Sgrillo and Daniels nursing cirrhosis is “focused on increasing patient comfort; monitoring daily weights, intake and output, and serum electrolytes; and preparing the patient for a paracentesis” (2014). To promote effective breathing, keep the head of bed elevated and position the patient on sides according to the comfort level. This ease respiration by decreasing pressure on the diaphragm and reduces risk of aspiration of secretions. Encourage the patient for frequent repositioning and deep-breathing exercises and coughing exercises. This helps in lung expansion.
Auscultate breath sounds, noting crackles, wheezes, rhonchi which may indicate developing complications. Presence of adventitious breath sounds may reflect accumulation of fluids or secretions, and absent or diminished sounds indicates atelectasis. Monitor respiratory rate, depth, and effort. Investigation and notation of changes in level of consciousness as alteration in mental status may reflect hypovolemia, hypoxemia and respiratory failure, which often accompany hepatic coma is essential.
Encourage bedrest as patient has ascites, it promotes recumbency-induced diuresis and decrease shortness of breath caused by physical exertion.
Monitor vital signs as indicated every 4 hours as indicated. An increased pulse with decreased BP can indicate loss of circulating blood volume, requiring further evaluation. Note jugular vein distension and abdominal vein distension. Provide supplemental oxygen when required to treat or prevent hypoxia. Measure intake and output, weigh daily, and note gain of more than 0.5 kg/day is done to assess circulating volume status, developing or resolution of fluid shifts, and response to therapeutic regimen. Weight gain often reflects to continual accumulation of fluid retention.Measure abdominal girth daily, indicates the accumulation of fluid (ascites) resulting from “the increase in collateral circulation to shunt the pressure in portal hypertension causes fluid to migrate into the abdomen” and decreases circulating volume, creating a deficit which is a sign of dehydration (Morrison, Sgrillo & Daniels, 2014).
Provide carbohydrate diet with sodium 2grams and protein 30 grams to include in daily meal plan as indicated.
Sodium is restricted to minimize fluid retention in extravascular spaces. Administer medications as indicated. Diuretics: spironolactone (Aldactone), furosemide (Lasix), Used with caution to control edema and ascites, block effect of aldosterone, and increase water excretion while sparing potassium. Prepare the patient for the procedure: Paracentesis (scheduled for 1630) which is done to remove ascites fluid to relieve abdominal pressure and facilitate ease breathing. Patientis high risk for injury related with abnormal prothrombin time which is 40 seconds and decreased white blood count of 3500/mm3 which is below the normal range. Assessment for signs and symptoms of gastrointestinal bleeding is vital. Observation of color and consistency of stools is essential for identification of bleeding. Because of the mucosal fragility, the esophagus and rectum are the most vulnerable sites for bleeding and alteration in hemostasis associated with Laennec’s Cirrhosis. Observation for presence of petechiae, ecchymosis and bleeding are important for early identification and early management. Use small needles for injections.
Application of pressure to the venipuncture sites for longer than usual is required for the prevention and reducing the risk of bleeding and hematoma. This indicates of anemia, active bleeding, or impending complications. Close supervision for intravenous catheter insertion site with saline locked. Monitor hemoglobin and hematocrit and clotting factors. Patient laboratory result for hemoglobin is 10.6g/dl and hematocrit 30% which are lower than normal. Provide the information to patient about disease process, prognosis and future expectations, emphasizethe importance avoiding alcohol as the patient has history of alcohol abuse. Assist the patient to identify support system and provide psychological support. Providing care for patients with alcoholic liver disease can be very challenging for nurses as patient’s clinical status can deteriorate very rapidly, vigilant nursing assessments and interventions are required along with thorough patient and family education.