TEACHING PRACTICE

ON
CIRRHOSIS OF LIVER

SUBMITTED TO:
Mrs. Simranjit Kaur
Assistant Professor
M.Sc (Child Health Nursing)

SUBMITTED BY:
Jatinder Kaur
M.Sc 2nd Year (Child Health
Nursing)
Adarsh College Of Nursing, Patiala
 BIODATA

Title of the course : Teaching Practice

Name of the Student teacher : Jatinder kaur

Subject : Pediatric Nursing

Topic : Cirrhosis Of Liver

Duration : 45 min

Date and Time : 07 /01 /2021

Place : M.Sc.(N) 2nd Year Classroom

Group of Student : M.Sc. (N)2nd yr

Method Of Teaching : Lecture cum discussion

Av Aids : Chalk Board, Power Point Presentation

Previous Knowledge

Students have some knowledge regarding Cirrhosis of Liver, Causes and its nursing
management.

GENERAL OBJECTIVE:

At the end of the class the students will be able to understand the definition, causes and
management of Cirrhosis of liver.

SPECIFIC OBJECTIVES:

At the end of the class, the students will be able to:

 Define cirrhosis of liver

 Enlist the causes of cirrhosis of liver
 Expain the pathophysiology.
 Describe the menifestations of cirrhosis of liver.
 illustrate the diagnostic evaluation.
 Explain the nursing management.
S.NO TIME SPECIFIC CONTENT TEACHING LEARNING AV AIDS EVALUATION
OBJECTIVE ACTIVITY ACTIVITY
To introduce
01 1 min self & topic. INTRODUCTION P.P.T
I am jatinder kaur student of M.Sc nursing 2 nd year
today I am discuss about the topic of cirrhosis of
liver.

02 2 min To Define the DEFINITION :- Lecture cum Listening P.P.T What is

Cirrhosis of Cirrhosis refers to the replacement of normal liver discussion And chalk Cirrhosis of
Liver. tissue with non-living scar tissue. It is always related board liver?
to other liver diseases.

03 5 min To Enlist CAUSES Lecture cum Listening P.P.T Describe causes

causes of Viral or autoimmune hepatitis: This disease discussion And chalk of cirrhosis of
cirrhosis of appears to be caused by the immune system and board liver?
liver. inflammatory responses by attacking the liver and
causing damage, and eventually scarring of the
liver tissues.

Bile ducts obstruction: The duct that carry the bile

out of the liver blocked, bile backs up and demage
liver tissue.

Drugs and toxin: Prolonged exposure to drugs and

environment toxins can lead to hepatic cell damage.
 Genetic disorder: It also can result from inherited
disease like cystic fibrosis, hemophilia, wilson
disease etc. Cirrhosis is a progressive disease,
developing slowly over many years, until
eventually it can stop liver function

04. 5min To explain the PATHOPHYSIOLOGY:- Lecture cum Listening P.P.T, Explain the
Pathophysiolo discussion chart pathophysiology
gy of of Cirrhosis of
Cirrhosis of Primary event is injury to hepatocellular elements liver?
liver

Initiates inflammatory response with cytokine

release ( toxic substances

Destruction of hepatocytes, bile duct cells,vascular

endothelial cells

Repair through cellular proliferation and

regeneration

Formation of fibrous scar

S.NO TIME SPECIFIC CONTENT TEACHING LEARNING AV AIDS EVALUATION
OBJECTIVE ACTIVITY AVTIVITY

05 7min To enlist the CLINICAL MANIFESTATIONS OF Lecture cum Listening P.P.T and What are the
clinical CIRRHOSIS OF LIVER discussion Chalk clinical
manifestation board manifestation of
of Cirrhosis  Hypoxemia cirrhosis of
of liver  Jaundice liver?
 Poor growth and development

Children with cirrhosis also Many children show no

obvious signs of cirrhosis early on - though the
medical condition which is causing the liver
damage is often known to the family or has its own
set of symptoms. As the scarring progresses,
children may have the following general symptoms:

 Nausea, loss of appetite, vomiting

 Weight loss (“failure to thrive” in babies)
 Weakness
 Abdominal pain and swelling
 Spider-like blood vessels on the skin
 Impaired intra hepatic blood flow
 Ascitis
 Edema
 GI bleeding
 Anemia

bruise and bleed easily and be more susceptible to

infection than other kids.
 CONTENT
S.NO TIME SPECIFIC TEACHING LEARNING AV AIDS EVALUATION
OBJECTIVE ACTIVITY AVTIVITY

06 6min To illustrate DIAGNOSTIC EVALUATION:- Lecture cum Listening P.P.T What are the
the diagnostic History of illness and physical examination to discussion And chalk diagnostic
evaluation of exclude clinical features help to diagnose the board evaluation of
cirrhosis of condition clinically. Laboratory investigations to cirrhosis of
liver. confirm the diagnosis may include the followings: liver?

