Liver cirrhosis represents the advanced stage of liver disease, characterized by irreversible scarring. This condition disrupts the liver’s vital functions, which include metabolism, detoxification, digestion, vitamin and mineral storage, and the production of clotting factors. The most prevalent causes of cirrhosis are chronic alcohol abuse, non-alcoholic fatty liver disease (NAFLD) often linked to obesity and diabetes, and viral hepatitis.
Complications of liver cirrhosis are extensive and can significantly impact a patient’s health. These include edema and ascites (fluid accumulation in the abdomen), splenomegaly (enlargement of the spleen), bleeding varices due to portal hypertension, increased susceptibility to infections, malnutrition, and hepatic encephalopathy – a condition where toxins build up in the brain, affecting cognitive function.
Nurses play a crucial role in the comprehensive management of liver cirrhosis. This involves not only addressing the physical symptoms through procedures like paracentesis and managing hepatic encephalopathy, but also focusing on nutritional support, preparing patients for potential liver transplantation, and providing essential education and emotional support to help patients navigate the complexities of this chronic illness and its complications.
Nursing Process in Cirrhosis Care
The nursing process is fundamental in the care of patients with liver cirrhosis. It provides a structured approach to patient care, encompassing assessment, diagnosis, planning, implementation, and evaluation. In the context of liver cirrhosis, this process is critical for managing the multifaceted aspects of the disease and its impact on the patient’s overall well-being.
Nursing Assessment for Liver Cirrhosis
The initial step in providing nursing care is a thorough nursing assessment. This involves collecting comprehensive data – physical, psychosocial, emotional, and diagnostic – to understand the patient’s condition fully. Both subjective and objective data are crucial in forming a complete picture of the patient’s health status in relation to liver cirrhosis.
Review of Health History
1. Identify General Symptoms: In the early stages of liver cirrhosis, symptoms are often vague and nonspecific. However, as liver function declines, more pronounced signs and symptoms emerge, reflecting the liver’s impaired capabilities. These include coagulopathy (affecting the liver’s ability to synthesize clotting factors), variceal bleeding (resulting from portal hypertension), and hepatic encephalopathy (due to reduced detoxification capacity). Early symptoms may manifest as:
- Anorexia
- Fatigue
- Nausea
- Fever
- Weakness
- Unexplained weight loss
2. Recognize Worsening Cirrhosis Signs: As liver cirrhosis progresses, the symptoms become more pronounced and indicative of severe liver dysfunction. Late-stage symptoms include:
- Alterations in mental status and cognition
- Easy bruising and bleeding tendencies
- Pruritus (itchy skin)
- Jaundice (yellowing of the skin and eyes)
- Pale-colored stools
- Presence of blood in the stool
3. Investigate Abdominal Pain Characteristics: Abdominal pain associated with liver cirrhosis is typically described as either a sharp or a dull, throbbing sensation localized in the right upper quadrant of the abdomen, just beneath the ribs. Besides ascites, the enlargement of the liver and spleen due to cirrhosis can contribute to generalized abdominal discomfort and pain.
4. Determine Risk Factors for Cirrhosis: Identifying modifiable risk factors is essential for patient education and preventative strategies. These include:
- Obesity: A significant risk factor for fatty liver disease, which can progress to cirrhosis.
- Sedentary Lifestyle: Increases the risk of non-alcoholic fatty liver disease (NAFLD).
- Diet: High-fat diets and consumption of raw or undercooked meats or seafood can elevate cirrhosis risk.
- Smoking: Accelerates the progression of cirrhosis, particularly in hepatitis B and C infections, and worsens liver fibrosis.
- Alcohol Consumption: A leading cause of liver disease, excessive alcohol intake can cause alcoholic hepatitis and ultimately lead to cirrhosis.
5. Check for Hepatitis History: Hepatitis B and C are major viral causes of cirrhosis. Chronic hepatitis infections can lead to liver inflammation and progressive, irreversible scarring.
6. Obtain Comprehensive Medical History: Beyond alcohol, NAFLD, and hepatitis, other conditions can contribute to liver cirrhosis. These include:
- Medications: Certain drugs like methotrexate and isoniazid.
- Autoimmune Hepatitis: A condition where the body’s immune system attacks the liver.
