Medical Management
Medical management is based on presenting symptoms.
• Treatment includes antacids, vitamins and nutritional sup-
plements, balanced diet; potassium-sparing diuretics (for
ascites); avoidance of alcohol.
• Colchicine may increase the length of survival in patients
with mild to moderate cirrhosis.
Nursing Management
Promoting Rest
• Position bed for maximal respiratory efficiency; provide oxy-
gen if needed.
• Initiate efforts to prevent respiratory, circulatory, and vas-
cular disturbances.
• Encourage patient to increase activity gradually and plan
rest with activity and mild exercise.
Improving Nutritional Status
• Provide a nutritious, high-protein diet supplemented by B-
complex vitamins and others, including A, C, and K.
• Encourage patient to eat: Provide small, frequent meals,
consider patient preferences, and provide protein supple-
ments, if indicated.
• Provide nutrients by feeding tube or total PN if needed.
• Provide patients who have fatty stools (steatorrhea) with
water-soluble forms of fat-soluble vitamins A, D, and E, and
give folic acid and iron to prevent anemia.
• Provide a low-protein diet temporarily if patient shows signs
of impending or advancing coma; restrict sodium if needed.
Providing Skin Care
• Change patient’s position frequently.
• Avoid using irritating soaps and adhesive tape.
• Provide lotion to soothe irritated skin; take measures to pre-
vent patient from scratching the skin.
Reducing Risk of Injury
• Use padded side rails if patient becomes agitated or restless.
• Orient to time, place, and procedures to minimize agitation.
• Instruct patient to ask for assistance to get out of bed.
• Carefully evaluate any injury because of the possibility of
internal bleeding.
• Provide safety measures to prevent injury or cuts (electric
razor, soft toothbrush).
• Apply pressure to venipuncture sites to minimize bleeding.
Monitoring and Managing Complications
• Monitor for bleeding and hemorrhage.
• Monitor the patient’s mental status closely and report
changes so that treatment of encephalopathy can be initi-
ated promptly.
• Carefully monitor serum electrolyte levels are and correct if
abnormal.
• Administer oxygen if oxygen desaturation occurs; monitor
for fever or abdominal pain, which may signal the onset of
bacterial peritonitis or other infection.
• Assess cardiovascular and respiratory status; administer
diuretics, implement fluid restrictions, and enhance patient
positioning, if needed.
• Monitor intake and output, daily weight changes, changes
in abdominal girth, and edema formation.
• Monitor for nocturia and, later, for oliguria, because these
states indicate increasing severity of liver dysfunction.
Promoting Home- and Community-Based Care
Prepare for discharge by providing dietary instruction, includ-
ing exclusion of alcohol.
• Refer to Alcoholics Anonymous, psychiatric care, counsel-
ing, or spiritual advisor if indicated.
• Continue sodium restriction; stress avoidance of raw shellfish.
• Provide written instructions, teaching, support, and rein-
forcement to patient and family.
• Encourage rest and probably a change in lifestyle (adequate,
well-balanced diet and elimination of alcohol).
• Instruct family about symptoms of impending encephalopa-
thy and possibility of bleeding tendencies and infection.
Medical management is based on presenting symptoms.
• Treatment includes antacids, vitamins and nutritional sup-
plements, balanced diet; potassium-sparing diuretics (for
ascites); avoidance of alcohol.
• Colchicine may increase the length of survival in patients
with mild to moderate cirrhosis.
Nursing Management
Promoting Rest
• Position bed for maximal respiratory efficiency; provide oxy-
gen if needed.
• Initiate efforts to prevent respiratory, circulatory, and vas-
cular disturbances.
• Encourage patient to increase activity gradually and plan
rest with activity and mild exercise.
Improving Nutritional Status
• Provide a nutritious, high-protein diet supplemented by B-
complex vitamins and others, including A, C, and K.
• Encourage patient to eat: Provide small, frequent meals,
consider patient preferences, and provide protein supple-
ments, if indicated.
• Provide nutrients by feeding tube or total PN if needed.
• Provide patients who have fatty stools (steatorrhea) with
water-soluble forms of fat-soluble vitamins A, D, and E, and
give folic acid and iron to prevent anemia.
• Provide a low-protein diet temporarily if patient shows signs
of impending or advancing coma; restrict sodium if needed.
Providing Skin Care
• Change patient’s position frequently.
• Avoid using irritating soaps and adhesive tape.
• Provide lotion to soothe irritated skin; take measures to pre-
vent patient from scratching the skin.
Reducing Risk of Injury
• Use padded side rails if patient becomes agitated or restless.
• Orient to time, place, and procedures to minimize agitation.
• Instruct patient to ask for assistance to get out of bed.
• Carefully evaluate any injury because of the possibility of
internal bleeding.
• Provide safety measures to prevent injury or cuts (electric
razor, soft toothbrush).
• Apply pressure to venipuncture sites to minimize bleeding.
Monitoring and Managing Complications
• Monitor for bleeding and hemorrhage.
• Monitor the patient’s mental status closely and report
changes so that treatment of encephalopathy can be initi-
ated promptly.
• Carefully monitor serum electrolyte levels are and correct if
abnormal.
• Administer oxygen if oxygen desaturation occurs; monitor
for fever or abdominal pain, which may signal the onset of
bacterial peritonitis or other infection.
• Assess cardiovascular and respiratory status; administer
diuretics, implement fluid restrictions, and enhance patient
positioning, if needed.
• Monitor intake and output, daily weight changes, changes
in abdominal girth, and edema formation.
• Monitor for nocturia and, later, for oliguria, because these
states indicate increasing severity of liver dysfunction.
Promoting Home- and Community-Based Care
Prepare for discharge by providing dietary instruction, includ-
ing exclusion of alcohol.
• Refer to Alcoholics Anonymous, psychiatric care, counsel-
ing, or spiritual advisor if indicated.
• Continue sodium restriction; stress avoidance of raw shellfish.
• Provide written instructions, teaching, support, and rein-
forcement to patient and family.
• Encourage rest and probably a change in lifestyle (adequate,
well-balanced diet and elimination of alcohol).
• Instruct family about symptoms of impending encephalopa-
thy and possibility of bleeding tendencies and infection.
0 comments:
Post a Comment