fibrotic strictures, or pancreatitis (“Handbook for Brunner”, 2010, p. 235; Huether et al., 2017). Risk Factors The risk factors that predispose individuals to cirrhosis vary with the type of cirrhosis. Excessive alcohol consumption is a risk factor for alcoholic cirrhosis. Obesity, type 2 diabetes mellitus, and coronary artery disease predispose an individual to nonalcoholic steatohepatitis, while infection with hepatitis and HIV predispose an individual to postnecrotic hepatitis. Some risk factors for biliary cirrhosis include congenital malformations such as biliary atresia and genetic liver disorders such as cystic fibrosis, Wilson’s disease, and hemochromatosis (Huether et al., 2017; Nordqvist, 2017). Signs, Symptoms, and Potential Complications The early stages of cirrhosis are compensated; therefore, individuals are asymptomatic or present with vague symptoms such as nausea, anorexia, fatigue, weight loss, fever, and abdominal pain. As cirrhosis progresses, it becomes decompensated, and signs and symptoms include jaundice, hepatomegaly, edema, high susceptibility to bruising, decreased protein and clotting factors, anemia, liver feels firm and hard upon palpitation, reduced libido, splenomegaly, and testicular atrophy and decreased testosterone in males, irregular menses and amenorrhea in females, hyperbilirubinemia, light or clay-colored stool, and vitamin A, C, and K deficiency (“Handbook for Brunner”, 2010, p. 235; Huether et al., 2017; Nordqvist, 2017). Potential complications of cirrhosis include portal hypertension, GI hemorrhage, esophageal varices, renal failure, ascites, coagulation disorders, hepatic encephalopathy, liver failure, and hepatocellular carcinoma (Huether et al., 2017). Medical Interventions, Labs, and Diagnostic Studies Several diagnostic studies are used to confirm the diagnosis of cirrhosis. Liver function

CIRRHOSIS 4 tests such as prothrombin time (PT), serum cholinesterase, and bilirubin are used to confirm the presence of cirrhosis and determine its severity. If cirrhosis is present, serum enzymes and bilirubin will be elevated, albumin will be decreased, and prolonged PT. A liver biopsy confirms the diagnosis of cirrhosis and determines its cause. Imaging tests such as computed tomography (CT) scan, ultrasound scanning, and MRI scans can also be done to see whether the liver is enlarged and detect any scarring or nodules (Huether et al., 2017; Nordqvist, 2017). Nursing Diagnosis Some nursing diagnoses associated with generalized seizures include Imbalanced Nutrition: Less than Body Requirements, Excess Fluid Volume, risk for Impaired Skin Integrity, risk for Bleeding, and Fatigue (Doenges, Moorhouse, & Murr, 2014, p. 417-425). Nursing Interventions There is no specific treatment for cirrhosis, but several nursing interventions are used to slow its progression and manage symptoms. Some of these interventions include promoting rest, improving the nutritional status of the patient, reducing the risk of injury, and monitoring and managing complications associated with cirrhosis. The nurse will also work in tandem with the health care provider to provide medications such as vitamin supplements and potassium-sparring diuretics. If the individual has alcoholic cirrhosis, the nurse would educate the client about the importance of ceasing alcohol consumption. For nonalcoholic steatohepatitis, the nurse would encourage the client to adopt certain behaviors such as engaging in regular exercise and would also provide dietary counseling. A drug named ursodeoxycholic acid may be given to slow the progression of primary biliary cirrhosis. Surgery or endoscopy may be done to relieve the obstruction in secondary biliary cirrhosis. Liver transplantation is currently the only life-saving procedure for the disease at its end-stage (Huether et al., 2017, Doenges et al., 2014, p. 412).

CIRRHOSIS 5 References Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2014). Nursing care plans: guidelines for individualizing client care across the lifespan (9th ed.). Philadelphia, PA: F. A. Davis Company. Handbook for Brunner and Suddarth’s Textbook of Medical-Surgical Nursing (12th ed.). 2010. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. Huether, S. E., McCance, K. L., Brashers, V. L., & Rote, N. S. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Elsevier. Nordqvist, C. (2017). Everything you need to know about cirrhosis. Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/172295.php...