Evidence - Based Practices in Caring Patients with Hepatic Disorders

Submitted by: Antonette Nicole R. Moscoso

Patients With Patients With Patients With Patients With

Compensated and Cirrhosis and Ascites Cirrhosis and GI Cirrhosis and
Decompensated and/or Edema Bleeding Bacterial Infections
Cirrhosis

Compensated Inpatient Care Inpatient Care Inpatient Care

Cirrhosis General measures General measures General measures
● Quantify ● Intravenous ● Start IV
General measures: ascites/edem saline for antibiotic
● Screening for a using 1‐3 volume therapy as
gastroesopha score* resuscitation early as
geal varices ● Confirm and red blood possible after
every 1‐2 patient is on count prescription
years in low‐sodium transfusions if ● Avoid using
patients with diet (< 100 hemoglobin < central IV line
no/small mmol/day) 7 g/dL. unless there
varices ● Start fluid Dextrose are specific
● Screening for restriction if solutions indications for
hepatocellular hyponatremic preferred to its use
carcinoma and/or if saline ● Use
every 6 patient is solutions for prophylactic
months, unable to use initial lactulose or
usually with diuretics due resuscitation lactitol to
ultrasound to kidney in patients have 3‐4
● Screening for dysfunction with ascites or bowel
covert HE at ● Confirm edema movements/d
every clinic monitoring of ● Check blood ay. If there
visit serum tests, are no bowel
● Assessment creatinine and particularly movements,
of electrolytes at hemoglobin, consider
cardiovascula admission regularly cleansing
r risk in and every 2‐4 ● Check for enemas
patients with days possible ● Measures to
NASH‐related ● Check urine infections prevent
cirrhosis sodium in a (e.g., skin, nosocomial
Specific nursing 24‐hour urine, lungs, infections
measures: collection in ascites) Specific nursing
● Regular all patients at ● Start oral or measures
follow‐up with admission rectal ● Insert an IV
standard and during lactulose or line; central
visits or hospitalization enemas to access may
phone calls in those who prevent be necessary
● Support and do not lose hepatic if the patient
 guidance for weight encephalopat is going to be
treatment of ● Start hy dismissed
alcohol use diuretics. ● Nutrition from the
disorder in Recommend support hospital on IV
alcohol‐ large‐volume Specific nursing antibiotics
associated paracentesis measures ● Provide
cirrhosis if large or ● Insert large‐ education
● Control and tense ascites bore about central
counseling of (grade 3) peripheral IV line care,
comorbidities Specific nursing (16‐18 gauge) signs and
associated measures ● Monitor vital symptoms of
with NASH, ● Monitor body signs, infection, and
such as weight and including potential
obesity, urine volume EKG, arterial complications
diabetes daily pressure, and ● Monitor signs
mellitus, ● Monitor heart rate of infection
arterial edema in ● Evaluate frequently
hypertension, extremities mental status (e.g., body
kidney and wrap legs periodically temperature,
dysfunction, as needed ● Monitor urine heart rate)
and/or ● Assist patient volume daily, ● Daily urine
hyperlipidemi with usually by collection is
a application of collection of important to
● Nutritional an abdominal spontaneous identify
and dietary binder if voiding. oliguria
counseling, umbilical Bladder promptly.
particularly in hernia is catheter may Instruct
patients with present be useful in patient/caregi
alcohol and ● Discuss hemodynamic vers to collect
NASH modifications ally unstable urine by
etiologies of diuretic patients spontaneous
● Nursing doses with ● Monitor skin voiding. Avoid
education of physician if pallor and using urinary
patients and weight gain, temperature bladder
caregivers no loss of ● Monitor catheters,
regarding body weight, characteristic except in
complications or decrease > s of emesis or hemodynamic
of cirrhosis 500 g/day for stool if blood ally unstable,
and their early 2 consecutive is present intubated
detection days in (black vs. patients or
patients bright red) patients with
Decompensated without lower ● If varices are severe AKI
cirrhosis limb edema, present, be ● Measure
or > 1 kg in aware of their arterial
General measures: patients with severity while pressure
● Assessment edema placing a frequently. In
of general ● Avoid bladder nasogastric very ill
health status catheter tube patients,
● Liver and ● Avoid use of arterial
renal tests saline Outpatient Care pressure
 measured solutions General measures should be
frequently ● Monitor ● Confirm all monitored at
● Assessment following patients have very short
of candidacy paracentesis an upper GI intervals
for liver for leaks endoscopy at ● Report any
transplantatio and/or diagnosis of significant
n infection from cirrhosis and decrease in
Specific nursing puncture sites at least every mean arterial
measures: ● Repeat 2 years pressure of
● Regular paracentesis afterward, to greater than
follow‐up with is often check for 10 mm Hg.
standard required. presence and Be aware that
visits or ● Administer size of patients with
phone calls 25% albumin gastroesopha advanced
● Standard vital as ordered geal varices cirrhosis are
signs, weight, during or ● Confirm usually
and following compliance hypotensive,
abdominal large‐volume with and
girth paracentesis measures to reductions in
● Nutritional prevent arterial
and dietary Outpatient care bleeding, pressure may
counseling Specific nursing either variceal be difficult to
● Compliance measures band ligation recognize
with diet and ● Educate or beta‐
medications patients and blocker Outpatient Care
● Assessment caregivers on therapy ● Educate
of quality of low‐sodium Specific nursing patients and
life, frailty, diet and measures caregivers on
sleeping alternatives to ● Assess early
habits, salt patients on identification
depression, ● Educate on beta‐blocker of signs of
and anxiety how to therapy for an infection
● Nursing monitor body adequate (particularly
education to weight and beta‐blocker fever,
patients and consult when effect (i.e., abdominal
caregivers on body weight reduction in pain, initial
complications increases > baseline heart signs of HE,
of cirrhosis 500 g/day for rate of 25% to dysuria,
and early at least 3 a value of and/or
detection and consecutive approximately respiratory
signs of days 55‐60 bpm) symptoms).
alarm, ● Explain the ● Educate Patients with
awareness use of patients and these
and diuretics and caregivers on symptoms
prevention of their possible how to should get in
falls, care of side effects identify GI contact with
fragile skin, ● Explain that bleeding, their nurse for
and effects NSAIDs (e.g., particularly advice or, if
and side aspirin, the presence not possible,
effects of ibuprofen) of melena, go to the
 medications must be and how to emergency
avoided and monitor room
educate on arterial ● Check if
alternative pressure and patients have
painkillers heart rate indications for
● Educate on regularly at prophylactic
the care of home antibiotic
skin in therapy and
edematous consult with
legs their
● Nutrition physician
counseling. about its use
Request a
nutritional
consultation
in
malnourished
patients or
patients with
poor
response to
diuretics

Reference(s):

Fabrellas, N., et al. (2020), Nursing Care of Patients With Cirrhosis: The LiverHope
Nursing Project, Retrieved online last 27th of February 2024 from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154704/