- Cholestasis: Conditions affecting bile flow:
- Primary biliary cholangitis (destruction of bile ducts)
- Primary sclerosing cholangitis (hardening and scarring of bile ducts)
- Biliary atresia (malformed bile ducts in infants)
- Alagille syndrome (genetic disorder causing bile accumulation)
- Metabolic Disorders:
- Hemochromatosis (iron overload)
- Wilson’s disease (copper accumulation)
- Alpha-1 antitrypsin deficiency
- Inherited glucose metabolism disorders (galactosemia, glycogen storage disease)
- Cystic Fibrosis: Genetic disease causing thick mucus buildup, affecting various organs including the liver.
- Infections: Syphilis and brucellosis.
- Chronic Heart Failure: Can lead to liver congestion and cirrhosis.
- Amyloidosis: Abnormal protein buildup in the liver.
Physical Assessment
1. Conduct a Detailed Physical Exam: Look for the following physical manifestations of liver cirrhosis:
- General: Fever, fatigue, unintentional weight loss, muscle wasting (cachexia).
- Central Nervous System (CNS): Reduced mentation and memory impairment.
- Head, Eyes, Ears, Nose, and Throat (HEENT): Yellowish sclera (jaundice).
- Respiratory: Decreased oxygen saturation, ventilation-perfusion mismatch, reduced pulmonary diffusion capacity, rapid breathing (hyperventilation).
- Gastrointestinal (GI): Loss of appetite, nausea, portal hypertension signs (e.g., ascites, esophageal varices), hepatomegaly (enlarged liver), splenomegaly (enlarged spleen), distended abdominal veins, ascites, blood in stool.
- Genitourinary (GU): Dark urine (brownish or orange), pale stools, steatorrhea (greasy stools).
- Reproductive: Reduced libido, gynecomastia (enlarged breasts) and testicular atrophy in males, premature menopause in females.
- Hematologic: Easy bruising and bleeding, folate deficiency anemia, hemolytic anemia, hypersplenism (overactive spleen), pancytopenia (low counts of red blood cells, white blood cells, and platelets).
- Lymphatic: Peripheral edema, particularly in the lower extremities.
- Integumentary: Jaundice, pruritus, palmar erythema (red palms), telangiectasia or spider angiomas (spider-like blood vessels).
2. Liver Palpation: Palpation of the liver may reveal enlargement, tenderness, and potentially palpable masses.
3. Assess Compensation Status: Cirrhosis can be clinically compensated or decompensated. Compensated cirrhosis may be asymptomatic, often diagnosed incidentally through lab tests or imaging. Decompensated cirrhosis presents with symptoms due to liver failure and portal hypertension.
Diagnostic Procedures
1. Blood Tests: Blood samples are crucial for assessing liver function and identifying potential causes. Key lab tests include:
- Elevated liver enzymes (AST, ALT, ALP, GGT)
- Elevated bilirubin levels (total and direct)
- Creatinine levels to assess kidney function
- Complete blood count (CBC) to check for anemia, thrombocytopenia, and leukopenia
- Viral hepatitis serology (HBsAg, anti-HCV)
- Prothrombin time (PT) and International Normalized Ratio (INR) to assess coagulation
2. Liver Markers: Gamma-glutamyl transferase (GGT) is particularly sensitive to liver damage and bile duct issues. Elevated GGT levels are indicative of liver disease.
3. Synthetic Liver Function Tests: PT and serum albumin levels are important indicators of the liver’s synthetic function. Reduced albumin levels and prolonged PT/INR reflect impaired liver function.
4. Imaging Studies: Various imaging techniques are used to evaluate liver structure and identify complications:
- Computed Tomography (CT) Scan: Detects vascular lesions, tumors, and liver size and shape.
- Ultrasound: Identifies liver nodules, increased echogenicity (characteristic of cirrhosis), ascites, and portal vein thrombosis.
- Duplex Doppler Ultrasound: Evaluates the patency of hepatic, portal, and mesenteric veins, assessing blood flow and portal hypertension.
- Magnetic Resonance Imaging (MRI): Useful for visualizing iron and fat deposition in the liver, as well as detailed liver anatomy.
- Transient Elastography (Fibroscan): Non-invasive method using ultrasound to measure liver stiffness, correlating with fibrosis severity.
- Endoscopic Retrograde Cholangiopancreatography (ERCP): Assesses bile duct abnormalities and can be used for interventions.
- Upper Endoscopy: Detects esophageal and gastric varices, as well as sources of bleeding in the upper GI tract.
5. Liver Biopsy: Considered the gold standard for confirming cirrhosis diagnosis, grading inflammation, and staging fibrosis. It provides histological information about the liver tissue.
