The major goals for a patient with cirrhosis are: Report decrease in fatigue and increased ability to participate in activities. Maintain a positive nitrogen balance, no further loss of muscle mass, and meet nutritional requirements. Decrease potential for pressure ulcer development and breaks in skin integrity.
Nursing care for patients with liver failure focuses on supporting body systems, managing signs and symp- toms of decreased liver function, and avoiding worsening cerebral edema. Monitor level of consciousness, blood pressure, volume status, blood and coagulation tests, and signs and symptoms.
Regardless of the cause of cirrhosis, nurses should counsel patients with compensated cirrhosis to eat a healthy diet, with high protein, low fat, low/moderate sodium, and increased fibre content. EASL clinical practic guidelines on nutrition in chronic liver disease.
Ascites is the most common complication of cirrhosis[7]. It is also the most common complication that leads to hospital admission[29]. Approximately 15% of the patients with ascites will die in one year and 44% will die in five years[6].
A build-up of fluid in your tummy area (ascites) or legs and ankles (peripheral oedema) is a common complication when cirrhosis progresses. The main treatments are cutting out salt from your diet and taking a type of medicine called a diuretic, such as spironolactone or furosemide.
Diuretic therapy with spironolactone is typically a first-line option for patients with cirrhosis and edema. If an inadequate response is achieved with spironolactone, then furosemide or thiazide diuretics can safely be added to the regimen.
The most important aspect of treatment in patients with acute liver failure is to provide good intensive care support. Patients with grade II encephalopathy should be transferred to the intensive care unit (ICU) for monitoring. As encephalopathy progresses, protection of the airway becomes increasingly important.
The damage caused by cirrhosis can't be reversed and can eventually become so extensive that your liver stops functioning. This is called liver failure. Cirrhosis can be fatal if the liver fails. However, it usually takes years for the condition to reach this stage and treatment can help slow its progression.
If cirrhosis gets worse, some of the symptoms and complications include: yellowing of the skin and whites of the eyes (jaundice) vomiting blood. itchy skin.
The main treatment for primary biliary cirrhosis is to slow liver damage with the drug ursodiol (Actigall, Urso). Ursodiol can cause side effects like diarrhea, constipation, dizziness, and back pain.
The first-level priority problems are health issues that are life-threatening and require immediate attention. These are health problems associated with ABCs; airway, breathing, and circulation, such as establishing an airway, supporting breathing, and addressing sudden perfusion and cardiac issues.
Airway, breathing, and circulation, otherwise known by the mnemonic “ABCs,” are another foundational element to assist the nurse in prioritization. Like Maslow's hierarchy, using the ABCs to guide decision-making concentrates on the most critical needs for preserving human life.
Nursing ABC's
The ABCs include airway, breathing, and circulation, the three most important details for every patient. If you see a priority question, the ABCs should be the first things you check off the list.
Complications of liver failure
Varices can rupture, resulting in severe bleeding. Ruptured varices are a very serious complication. They are one of the major causes of death in people with cirrhosis.
Contact your provider if you develop symptoms of cirrhosis. Get emergency medical help right away if you have: Abdominal or chest pain.
The final days of liver failure can vary, depending on the person. Someone may experience symptoms such as yellow skin and eyes, confusion, swelling, and general or localized pain. The symptoms of end-stage liver disease typically worsen as the patient becomes closer to death.
Cirrhosis puts people at greater risk for: bruising and bleeding easily. high blood pressure in the liver, or portal hypertension, which can then lead to enlarged veins and internal bleeding, fluid build-up in the abdomen, swelling in the lower extremities, and difficulty thinking.
Prednisolone – steroids can help to reduce inflammation in the liver. Steroids are usually prescribed as a reducing course. It is best to take this medication with/after food. Calcium and vitamin D supplementation – such as Adcal D3, can be prescribed for bone protection whilst taking a course of steroids.
Ursodeoxycholic acid (UDCA) is the first-line therapy for primary biliary cirrhosis (PBC). As a major consequence of the progression of CLD, portal hypertension (PHT) can lead to death or liver transplantation.
The most important part of treatment is to completely stop drinking alcohol. Sometimes diet changes are advised, too. The liver is often able to repair some of the damage caused by alcohol so that you can live a normal life. In some cases, liver transplant may be considered.
In general, acetaminophen at reduced dosing is a safe option. In patients with cirrhosis, nonsteroidal anti-inflammatory drugs should be avoided to avert renal failure, and opiates should be avoided or used sparingly, with low and infrequent dosing, to prevent encephalopathy.