I. Pathophysiology (Murphy, 2006)
a. Alteration in structure and degenerative changes resulting
from buildup of diffuse bands of fibrotic connective tissue
causing widespread destruction of hepatic cells, impairing
liver function, and impeding blood flow through the liver
b. Compensated cirrhosis: Liver function may continue for some
time, even with significant scarring, but metabolic abnormalities
can occur, such as coagulation defects and malnutrition.
c. Decompensated cirrhosis: progression of failure with
significant complications, such as portal hypertension with
bleeding varices, ascites, peritonitis, hepatorenal syndrome,
a. Rate of progression of fibrosis to cirrhosis varies for
b. Multiple causation (Wolf, 2007)
i. Hepatitis C (26%), B, and D (15%)
ii. Alcoholic liver disease (21%)
iii. Cholestatic diseases: biliary atresia, primary biliary
cirrhosis, cystic fibrosis, primary sclerosing cholangitis
iv. Miscellaneous liver disorders, including autoimmune,
Wilson’s disease, alpha1-antitrypsin deficiency,
v. Injury from trauma, drugs, or other environmental toxins
a. Goals are to slow the progression of the disease and
alleviate the symptoms.
b. Liver transplantation is currently the only life-saving procedure
for end-stage disease.
a. Morbidity: In 2005, 112,000 hospitalizations for chronic
liver disease or cirrhosis; approximately 17,000 individuals
awaiting liver transplant (Scientific Registry of Transplant
Recipients [SRTR], 2007).
b. Mortality: Approximately 35,000 deaths annually due
to chronic liver disease and cirrhosis (Wolf, 2007); in
2005, cirrhosis and other liver disorders were listed
as the 12th leading cause of death in the United States
Client may be hospitalized on a medical unit during initial
or recurrent acute episodes with potentially life-threatening
complications. Otherwise, this condition is managed at the
community, outpatient level.
Alcohol: acute withdrawal,
Substance dependence/abuse rehabilitation,
Fluid and electrolyte imbalances,
Psychosocial aspects of care,
Renal dialysis—general considerations,
Renal failure: acute,
Total nutritional support: parenteral/enteral feeding,
Upper gastrointestinal/esophageal bleeding,
1. Maintain adequate nutrition.
2. Prevent complications.
3. Enhance self-concept and acceptance of situation.
4. Provide information about disease process, prognosis,
potential complications, and treatment needs.
1. Nutritional intake adequate for individual needs.
2. Complications prevented or minimized.
3. Deals effectively with current reality.
4. Disease process, prognosis, potential complications, and
therapeutic regimen understood.
5. Plan in place to meet needs after discharge.