MUFULIRA SCHOOLS OF

NURSING AND
MIDWIFERY
 LIVER
CIRRHOSIS
DEFINITION
• It is a chronic progressive
disease of the liver caused by
repeated inflammation of the
liver and healing by fibrosis
characterized by extensive
degeneration and destruction of
the liver parenchymal cells.
DIAGRAM OF THE HUMAN LIVER
 CLASSIFICATION
1. Laenecs partial cirrhosis(alcoholic
or nutritional): Chronic alcoholism
leading to scar tissue forming around
the portal area and there is
infiltration of the liver with
neutrophils.
2. This is due to alcohol abuse, changes
in the liver are reversible when some
one stops taking alcohol.
2. Post necrotic: it comes about due
to previous infection of the liver
either caused by viral or toxic or
idiopathic hepatitis.
3. Billiary cirrhosis: usually
associated with chronic billiary
obstruction.
Either primary – due to intra hepatic
obstruction.
Secondary – due to extra hepatic
obstruction.
4. Cardiac cirrhosis: results
from long standing severe right
sided heart failure, tricuspid
insufficiency and constrictive
pericarditis.
 CAUSES
i. All types of hepatitis
ii. Alcohol
iii. Malnutrition
iv. Haemochromatosis in which
excessive iron is absorbed
and deposited into other
organs.
 CAUSES cont…

v. Drug induced liver disease

vi. Wilson’s disease – abnormal
storage of copper in the liver.
 PATHOPHYSIOLOGY
Liver cirrhosis is a slowly
progressing disease in which
cell necrosis occurs. Destroyed
liver is replaced by fibrous
tissue. There is hyperplesia of
hepatocytes adjacent to
damaged areas in an attempt to
compensate for the destroyed
cells.
 Pathophysiology cont…
There will be healing by fibrosis
leading to formation of nodules
and scar tissue, eventually it
will become irregular and
disorganized blocking the flow
of blood through the liver
leading to distortion of liver
function.
 SIGN AND SYMPTOMS
i. Dyspepsia due to disturbed
carbohydrate and fat
metabolism.
ii. Flatulence due to disturbed
metabolism of fat,
carbohydrates and proteins.
 SIGN AND SYMPTOMS cont…
iii. Dull pain in the upper right
quadrant due to inflammation.
iv. Pruritis due to accumulation of
bile salts on the skin.
v. Jaundice due to inability of the
liver to conjugate and excrete
bilirubin.
 SIGNS AND SYMPTOMS cont…
vi. Ascitis due to portal
hypertension.
vii. Pallor due to inadequate red
blood cell production.
viii. Epistaxis due to failure of the
liver to produce vitamin K.
 SIGNS AND SYMPTOMS cont…
ix. Skin lesions due to increase in
circulation of oestrogen because
the liver is unable to metabolize
the steroids.
x. Nausea and vomiting due to
altered metabolism of
carbohydrates, fats and proteins.
 MANAGEMENT
INVESTIGATIONS
1. Liver biopsy: This is a definite test
for cirrhosis. Biopsy detects hepatic
tissue destruction.
2. Esophagogastroduodenoscopy:
Reveals bleeding oesophageal
varices, stomach irritation or
ulceration or duodenal bleeding.
 INVESTIGATIONS cont…
3. Computed Tomography and liver
scans .The studies determine liver
masses and visualise hepatic
blood flow and obstruction.
4. Blood studies: liver enzyme test.
Alanine amino transferase and
asparate amino transferase levels
are elevated.
 INVESTIGATIONS cont…
5. Urine and stool studies ;Urine
studies of bilirubin and
urobilinogen will reveal
increased levels .
 TREATMENT
Non pharmacological
i. Vitamins nutritional
supplements and improve the
patient’s nutritional status.
ii. Low salt diet sodium
consumption is usually
restricted to 500mgs/day to
help manage ascitis and
oedema.
 Non pharmacological Treatment
cont…
iii. Stop alcohol ingestion if the
patient takes alcohol.
iv. Adequate rest is important .It
promotes venous return
therefore prevents oedema.
 Non pharmacological Treatment
cont…
v. Stop drugs which cause
pressure in the billiary tract
such as morphine paradhyd
because they increase pressure
which lead to obstruction in the
bile flow .
Pharmacological Treatment
i. Diuretic therapy is an important
part of management e.g.
• Spinolactone (aldactore) dose
100mg (It is a potassium sparing
drugs).
• Frusemide (lasix) This is a high
potency loop diuretic dose 20 -
40 mgs daily.
Pharmacological Treatment cont…

ii. A paracentesis(needle
puncture)of the abdominal
cavity may be performed to
remove ascitic fluid. It is a
temporal measure because the
fluid tend to accumulate .
Pharmacological Treatment cont…

