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Managing Liver Cirrhosis:
Reducing Ammonia Levels and
Preventing Complications
Liver
Interventions to Decrease Ammonia Levels in Clients with
End-Stage Cirrhosis and Encephalopathy
The nurse should plan to reduce the client's intake of protein to help decrease the client's ammonia level. Ammonia is formed in the gastrointestinal tract by the action of bacteria on protein. Limiting dietary protein intake can assist with decreasing the client's ammonia level. Protein is necessary for healing, so strict limitation of dietary protein is not recommended. Diuretics, restricting fluid intake, and administering vitamin K do not help to decrease a client's ammonia level.
Causes of Liver Cirrhosis
Chronic alcohol use disorder is one of the primary causes of cirrhosis of the liver. Chronic ingestion of caffeine, cocaine, and inhalants are not associated with liver cirrhosis.
Expected Laboratory Findings in a Client Receiving
Spironolactone for Liver Failure with Ascites
The nurse should expect a decreased sodium level. Spironolactone is a potassium-sparing diuretic that inhibits the action of aldosterone, resulting in an increased excretion of sodium. The nurse should not expect a decreased phosphate, potassium, or chloride level. Spironolactone inhibits the action of aldosterone, resulting in the retention of these electrolytes.
Indicators of Gastrointestinal Bleeding in a Client with
Liver Cirrhosis
An elevated blood urea nitrogen (BUN) indicates that the client's gastrointestinal (GI) tract is digesting and absorbing blood. Elevated HbA1c and decreased chloride are not indicators of GI bleeding. Bilirubin levels rise with cirrhosis and with hemolysis of red blood cells.
Dietary Considerations for a Client with Cirrhosis
Prescribed Bumetanide
The nurse should identify a baked potato as an appropriate item for the client's lunch tray, as it contains a high amount of carbohydrates. The nurse should identify stewed tomatoes as a contraindicated item, as they are high in potassium, and clients prescribed loop diuretics like bumetanide are at risk for potassium depletion. The nurse should identify a ham sandwich as a contraindicated item, as it is high in sodium and can increase fluid retention, leading to edema. The nurse should identify a milkshake as an appropriate item, as the client with cirrhosis requires a diet high in protein.
Nursing Actions for a Client with Cirrhosis of the Liver
The nurse should administer furosemide to the client to reduce fluid accumulation in the abdomen. The nurse should implement a low-sodium diet to control fluid accumulation in the abdomen. The nurse should measure the client's abdominal girth, as this is an indicator of fluid accumulation. The nurse should avoid administering warfarin to the client due to possible destruction of platelets caused by splenomegaly, which can result in spontaneous bleeding. The nurse should avoid encouraging weight lifting during physical therapy, as this can cause bleeding.
Stages of Grief in a Client with End-Stage Liver Cancer
The statement "I can't believe the doctor graduated from medical school" is an example of the anger stage of the grief process. The statement "This can't be happening to me" is an example of the denial stage of the grief process. The statement "I just want to sleep all the time" is an example of the depression stage of the grief process.
Self-Management Instructions for a Client with Hepatitis B
The nurse should instruct the client that clients who contract hepatitis are restricted from donating blood, body organs, or tissue for the remainder of their life. The nurse should recommend a diet high in carbohydrates and moderate in protein and fat, as the liver's ability to metabolize protein by-products is impaired. The nurse should recommend the client rest frequently throughout the day to reduce the metabolic demands upon the liver and decrease energy demands. The nurse should instruct the client to contact their provider before taking any medication, nutritional supplement, vitamin, or herbal preparation, as medications that must be metabolized by the liver, such as acetaminophen, are avoided.
Care Plan for a Client with Viral Hepatitis
Diet : The client should consume a diet high in carbohydrates and protein in moderation to promote healing. Medication : The client should avoid acetaminophen, which is metabolized in the liver, and instead receive antiviral medication. Fluid intake : The client should not have their fluid intake restricted unless other medical conditions warrant it. Activity : The client should alternate between activity and rest.
Care for a Newborn Whose Mother is Hepatitis B Surface
Antigen Positive
A newborn whose mother is positive for the hepatitis B surface antigen should receive both the hepatitis B vaccine and the hepatitis B immune globulin within 12 hours of birth.
Care for a Client with Hepatitis B
The nurse should encourage a client with hepatitis B to consume a diet high in carbohydrates and not restrict their fluid intake unless other medical conditions warrant it. The nurse should also administer antiviral medication and encourage the client to alternate between activity and rest.
Handling Needles when Administering Injections to a
Client with Hepatitis C
When administering an IM injection to a client with hepatitis C, the nurse should immediately place the uncapped needle in a puncture-resistant container to prevent a needle stick with the contaminated needle.
Precautions for a Client with Hepatitis C
The nurse should implement standard precautions when in contact with the client's blood, body fluids (except sweat), broken skin, and mucous membranes. The nurse should wear additional personal protective equipment if there is a possible risk of blood contact or splashes or sprays of blood or body fluids.
Assessing Risk Factors for Hepatitis C
A client who has multiple tattoos is at risk for developing hepatitis C due to the potential for blood-to-blood contact from improperly maintained tattoo equipment.
Medication for a Client with Cirrhosis and Prolonged
Prothrombin Time
A client with cirrhosis and a prothrombin time of 30 seconds, indicating a prolonged clotting time and increased risk of bleeding, should receive
vitamin K. Vitamin K injection increases the synthesis of prothrombin by the liver, which can help improve the client's clotting ability.
Liver
Cirrhosis
Expected Findings in Clients with Cirrhosis
Dry skin is an expected finding for a client who has cirrhosis. Spider angiomas, which are lesions with a red center and numerous extensions that spread out like a spider web, are an expected finding for a client who has cirrhosis. Clay-colored stools are an expected finding for a client who has cirrhosis. Dark-colored, foamy urine is an expected finding for a client who has cirrhosis.
Manifestations of Advanced Cirrhosis
Petechiae due to impaired coagulation from a dysfunctional liver is a manifestation of advanced cirrhosis. Clients with advanced cirrhosis will experience hypotension, not hypertension. Clients with advanced cirrhosis will develop osteoporosis, especially with primary biliary cirrhosis, not osteoarthritis. Peripheral ulcers are a manifestation of atherosclerosis, not cirrhosis.
Causes of Cirrhosis
Excessive alcohol consumption can cause liver cirrhosis. Hepatitis C can cause liver cirrhosis. Hepatotoxic medications can cause liver cirrhosis. Prolonged obstruction of the common bile duct is the most common cause of biliary cirrhosis.
Role of Lactulose in Cirrhosis
In clients with cirrhosis, lactulose is used to decrease levels of ammonia in the bloodstream. Accumulation of ammonia in the bloodstream, which occurs in pathologic conditions of the liver, such as cirrhosis, may affect the central nervous system, causing hepatic encephalopathy or coma.
Nursing Care for Clients with Cirrhosis and Ascites
The nurse should restrict fluids for a client who has cirrhosis and ascites due to the client's risk for increased fluid retention.
