CASE: LIVER CIRRHOSIS ASSESSMENT: Subjective: Wala akong ganang kumain as verbalized by the patient.

Objective: Weak in appearance Refusal to eat Weight loss Low serum protein levels

NURSING DIAGNOSIS: Imbalanced nutrition: less than body requirements, related to anorexia and possible alcohol abuse manifested by weight loss and low serum protein levels. NURSING INFERENCE: Cirrhosis of the liver is a chronic disease that causes cell destruction and fibrosis (scarring) of hepatic tissues. Fibrosis alters normal liver structure and vasculature, impairing blood and lymph flow and resulting in hepatic insufficiency and hypertension in the portal vein. Complications include hyponatremia, water retention, bleeding esophageal varices, coagulopathy, spontaneous bacterial peritonitis, and hepatic encephalopathy. NURSING GOAL: After 3 weeks of rendering nursing intervention, the patient will gain 1.5 lb (0.68 kg) per week without evidence of increased fluid retention and serum albumin levels will return to normal range.

NURSING INTERVENTION 1. Assist in oral hygiene before meals. 2. Discuss eating habits including food preferences. 3. Serve favorite foods that are not contraindicated. 4. Prevent or minimize unpleasant odors during meal time.

RATIONALE A clean mouth enhances appetite. To appeal the client likes and dislikes. To stimulate the appetite. May have negative effect on appetite.

5. Serve foods that are attractive and palatable. 6. Recommend small, frequent meals. 7. Restrict intake of caffeine, gasproducing or spicy and excessively hot or cold foods. 8. Provide assistance with activities as needed. Promote undisturbed rest periods, especially before meals.

To stimulate the appetite. Poor tolerance to larger meals may be due to increased intra abdominal pressure/ascites. Aids in reducing gastric irritation and abdominal discomfort that may impair oral intake/digestion. Conserving energy reduces metabolic demands on the liver and promotes cellular regeneration.

EVALUATION: After 3 weeks of rendering nursing intervention, the patient was able to gain 1.5 lb (0.68 kg) per week without evidence of increased fluid retention and serum albumin levels will return to normal range.

CASE: LIVER CIRRHOSIS ASSESSMENT: Subjective: I feel that my tummy is getting bigger as verbalized by the patient. Objective: Weight gain Altered electrolyte levels Edema V/S taken as follows: T: 37.0 C P: 92 bpm R: 20 cpm BP: 120/80 mmHg

NUSING DIAGNOSIS: Excess fluid volume related to electrolyte imbalance and hypoalbuminemia as manifested by ascites and peripheral edema. NURSING INFERENCE: Chronic liver disease develops cardiovascular abnormalities due to an increased cardiac output and decreased peripheral vascular resistance, possibly resulting from the release of vasodilators. NURSING GOAL: After 3 days of applying appropriate nursing interventions, the patient`s abdominal girth will decrease by 1 to 2 cm per day and peripheral edema will decrease. NURSING INTERVENTION 1. Measure intake and output, weight RATIONALE Reflects circulating volume status.

daily and note weight gain more than 0.5 kg/day. 2. Restrict sodium and fluids as ordered.

3. Monitor blood pressure.

4. Compare current weight with admission and/or previously stated weight. 5. Measure abdominal girth for changes that may indicate increasing fluid retention/edema. 6. Weigh daily or on a regular schedule. 7. Encourage bed rest when ascites is present. 8. Administer medications as ordered such as diuretics. 9. Monitor electrolytes. 10. Assist with Paracentesis procedure.

Positive balance/weight gain after reflects continuing fluid retention. Sodium may be restricted to minimize fluid retention in extravascular spaces. Fluid restriction may be necessary to prevent dilutional hyponatremia. BP elevation usually associated with fluid volume excess but may not occur because of fluid shifts out of the vascular space. To evaluate degree of excess. To evaluate severity of fluid retention/edema. Provides comparative baseline. May promote recumbency-induced diuresis. To control edema and ascites. To correct further imbalances. Done to remove ascites fluid.

EVALUATION: After 3 days of applying appropriate nursing interventions, the patient`s abdominal girth decreased by 1 to 2 cm per day and peripheral edema decreased. The goal was completely met.

CASE: LIVER CIRRHOSIS ASSESSMENT: Subjective: Ina-antok ako palagi, hindi ako makapag-isip ng maayos as verbalized by the patient. Objective: Changes of the behavior Asterexis Impaired thinking Lethargy

NURSING DIAGNOSIS: Disturbed thought processes, related to effects of high ammonia levels as manifested by lethargy. NURSING INFERENCE: Cirrhosis of the liver is a chronic disease that causes cell destruction and fibrosis (scarring) of hepatic tissues. Fibrosis alters normal liver structure and vasculature, impairing blood and lymph flow and resulting in hepatic insufficiency and hypertension in the portal vein. Complications include hyponatremia, water retention, bleeding esophageal varices, coagulopathy, spontaneous bacterial peritonitis, and hepatic encephalopathy. NURSING GOAL: After 8-10 hours of rendering nursing intervention, the patient will be alert and oriented and serum ammonia levels are within normal range. NURSING INTERVENTIONS RATIONALE

1. Restrict dietary protein as prescribed for transient period. 2. Give frequent, small feedings of carbohydrates.

Reduces source of ammonia (protein foods). Promotes consumption of adequate carbohydrates for energy requirements and spares protein from breakdown for energy. Minimizes risk for further increase in metabolic requirements. Minimizes shivering, which would increase metabolic requirements. Provides stimulation to the patient and opportunity for observing the patient`s level of consciousness. Promoting activities such as listening to music, relaxation techniques or preillness coping strategies can reduce anxiety. Actively listening demonstrates caring and concern.

3. Protect from infection. 4. Keep environment warm and draftfree. 5. Awaken at intervals (every 2-4 h) to assess cognitive status. 6. Encourage patient and family to participate in therapeutic strategies to enhance coping with episodes of mental deterioration. 7. Encourage patient and family to discuss feeling of fear, powerlessness or emotional distress related to patient`s mental deterioration.

EVALUATION: After 8 hours of rendering nursing intervention, the patient was alert and oriented and serum ammonia levels are within normal range.

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

MEDICATIONS: 1)Lactulose. 2) Spironolactone for patients with ascites. 3) Lasix.