Alt text: Microscopic view of liver tissue showing cirrhosis, characterized by scarring and nodule formation.
Nursing Interventions for Liver Cirrhosis
Nursing interventions are critical in managing liver cirrhosis, focusing on treating the underlying cause, preventing complications, and mitigating further liver damage.
Treat the Underlying Cause of Cirrhosis
1. Minimize Complications: Addressing the root cause of cirrhosis in its early stages can significantly reduce liver damage and prevent the onset of severe complications.
2. Support Alcohol Cessation: For patients with alcohol-induced cirrhosis, quitting alcohol is paramount. Nurses should facilitate access to alcohol addiction treatment programs and support resources.
3. Achieve Healthy Weight: Weight loss and blood sugar management are crucial for individuals with NAFLD-related cirrhosis. Lifestyle modifications and dietary changes are key.
4. Manage Viral Hepatitis: Antiviral medications are effective in treating hepatitis C, and advancements in treatment can lead to viral eradication. Hepatitis B can be managed with antiviral therapy to slow disease progression.
5. Symptom Management: Medications can slow the progression of certain types of cirrhosis, such as primary biliary cholangitis, if diagnosed early. Symptom-specific medications are also used to alleviate pruritus, fatigue, and pain.
6. Nutritional Support for Malnutrition: Cirrhosis often leads to anorexia and malnutrition due to symptoms and ascites. Enhancing nutrition through increased calorie and protein intake is vital. This can be achieved by recommending 5-6 small, frequent meals per day and a high-protein, carbohydrate-rich nighttime snack to minimize catabolism during fasting.
7. Consider Total Parenteral Nutrition (TPN): For patients unable to meet nutritional needs orally or through enteral feeding, TPN may be necessary. TPN solutions provide adequate fat emulsions to prevent essential fatty acid deficiencies.
8. Pain Management Strategies: NSAIDs and aspirin should be avoided in cirrhosis patients due to the risk of GI bleeding and renal insufficiency. Low-dose acetaminophen is generally permitted. Opioid analgesics can be used but with caution due to altered drug metabolism in liver disease.
Prevent Cirrhosis Complications
1. Manage Fluid Accumulation: Ascites and edema are managed with a low-sodium diet and diuretics to reduce fluid retention. Paracentesis may be required to remove large volumes of ascitic fluid.
2. Manage Portal Hypertension: Elevated pressure in the portal venous system can be controlled with medications like beta-blockers and nitrates, reducing the risk of variceal bleeding.
3. Control Bleeding Varices: Bleeding varices may necessitate procedures such as band ligation or sclerotherapy to stop or prevent bleeding. Surgical shunts, like transjugular intrahepatic portosystemic shunt (TIPS) or distal splenorenal shunt, can divert blood flow and reduce portal pressure.
4. Eliminate Toxins in Hepatic Encephalopathy: Lactulose is administered to reduce ammonia levels and other toxins in the blood, which contribute to hepatic encephalopathy. Rifaximin, an antibiotic, may also be used to reduce ammonia-producing bacteria in the gut.
5. Liver Transplantation Referral: Liver transplantation should be considered in cases of hepatic decompensation. Patient selection is rigorous, but transplant outcomes have improved significantly, offering increased survival rates and improved quality of life.
Prevent Further Liver Damage
1. Emphasize Alcohol Abstinence: Regardless of the cause of cirrhosis, alcohol consumption must be strictly avoided as it can exacerbate liver damage.
2. Restrict Sodium Intake: High sodium intake leads to fluid retention, worsening edema and ascites. Patients should be educated on sodium restriction and advised to use herbs and spices for flavoring instead of salt.
3. Meal Planning and Diet Education: A balanced diet is crucial. Patients should consume a variety of fruits and vegetables and lean proteins such as fish, poultry, and legumes. Raw seafood should be strictly avoided due to infection risk.
4. Infection Prevention: Cirrhosis patients are immunocompromised and more susceptible to infections. Education on hand hygiene, avoiding contact with sick individuals, and safe needle practices is essential. Vaccinations against influenza, pneumonia, and hepatitis A and B are recommended.
5. Medication Precautions: The liver’s ability to process medications is impaired in cirrhosis. Patients should always consult their healthcare provider before taking any new medications, including over-the-counter drugs. NSAIDs, aspirin, and certain antibiotics and cholesterol-lowering drugs should be avoided or used with caution.
