Cirrhosis

Question 1

What is cirrhosis? What are the types?

Answer 1

Extensive and irreversible scarring of the liver

Post-Necrotic/Post Hepatic-drugs/toxins/viruses

Laennec’s-Alcohol consumption

Biliary-gallbladder disease/autoimmune

Cardiac- right sided heart failure

Question 2

What puts an individual at risk for developing cirrhosis?

Answer 2

Alcohol consumption

Hepatitis (C mainly, sometimes B)

RS heart failure

Gallbladder diseases

Question 3

If uncontrolled, what are some major complications for cirrhosis?

Answer 3

Hepatorenal syndrome

Spontaneous bacterial peritonitis

Hepatopulmonary syndrome

Question 4

What are s/s of early stage cirrhosis?

Answer 4

Fatigue/weakness
Weight loss
Anorexia
Tender abdomen (URQ and Back)
Vomiting

Question 5

What are a/s of late stage cirrhosis?

Answer 5

Asterixis (hand tremor)
Hepatic foetor (bad breath)
Jaundice 
Increased ammonia (resulting in mental status change)
Edema in legs (result of low albumin and congested hepatic veins)
Varices 
Decreased appetite 
Deficient fat soluble vitamins (b13, A, C, D, E, K)
Itchy skin
Spider angiomas 
Ascietes
Splenomegaly 
Impotence, infertility

Question 6

How is cirrhosis diagnosed?

Answer 6

Liver biopsy, liver enzyme labs (AST, ALT), platelet/PT/INR labs, bili levels, Hep b/c dx

Question 7

What should the nurse consider when caring for/teaching a patient with cirrhosis?

Answer 7

Avoid alcohol and Tylenol

Limit invasive procedures/injections

If Nero system compromised, low protein diet. If not, high in lean protein (no uncooked seafood)

Pt is at risk for activity intolerance

Question 8

What medications might a cirrhosis pt have on board? Why?

Answer 8

Lactulose-decrease ammonia through diarrhea

Spironalactone/Lasix-decrease fluid load

Vasopressin/Nadalol/nitroglycerin-decreases portal vein pressure and BP in varices

Vanc/metronidazole-antibiotic to treat underlying infection

Ferrous sulfate, folic acid, Vit K-replace vitamins and assist in clotting

Question 9

What are nursing considerations for a patient who has a paracentesis?

Answer 9

Weigh before and after procedure
Elevate head of bed before
Encourage pt to void before 
Measure and describe the drainage 
Bed rest post

Question 10

What other interventions might a pt with cirrhosis have?

Answer 10

Liver transplant 
Administer blood products and Vit K
Paracentesis 
EVL banding
Sclerotherapy 
Balloon tamponade
TIPS procedure