RANDALL CRUZ CARIASO

BSN 3B GROUP B4

Liver diseases Management

Treatment for liver disease depends on your diagnosis. Some liver problems can be treated with
lifestyle modifications, such as stopping alcohol use or losing weight, typically as part of a
medical program that includes careful monitoring of liver function. Other liver problems may be
treated with medications or may require surgery.

Treatment for liver disease that causes or has led to liver failure may ultimately require a liver
transplant.

The patient with cirrhosis needs close observation, first-class supportive care, and sound
nutrition counseling.

Promoting Rest
 Position bed for maximal respiratory efficiency; provide oxygen if needed.
 Initiate efforts to prevent respiratory, circulatory, and vascular disturbances.
 Encourage patient to increase activity gradually and plan rest with activity and mild
exercise.

Improving Nutritional Status

 Provide a nutritious, high-protein diet supplemented by B-complex vitamins and others,
including A, C, and K.
 Encourage patient to eat: Provide small, frequent meals, consider patient preferences, and
provide protein supplements, if indicated.
 Provide nutrients by feeding tube or total PN if needed.
 Provide patients who have fatty stools (steatorrhea) with water-soluble forms of fat-
soluble vitamins A, D, and E, and give folic acid and iron to prevent anemia.
 Provide a low-protein diet temporarily if patient shows signs of impending or advancing
coma; restrict sodium if needed.

Providing Skin Care

 Change patient’s position frequently.
 Avoid using irritating soaps and adhesive tape.
 Provide lotion to soothe irritated skin; take measures to prevent patient from scratching
the skin.
Reducing Risk of Injury

 Use padded side rails if patient becomes agitated or restless.

 Orient to time, place, and procedures to minimize agitation.
 Instruct patient to ask for assistance to get out of bed.
 Carefully evaluate any injury because of the possibility of internal bleeding.
 Provide safety measures to prevent injury or cuts (electric razor, soft toothbrush).
 Apply pressure to venipuncture sites to minimize bleeding.

Monitoring and Managing Complications

 Monitor for bleeding and hemorrhage.
 Monitor the patient’s mental status closely and report changes so that treatment of
encephalopathy can be initiated promptly.
 Carefully monitor serum electrolyte levels are and correct if abnormal.
 Administer oxygen if oxygen desaturation occurs; monitor for fever or abdominal pain,
which may signal the onset of bacterial peritonitis or other infection.
 Assess cardiovascular and respiratory status; administer diuretics, implement fluid
restrictions, and enhance patient positioning, if needed.
 Monitor intake and output, daily weight changes, changes in abdominal girth, and edema
formation.
 Monitor for nocturia and, later, for oliguria, because these states indicate increasing
severity of liver dysfunction.

Lifestyle and home remedies

Changing certain lifestyle habits can often help improve your liver health. If you've been
diagnosed with liver disease, your doctor may recommend that you:

 Drink alcohol sparingly, if at all.

 Avoid red meat, trans fats, processed carbohydrates and foods with high-fructose corn
syrup.
 Exercise 30 to 60 minutes around three to four times a week at a moderate intensity.
 Cut calories by 500 to 1,000 calories daily, if you're overweight.
 Prepare for discharge by providing dietary instruction, including exclusion of alcohol.
 Refer to Alcoholics Anonymous, psychiatric care, counseling, or spiritual advisor if
indicated.
 Continue sodium restriction; stress avoidance of raw shellfish.
 Provide written instructions, teaching, support, and reinforcement to patient and family.
  Encourage rest and probably a change in lifestyle (adequate,well-balanced diet and
elimination of alcohol).
 Instruct family about symptoms of impending encephalopathy and possibility of bleeding
tendencies and infection.
 Offer support and encouragement to the patient and provide positive feedback when the
patient experiences successes.
 Refer patient to home care nurse, and assist in transition from hospital to home.

Medical Management
Treatment is designed to remove or alleviate the underlying cause of cirrhosis.

 Diet. The patient may benefit from a high-calorie and a medium to high protein diet, as
developing hepatic encephalopathy mandates restricted protein intake.
 Sodium restriction.is usually restricted to 2g/day.
 Fluid restriction. Fluids are restricted to 1 to 1.5 liters/day.
 Activity. Rest and moderate exercise is essential.
 Paracentesis. Paracentesis may help alleviate ascites.
 Sengstaken-Blakemore or Minnesota tube. The Sengstaken-Blakemore or Minnesota tube
may also help control hemorrhage by applying pressure on the bleeding site.

Pharmacologic Therapy
Drug therapy requires special caution because the cirrhotic liver cannot detoxify harmful agents
effectively.

 Octreotide. If required, octreotide may be prescribed for esophageal varices.

 Diuretics. Diuretics may be given for edema, however, they require careful monitoring
because fluid and electrolyte imbalance may precipitate hepatic encephalopathy.
 Lactulose. Encephalopathy is treated with lactulose.
 Antibiotics. Antibiotics are used to decrease intestinal bacteria and reduce ammonia
production, one of the causes of encephalopathy.

Surgical Management
Surgical procedures for management of hepatic cirrhosis include:

Transjugular intrahepatic portosystemic shunt (TIPS) procedure. The TIPS procedure is

used for the treatment of varices by upper endoscopy with banding to relieve portal hypertension.
Nursing Management
Nursing management for the patient with cirrhosis of the liver should focus on promoting rest,
improving nutritional status, providing skin care, reducing risk of injury, and monitoring and
managing complications.

Assessment of the patient with cirrhosis should include assessing for:

 Bleeding. Check the patient’s skin, gums, stools, and vomitus for bleeding.
 Fluid retention. To assess for fluid retention, weigh the patient and measure abdominal
girth at least once daily.
 Mentation. Assess the patient’s level of consciousness often and observe closely for
changes in behavior or personality.

PERSONAL COMMENTS:
Liver diseases are complex topic, wherein It includes multiple diseases such as hepatitis A,B,C
and etc. The liver is responsible for certain vital functions that keep us alive. You can't survive without a
liver entirely, it’s main job is to filter the blood coming from the digestive tract, before passing it to the
rest of the body. The liver also detoxifies chemicals and metabolizes drugs. As it does so, you can live for
just a portion of it. For just under half of their liver, many people can act normally. Your liver will also
recover its original size in a matter of months.