6. Recognize When to Seek Urgent Care: Patients should be educated to seek immediate medical attention for:
- Signs of increased bleeding
- Worsening jaundice
- Difficulty breathing
- Increased ascites or edema
- Changes in mental status or confusion
- Decreased level of consciousness
Nursing Care Plans for Liver Cirrhosis
Nursing care plans are essential tools for organizing and prioritizing nursing care for patients with liver cirrhosis. They guide assessments and interventions to achieve both short-term and long-term care goals. Here are examples of nursing care plans addressing common nursing diagnoses in liver cirrhosis.
Acute Confusion
Hepatic encephalopathy, caused by the liver’s inability to detoxify substances, leads to toxin accumulation in the blood, affecting brain function and resulting in acute confusion.
Nursing Diagnosis: Acute Confusion
Related to:
- Hepatic encephalopathy (HE)
- Elevated serum ammonia levels
As evidenced by:
- Confusion
- Agitation
- Slurred speech
- Lethargy
- Impaired decision making
- Lack of coordination
- Difficulty concentrating
Expected outcomes:
- Patient will maintain orientation to person, place, and time.
- Patient will adopt lifestyle modifications to prevent recurrence of HE (e.g., alcohol abstinence).
Assessment:
1. Monitor Serum Ammonia Levels: While ammonia levels don’t always directly correlate with HE severity, trending levels can indicate improvement or worsening.
2. Review Neurological Imaging: EEG, MRI, or CT scans can rule out other causes of altered mental status such as tumors or stroke, ensuring accurate diagnosis and treatment.
Interventions:
1. Administer Lactulose: Lactulose is a laxative that promotes the excretion of ammonia and toxins through bowel movements. Monitor for effectiveness and potential side effects like dehydration and electrolyte imbalance.
2. Implement Fall and Injury Precautions: Due to cognitive impairment, patients are at high risk for falls and injuries. Ensure bed alarms are active, side rails are used as appropriate, and provide close supervision and assistance with mobility and activities of daily living (ADLs).
3. Provide Reorientation Regularly: Frequent reorientation to person, place, time, and situation helps reduce confusion and maintain reality orientation. Use clear and simple communication.
4. Educate on Lifestyle Modifications: Patient education on managing cirrhosis, including alcohol avoidance, medication adherence, and dietary recommendations, is crucial for preventing HE episodes.
5. Minimize Environmental Stimuli: A calm, quiet environment can reduce agitation and confusion. Limit noise and excessive stimulation to promote relaxation and cognitive clarity.
Dysfunctional Family Processes: Alcoholism
Alcoholic liver disease is a major cause of cirrhosis, often resulting from years of heavy alcohol consumption, impacting not only the patient but also family dynamics.
Nursing Diagnosis: Dysfunctional Family Processes: Alcoholism
Related to:
- Chronic heavy alcohol use
As evidenced by:
Physical effects of alcohol on the liver:
- Portal hypertension
- Ascites
- Jaundice
- Splenomegaly
- Malnutrition
Emotional/psychological symptoms:
- Denial of alcohol addiction
- Anxiety and depression
- Guilt
- Social isolation and loneliness
- Marital and family problems
- Financial difficulties
- Disrupted family roles
- Unresolved grief related to the impact of alcoholism
- Ineffective coping mechanisms
- Knowledge deficit regarding alcoholism and its consequences
Expected outcomes:
- Patient will verbalize understanding of the long-term effects of alcohol on liver health.
- Patient will agree to participate in rehabilitation or Alcoholics Anonymous (AA) for addiction support.
- Patient will articulate the consequences of alcohol abuse and identify necessary steps for change.
Assessment:
1. Assess for Alcohol Withdrawal: Alcohol withdrawal syndrome can be life-threatening, including delirium tremens (DTs) which can lead to seizures. Monitor for withdrawal symptoms closely and administer benzodiazepines as prescribed to manage symptoms, while being cautious of potential hepatic encephalopathy exacerbation.
2. Monitor Liver Function Tests: Assess liver enzymes (AST, ALT, GGT) to evaluate liver damage and monitor disease progression. GGT is particularly sensitive to chronic alcohol use.
3. Evaluate Support System: Assess the impact of alcoholism and cirrhosis on family dynamics and the patient’s support network. Determine the availability and quality of support from family, spouse, or friends.
