Liver Cirrhosis Concept Map

Liver Functions (Normal)

• Stores vitamins A, D, E, K, B12, zinc, iron, magnesium

• Produces insulin (carb metabolism → glycogen storage)

• Converts ammonia → urea

• Excretes bilirubin

• Synthesizes bile for fat digestion

• Produces prothrombin (clotting)

• Detoxifies drugs/alcohol

What causes ascites in cirrhosis?

Low albumin & decreased oncotic pressure → fluid leaks into peritoneal cavity

Key cues of ascites?

↑ Abdominal girth, shortness of breath

Nursing actions for ascites?

• Daily weight & abdominal girth

• Low-sodium diet

• Diuretics (monitor K⁺)

• Elevate HOB 30° (so they an breath)

• Paracentesis: empty bladder before (could accidentally puncture bladder), upright position, do not drain >1L at a time (draws fluid out)

Complication of portal hypertension?

Esophageal varices → hematemesis, melena

Nursing actions for varices?

• Assess for bruising, hematemesis, melena

• Bleeding & fall precautions

• Administer platelets/FFP, beta blockers (propranolol), vasopressin

• Manage NG tube

What causes hepatic encephalopathy?

↑ Ammonia → altered LOC, coma

Nursing actions for encephalopathy?

• Monitor ammonia, LOC

• Administer lactulose & neomycin

• Avoid constipation, analgesics, sedatives

• Small frequent meals, high fiber, moderate protein

What causes jaundice in cirrhosis?

Damaged liver cells or blocked bile ducts → ↑ bilirubin

Symptoms of biliary obstruction?

Jaundice, scleral icterus, pruritis

Nursing actions for biliary obstruction?

Cool room, corticosteroid cream, cool showers, SSRIs (sertraline)

Why do cirrhosis patients bruise easily?

Decreased vitamin K, prothrombin → poor clotting

Coagulation Impairment: Nursing actions?

Monitor bruising, bleeding, transfuse platelets/FFP as ordered

Why is perfusion affected?

Hypovolemia from bleeding/ascites decreases perfusion

Perfusion & Oxygenation: Nursing actions?

• Rest between activity

• O₂ therapy, monitor BP

• Elevate HOB (if they lie flat its bad blood clots)

What is Spontaneous Bacterial Peritonitis (SBP)?

Infection of ascitic fluid

Cues of SBP?

• Fever

• Chills

• Abdominal pain

• Rgid abdomen

• ↓ bowel sounds

• Altered LOC

SBP: Nursing actions?

Obtain ascitic fluid culture, administer antibiotics (cefotaxime)

What causes hepatorenal syndrome?

Hypovolemia from ascites → ↓ renal perfusion

Hepatorenal Syndrome: Cues?

Oliguria (<500 mL/24 hr), ↑ BUN/creatinine, ↓ urine sodium, ↑ urine osmolarity

Hepatorenal Syndrome: Nursing actions?

Monitor O₂ sat, elevate HOB & feet, use elastic stockings

What diet is recommended for cirrhosis?

Soft, high-protein, low-fat diet, small frequent meals

Nutrition: Why supplement vitamins?

Impaired storage → IV/IM vitamins may be required (1st PASS EFFECT)

What should cirrhosis patients avoid due to drug toxicity risk?

Hepatotoxic drugs (ex: NO acetaminophen)

What should the nurse do before giving hepatotoxic drugs?

Obtain liver function tests (LFTs) to assess safety

• Life over limb*

Why should patients discuss herbs, supplements, and OTC drugs with their provider?

Many are hepatotoxic and can worsen liver damage

What is the preferred method of drug administration with a cirrhosis patient?

IV (intravenous) route — it bypasses the liver’s impaired first-pass metabolism, providing more predictable absorption and reducing risk of toxicity.