1. PATHOPHYSIOLOGY Cirrhosis is caused by irreversible scarring of the liver caused by chronic inflammation or necrosis; tissue becomes nodular and blocks bile ducts and normal blood flow thru liver; liver enlargement ensues
2. TREATMENT: Drug therapy to prevent bleeding, beta blockers to lower portal pressure; nutrition therapy such as low Na, vitamins and low protein. Paracentesis and diuretics to remove excess volume and improve edema and breathing. Lactulose and ABX
3. Impaired SKin
   1. S/SX
      1. SIGNS/SYMPTOMS
         1. PT FINDINGS
      2. Assess Bilirubin
      3. Assess for itching and scratching
      4. assess for jaundice
      5. assess skin temp
      6. presence of broken skin
   2. NIC
      1. NURSING INTERVENTIONS
         1. PT RESPONSE
      2. apply lotions
      3. discourage scratcing
      4. admin anti-histamines
      5. treat skin lesions
4. Disturbed Sensory Perception
   1. S/SX
      1. SIGNS/SYMPTOMS
         1. PT FINDINGS
      2. Delirium Tremors/Disoriented
      3. Inability to follow commands
      4. Acute intoxication
      5. Hepatic metabolic insufficiency
      6. Hepatic Encephalopathy
      7. End Stage Liver DX
   2. NIC
      1. NURSING INTERVENTIONS
         1. PT RESPONSE
      2. Monitor blood ammonia levels
      3. admin lactulose
      4. low protein diet
      5. dec Intestinal bacteria with ABX
      6. restrain if needed per MD order
      7. protect pt from physical harm
5. Imbalanced Nutrition
   1. S/SX
      1. SIGNS & SYMPTOMS
         1. PT FINDINGS
      2. weight loss
      3. muscle wasting
      4. N & V
      5. Dark Urine
      6. Clay colored stools
   2. NIC
      1. NURSING INTERVENTIONS
         1. PT RESPONSE
      2. Obtain Weight History
      3. Assess intake
      4. Monitor Chem 7, protein, albumin
      5. Admin dietary supp & fat soluble vit
      6. admin antiemetics & H2 blockers
6. Excess Fluid Volume ( ascites & edema)
   1. S/SX
      1. SIGNS & SYMPTOMS
         1. PT FINDINGS
      2. Increased abdominal girth
      3. peripheral edema
      4. taut abdomen
      5. aldosterone imbalance
      6. diuretic use
      7. poor lung expansion
   2. NIC
      1. Assess I & O
         1. PT RESPONSE
         2. & Nsg Interventions
      2. Measure abdomen
      3. Monitor breathing
      4. HOB raised, check Sa02
      5. Restrict Na
      6. Paracentesis or Shunt
      7. Admin diuretics