Interventions:
1. Address Alcohol Cravings: Medications like disulfiram, topiramate, and baclofen can aid in managing alcohol addiction by reducing cravings and withdrawal symptoms. Provide information and access to pharmacological support.
2. Refer to Rehabilitation and Support Groups: Recommend and facilitate referrals to addiction counseling, inpatient or outpatient rehabilitation programs, and AA or other support groups. Addressing the underlying addiction is crucial for long-term management.
3. Coordinate Dietician Consultation: Cirrhosis and alcoholism often lead to significant malnutrition and nutrient deficiencies (folate, B vitamins, vitamin A, thiamine, zinc). A dietician can assess nutritional status and develop a tailored nutrition plan.
4. Prepare for Liver Transplant Evaluation: Liver transplantation may be the only option for end-stage alcoholic liver disease. To be eligible, patients must demonstrate a commitment to sustained alcohol abstinence. Initiate discussions and referrals for transplant evaluation when appropriate.
Ineffective Breathing Pattern
Ascites and abdominal distention in liver cirrhosis increase pressure on the diaphragm, impairing respiratory function. Hepatopulmonary syndrome, a complication of advanced cirrhosis, can cause severe hypoxemia and shortness of breath.
Nursing Diagnosis: Ineffective Breathing Pattern
Related to:
- Disease process of liver cirrhosis
- Ascites and abdominal distention
- Organomegaly (hepatomegaly, splenomegaly)
- Increased intra-abdominal pressure
- Hepatopulmonary syndrome
- Abdominal discomfort or pain
- Fatigue and weakness
- Anxiety
As evidenced by:
- Dyspnea (shortness of breath)
- Tachypnea (rapid breathing)
- Cyanosis (bluish discoloration of skin and mucous membranes)
- Orthopnea (difficulty breathing while lying flat)
- Hyperventilation
- Hypoxemia (low blood oxygen levels)
- Hypoxia (tissue oxygen deficiency)
Expected outcomes:
- Patient will exhibit a normal breathing pattern without signs of respiratory distress.
- Patient will report the ability to breathe comfortably in both sitting and lying positions.
Assessment:
1. Monitor Respiratory Status: Assess respiratory rate, depth, and effort. A respiratory rate above 30 breaths per minute, especially with other signs of distress, indicates significant respiratory compromise.
2. Auscultate Breath Sounds: Abnormal breath sounds such as crackles or wheezes may indicate complications like atelectasis, fluid overload, or infection.
3. Assess Level of Consciousness: Hypoxemia associated with ineffective breathing can affect CNS function, leading to changes in mentation and decreased level of consciousness.
Interventions:
1. Position for Comfort: Patients often experience dyspnea when lying flat due to ascites and organomegaly. Elevate the head of the bed or assist the patient to sit upright to facilitate lung expansion and breathing.
2. Use Supportive Pillows: Providing pillows to support the arms and chest can improve comfort and ease breathing effort.
3. Monitor Arterial Blood Gases (ABGs) and Oxygen Saturation: Regular monitoring of ABGs and oxygen saturation levels is essential to detect and manage hypoxemia and respiratory compromise promptly.
4. Administer Supplemental Oxygen: Oxygen therapy via nasal cannula or mask should be provided as indicated to treat hypoxia and alleviate dyspnea.
5. Prepare for Paracentesis: Abdominal paracentesis can relieve pressure from ascites, improving diaphragmatic movement and easing breathing. Prepare the patient for the procedure as needed.
Ineffective Tissue Perfusion (Hepatic)
Cirrhosis results in liver damage and cell death, leading to scar tissue formation and significantly reduced liver perfusion, impairing its vital functions.
Nursing Diagnosis: Ineffective Tissue Perfusion
Related to:
- Disease process of liver cirrhosis
- Excessive alcohol use
- Viral hepatitis
- Genetic disorders affecting the liver
- Bile duct abnormalities
- Hepatotoxic medications
As evidenced by:
- Easy bruising and bleeding tendencies
- Jaundice
- Peripheral edema
- Ascites
- Abdominal pain
- Confusion or altered level of consciousness
- Skin abnormalities such as spider angiomas and palmar erythema
Expected outcomes:
- Patient will demonstrate liver enzymes, coagulation factors, and blood cell counts within acceptable ranges.
- Patient will remain free from complications of ineffective tissue perfusion such as jaundice, ascites, and bleeding.
Assessment:
1. Assess for Symptoms of Impaired Liver Perfusion: Early liver damage may be asymptomatic. As cirrhosis progresses, symptoms may include fatigue, jaundice, loss of appetite, bruising, and abdominal swelling.
