1. The client/caregiver has a basic under- standing of the anatomy and physiology of the liver.
   1. The liver is the largest organ of the body and is located in the upper right part of the abdominal cavity.
   2. The liver has multiple functions:
      1. It produces bile, which aids digestion in the intestines.
      2. It stores vitamins A, D, E, K, and B12.
      3. It stores glycogen, releasing it as glucose when needed.
      4. It metabolizes fats, carbohydrates, and protein.
      5. It metabolizes estrogens.
      6. It is very important in the coagulation (blood clotting) process.
      7. It destroys old, red blood cells and removes bacteria and foreign bodies from the blood stream.
2. The client/caregiver can define cirrhosis.
   1. It is the result of chronic liver disease that causes death of liver cells.
   2. The death of cells is replaced by scar tissue and results in liver dysfunction.
3. The client/caregiver is aware of causes of chronic liver disease.
   1. Long-term alcohol abuse (primary cause)
   2. Drug and substance abuse
   3. A history of biliary obstruction and infection
   4. Viral hepatitis infections
   5. Exposure to chemical and industrial toxins
   6. Metabolic disorders such as hemochro- matosis and Wilson’s disease
4. The client/caregiver can recognize signs and symptoms of cirrhosis.
   1. Early symptoms
      • Swelling of legs
      • Vomiting blood
      • Confusion
      • Jaundice (yellow tinted skin)
      • Small red spider-like blood vessels on the skin
      • Weakness and fatigue
      • Weight loss
      • Nausea and vomiting
      • Impotence and loss of interest in sex
      • Itching
      • Ascites (swelling of abdomen)
      • Bleeding hemorrhoids
      • Decreased urine output
      • Pale or clay colored stools
      • Nose bleeds or bleeding gums
      • General bleeding disorders
      • Gynecomastia (breast development in males)
5. The client/caregiver can list measures that prevent or manage cirrhosis.
   1. Abstain from all alcohol.
   2. Avoid over-the-counter drugs.
   3. Plan regular rest periods to decrease demands of the body and increase blood supply to the liver.
   4. Provide adequate skin care to protect from injury and to relieve itching.
      1. Prevent trauma to skin with frequent position changes, pressure-relief devices, and so forth.
      2. Follow good hygiene measures, using soap very sparingly.
      3. Keep fingernails short to prevent irritation from scratching.
      4. Take medications or treatment as ordered to decrease itching.
      5. Use lotions to moisturize skin.
      6. Keep the room temperature cool.
   5. Assess for early signs of fluid retention
      1. Weigh daily.
      2. Measure abdominal girth.
   6. Promote adequate nutrition
      1. Eat small, frequent meals.
      2. Eat foods that are high in calories and carbohydrates.
      3. Eat foods that are low in fats and sodium (check the therapeutic diets chapter).
      4. Proteins may be limited. Monitor ammonia levels.
      5. Adjust texture of foods if mouth or esophagus bleeding.
      6. Take vitamin supplements (especially B vitamins) as ordered.
      7. Sodium and fluids may be restricted by physician to control edema.
   7. Avoid contact with people who are ill to avoid infections and report any early signs of infection.
   8. Report signs of bleeding and minimize possibility of trauma. Avoid forceful nose blowing, avoid straining at stool, use soft toothbrush, and so forth.
   9. Report changes to physician such as any increased edema, fever, rapid weight loss, bleeding of any kind, confusion, personality change, and increased abdominal girth.
   10. Take medications as prescribed and assess for side effects (decreased metabolism increases the risk for toxicity).
   11. Keep follow-up appointments with the physician.
   12. Use a Medic Alert bracelet or card.
6. The client/caregiver is aware of possible complications.
   1. Bleeding esophageal varices
   2. Portal hypertension
   3. Hepatic encephalopathy
   4. Kidney failure
   5. Ascites
   6. Hepatic coma
   7. Mental confusion
   8. Liver cancer
   9. Sepsis

Resources

American Liver Foundation
www.liverfoundation.org

Hepatitis B Foundation
www.hepb.org

Alcoholics Anonymous
www.alcoholics-anonymous.org/

Narcotics Anonymous
www.na.org/

Community support groups

Mental health counseling

References

Ackley, B. J., & Ladwig, G. B. (2006). Nursing diagnosis handbook: A guide to planning care. Philadelphia: Mosby Inc.
Cohen, B. J., & Taylor, J. J. (2005). Memmler’s The Human Body in Health and Disease (10th ed.). Philadelphia: Lippincott Williams & Wilkins.
Lutz, C., & Przytulski, K. (2001). Nutrition and diet therapy. Philadelphia: F. A. Davis Company.
Nutrition made incredibly easy. (2003). Philadelphia: Lippincott Williams & Wilkins.
Perry, A., & Potter, P. (2006). Clinical nursing skills & technique. St. Louis: Mosby Inc.
Taylor, C., Lillis, C., & LeMone, P. (2005). Fundamentals of nursing. Philadelphia: Lippincott, Williams & Wilkins.
Timby, B. K., & Smith, N. C. (2003). Introductory medical-surgical nursing (8th ed.). Philadelphia: J. B. Lippincott Williams & Wilkins.

Credits

Client Teaching Guides for Home Health Care, 2nd ed.
© 2008 Jones and Bartlett Publishers, Inc.
www.jbpub.com