iii. Anti-acid :To reduce gastric

distress and decrease the potential
for gastro intestinal bleeding.
• Magnesium Triscillicate 200mgs 8
hourly for 4 days.
Side effects ;constipation
 Nursing management
Environment
• The patient will be nursed in a
medical ward.
• The environment should be free
from unnecessary noise.
• Dump dust the environment to
prevent cross infection.
 Environment cont…
• The room should be generally
clean and well ventilated to
provide a conducive
atmosphere which is free of
infection and dust.
• The room should have good
lighting for easy observation.
 Position
• Patient to be nursed in the fowlers
position to allow for maximum
respiratory efficiency.
• Use pillows at the back to promote
comfort and ability to breath.
• Reposition patient at least after 2
hours to relieve pressure over bony
prominences.
• Elevate oedematous areas to promote
venous drainage.
 Rest
• Create a noise free
environment.
• Restrict visitors to allow the
patient to rest.
• Plan your care by doing
procedures in groups to lessen
disturbing the patient.
 Rest cont…
• Encourage bed rest or light activity
to conserve energy and promote
comfort.
• Assist patient to lie in a
comfortable position.
• Provide diversional therapy to
assist patient cope with discomfort
of itchiness thereby promote rest.
 Observations
• Monitor intake and output to
maintain necessary fluid
restrictions and assess renal
function.
• Observe for bleeding gums,
epistaxis and petechiae.
 Observations cont…
• Monitor for haemorrhage by
assessing for epistaxis, purpura,
petechiae (bleeding under the
skin) easy bruising, gingival
bleeding, heavy menstrual
bleeding, hematuria, melena
because liver disease results in
impaired.
 Observations cont…
• Inspect stool amount, colour and
consistency.
• Assess location and extent of
oedema by weighing patient at the
same time each day, taking daily
measurements of extremities and
of abdominal girth(same location
each time) to determine patient’s
response to treatment .
 Observations cont…
• Check temperature to rule out
hyperthermia and hypothermia.
• Check respiratory rate and
rhythm to identify increasing
dyspnoea.
• Check and record of BP to rule
out hypertension and
hypotension.
 Observations cont…
• Observe for signs of hepatic
encephalopathy assess patients
general behaviour orientation to
place and time, speech, blood ph
and ammonia level because liver is
unable to convert accumulated
ammonia to urea for renal
excretion.
 Psychological care
• Create a therapeutic nurse
patient relationship to gain
patient’s confidence.
• Explain the disease process to
the patient to help him gain
knowledge thus promoting
cooperation.
 Psychological care cont…
• Explain the possible causes of
liver cirrhosis to the patient to
gain cooperation and allay
anxiety.
• Encourage the patient to
express his /her concerns ,fears
and ask questions to allay
anxiety.
 Psychological care cont…
• Be calm and reassure the patient
that everything possible is being
done to help them.
• Provide a supportive environment
by allowing the family to participate
in the care.
• Encourage the patient to participate
in his own care to gain cooperation.
 Psychological care cont…
• Explain reasons for adhering to
treatment schedule.
• Explain every procedure you are
doing on the patient to allay
anxiety.
• Explain the reason for strictness in
monitoring sodium intake.
 Nutrition
• Determine food preferences and
provide the patients prescribed
diet limitation.
• Offer frequent small meals to
prevent feeling of fullness and
maintain nutritional status.
• Restrict fluid intake as ordered to
prevent further fluid overload.
 Nutrition cont…
• Provide low protein or no
proteins ordered because
ammonia a broken down
product of protein is
responsible for mental change
• Restrict sodium intake as
ordered to prevent additional
fluid retention.
 Nutrition cont…
• Provide oral care before meals
to remove foul tastes and
improve taste of food.
• Administer antiemetics as
ordered to relieve vomiting.
 Hygiene
• Bath the patient if he can’t do it
and if he can encourage him to
bath to promote blood
circulation to all parts of the
body.
• Do oral care to prevent halitosis,
gingivitis and dental caries.
 Hygiene cont…
• Do hair care to prevent
pediculosis.
• Clip patient’s nails short to
prevent diseases like diarrhoea.
• Change soiled linen to promote
hygiene.
 Infection Prevention
• Monitor the patient’s temperature
to rule out fever.
• Monitor white blood cell count to
assess patient’s response to
treatment.
• Protect the patient from others
with infections to reduce the risk of
infection secondary to decreased
resistance.
 Infection prevention cont…
• Use appropriate infection control
measures such as hand washing to
prevent cross infection.
• Infection prevention . Observe for
any local and systemic
manifestations of infection to
enable early diagnosis and
treatment.
 Prevention on injury
• Assess for numbness and tingling
of lower extremities ,decreased
sensation in lower extremities to
determine risk of injury.
• Do not use restrictive bed linens
because they reduce circulation
and place pressure on oedematous
tissue.
 Prevention on injury cont…
• Instruct patient to avoid tight
clothing because it disturbs
circulation.
• Use care with heat and cold
applications because patient’s ability
to perceive temperature is impaired.
• Assist with ambulation to assess
patient’s ability to safely ambulate
and prevent injury
 Information, Education and
Communication
• Explain to the patient and family
the importance of continuous
health care so that they understand
that cirrhosis is a chronic liver
disease.
• Explain to the patient the
symptoms of complications and
when to seek medical attention to
enable prompt treatment.
 Information, Education and
Communication cont…
• Teach the patient the proper diet to
take because a low protein, high
carbohydrate diet is usually
indicated and difficult to follow.
• Teach the patient potentially
hepatotoxic over the counter drugs
because the diseased liver is unable
to metabolise these drugs.
 Information, Education and
Communication cont…
• Encourage abstinence from alcohol.
• Instruct the patient to avoid aspirin
and control coughing to prevent
• Haemorrhage when oesophageal or
gastric varies are present.
 COMPLICATIONS
1. Portal hypertension due to
structural changes in the liver.
2. Cancer of the liver due to
chronic hyperplesia of the
liver cells.
 COMPLICATION cont…
3. Hepatic encephalopathy due
to damaged liver which is
unable to detoxify ammonia
which enters the circulatory
system.
4. Renal failure due to reduced
blood flow to the kidneys.
 COMPLICATION cont…

5. Oesophageal varices due to

portal hypertension.