2. Abdominal Assessment: Palpate the abdomen to assess for hepatomegaly in early stages and ascites in later stages. Measure abdominal girth regularly to monitor fluid accumulation.
3. Review Liver Function Tests: Monitor serum AST, ALT, ALP, bilirubin, albumin, PT/INR. Initially, AST and ALT may be elevated due to liver inflammation. As liver function deteriorates, albumin decreases and PT/INR prolongs.
4. Review Diagnostic Imaging: CT, MRI, Doppler ultrasound, and liver elastography results provide information on liver structure, blood flow, fibrosis, and presence of complications like portal hypertension and varices.
Interventions:
1. Administer Diuretics as Prescribed: Diuretics such as spironolactone and furosemide are used to manage edema and ascites. Monitor electrolyte balance and renal function. Ursodiol may be prescribed for primary biliary cirrhosis to improve bile flow.
2. Monitor Abdominal Girth: Regular measurement of abdominal girth helps assess ascites progression or response to treatment.
3. Prepare for Surgical Interventions: Liver transplantation is considered for advanced cirrhosis. Prepare patients for evaluation and potential transplant. Procedures like TIPS may be used to manage portal hypertension and variceal bleeding.
4. Monitor Mental Status: Hepatic encephalopathy due to toxin buildup can cause confusion and altered mental status. Monitor neurological status and administer lactulose and/or rifaximin as prescribed to reduce ammonia levels.
5. Monitor for Bleeding: Cirrhosis increases the risk of bleeding due to impaired coagulation and varices. Monitor for signs of bleeding (e.g., bruising, petechiae, melena, hematemesis) and implement bleeding precautions.
Risk for Impaired Skin Integrity
Liver cirrhosis compromises skin integrity due to fluid accumulation, bile salt deposition causing pruritus, and bleeding tendencies.
Nursing Diagnosis: Risk for Impaired Skin Integrity
Related to:
- Accumulation of bile salts leading to jaundice and pruritus
- Fluid overload causing edema and ascites
- Bleeding tendencies and spider angiomas
- Poor nutritional status
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms, as the problem has not yet occurred. Nursing interventions are focused on prevention.
Expected outcomes:
- Patient will maintain intact skin without breakdown throughout hospitalization or care period.
- Patient will monitor for and report any signs of worsening edema and ascites to healthcare provider.
- Patient will demonstrate and implement at least two strategies to prevent skin breakdown.
Assessment:
1. Perform Comprehensive Skin Assessment: Regularly assess skin integrity, noting color, turgor, presence of edema, bruising, spider angiomas, and any lesions or areas of breakdown. Pay attention to areas prone to pressure.
2. Assess Nutritional Status: Evaluate nutritional intake, hydration status, and indicators of malnutrition. Poor nutrition impairs skin healing and integrity.
Interventions:
1. Prevent Skin Trauma: Handle patients gently to avoid skin tears and shearing, especially when moving, turning, or providing hygiene care. Use lift sheets when repositioning.
2. Manage Edema: Implement measures to reduce edema, such as sodium restriction, diuretics, and elevation of extremities. Monitor and document edema severity and distribution.
3. Monitor Post-Paracentesis Site: After paracentesis, monitor the puncture site for signs of infection, bleeding, or leakage. Apply sterile dressing and ensure site is kept clean and dry.
4. Manage Pruritus: Advise patient to avoid scratching to prevent skin breakdown. Recommend cool baths with mild soaps, avoid hot water and harsh soaps. Calamine lotion or antipruritic lotions may provide relief. Administer antihistamines like diphenhydramine (Benadryl) or hydroxyzine as prescribed to reduce itching.
5. Optimize Nutrition: Improve nutritional status by encouraging a high-protein, high-calorie diet with adequate vitamins and minerals. Provide frequent, small meals and snacks. Consider enteral or parenteral nutrition if oral intake is insufficient. Provide a nighttime snack to prevent catabolism.
Alt text: Nurse performing abdominal assessment on a patient with liver cirrhosis, checking for ascites and hepatomegaly.
References
- упомянуть источники как в оригинальной статье (если они есть, или добавить общие источники по теме – nursing textbooks, reputable medical websites like Mayo Clinic, NIH, etc.) (The original article does not list specific references, so I will keep it that way. If references are needed, general reputable sources on liver cirrhosis nursing care can be added.)