 CT scan or ultrasound ,MRI: show

shrinkagew or abnormal appearance of the
liver.
 Laboratory studies: bilirublin, albumin,
alanine transaminase, aspartate
transaminase, prothrombin time, serum
ammonia,
 Laparoscopy and liver biopsy : direct
visualization of the liver, analyzing a
sample of liver tissue removed via a thin
needle inserted into the liver.
 Paracentesis: To examine ascetic fluid for
cell, protein and bacterial counts.
 Esophagoscopy: To determine the presence
of esophageal varices.
07 15min To explain the NURSING MANAGEMENT:- Lecture cum Listening P.P.T What is the
nursing discussion nursing
management ASSESSMENT: monitor vital signs, intake and management of
of cirrhosis output and electrolyte levels to determine fluid Cirrhosis of
of liver. volume status. Monitoring the child’s weight on liver?
daily and weekly basis and recording intake and
output can provide critical information about edema
and growth. To assess fluid retention , measure and
record abdominal girth every shift.
Observe and document for bleeding gums,
epistaxis,skin jaundice. Inspect stools for amount ,
colour and consistency. Test stools and vomitus for
occult blood as order.
Watch for sign of anxiety, epigastric fullness,
restlessness and weakness.

PSYCHOLOGICAL SUPPORT : observe closly

for signs of behavioural changes. Report increasing
stupor, lethargy, hallucination etc. watch for
asterixis (also called liver flap).

NUTRITIONAL SUPPORT: As the liver is

responsible for metabolisim, malnutrition in
children and failure to thrive in infants is
commonly obsereved. Nutritional management is
essential to promote recovery from disease,
optimise preparational for liver transplantation. The
diet needs to be high carbohydrates, normal protein,
high calorie and low fat. Restrict sodium and fluid
intake as prescribed.
 VITAMIN SUPPORT: In children with
cholestasis, fat soluble vitamin absorption is
severely affected. Even with vigilant monitoring of
levels and deficiency can occure specially if the
child has chronic liver disease. All children with
jaundice will require fat soluble vuitamin
supplementation and dosing is likely to be
significantly higher than what is generally
recommended.

SKIN CARE: Pruitus is intense itching caused by

the irriation of the cutaneous sensory nerves,
probably by retained bile salts. Treatments inculde
pharamacological and complementary therapies,
like coloidal oatmeal baths and calamine lotion are
used for temporary relief. Drugs are not usually
used as impaired liver function affects metabolism
of drugs. Keeping nails trimmed short and use of
cotton gloves during sleep can minimize damage to
the skin from scratching. Caring the brusing can
prevent further complication.

08 2min To summarize SUMMARIZATION:

the topic. Today we have discussed:

 Define cirrhosis of liver

 Enlist the causes of cirrhosis of liver
 Explain the pathophysiology.
 Describe the menifestations of
 cirrhosis of liver.
 Illustrate the diagnostic evaluation.
 Explain the nursing management.

2min To
RECAPITALIZATION :
recapitalize
the topic
 What is definition of Cirrhosis of liver?
 What is the etiology of Cirrhosis of liver?
 What is pathophysiology of Cirrhosis of
liver?
 What are the sign and symptoms of
Cirrhosis of
 liver ?
 What are the diagnosis of Cirrhosis of
liver ?
 What is the Nursing management of
Cirrhosis of
 liver ?
BIBLIOGRAPHY:-

-Marlow R.Dorothy. Textbook of Pediatric

Nursing. Sixth edition. Elsevier publishers, 2007,
Page numb 834-839.

-sarkar subrata, Pediatric Nursing,

First edition. jaypee brothers medical
publisher.2018. page no. 283-284.

- Datta Parul. Essential of Pediatric nursing. Third

edition.Japee Brothers Medical publishers, 2014,
page numb 344-346 .