Nursing Care Plan for Hepatic Cirrhosis / Liver Cirrhosis

Hepatic cirrhosis is a chronic disease of the liver with inflammation and liver fibrosis which results in the distribution of hepatic structures and loss of most liver function. Major changes that occur due to cirrhosis are the death of liver cells, the formation of fibrotic cells (mast cells), cell regeneration and scar tissue that replaces normal cells (Baradero, 2008).According to Black (2014) liver cirrhosis is a progressive chronic disease characterized by extensive fibrosis (scar tissue) and nodule formation. Cirrhosis occurs when the normal flow of blood, bile and hepatic metabolism is altered by fibrosis and changes in hepatocytes, bile ducts, vascular pathways and reticular cells.

Cirrhosis is the final stage in many types of liver injury. Cirrhosis of the liver usually has a nodular consistency, with bundles of fibrosis (scar tissue) and small areas of tissue regeneration. There is extensive damage to hepatocytes. Changes in heart shape change the flow of the vascular and lymphatic systems and bile duct pathways. The exacerbation period is characterized by static bile, jaundic deposits (Black & Hawks, 2014).

According to Nurdjanah (2014), the causes of cirrhosis are various,
sometimes more than one cause is in one sufferer. Chronic alcoholism with the hepatitis C virus is a common cause. Whereas Black (2014) argues, the cause of cirrhosis has not been clearly identified, although the relationship between cirrhosis and excessive alcohol consumption has been established.
The tendency of families with genetic predisposition, as well as hypersensitivity to alcohol, is seen in alcoholic cirrhosis.

Rubenstein, Wayne, and Bradley (2007) divide hepatic cirrhosis
in several classifications, namely:
1. Micronodular (portal cirrhosis) characterized by a regular thick fibrotic band that connects portal vessels with the hepatic vein, and is accompanied by small regenerative nodules. The liver initially enlarges with a flat edge but eventually shrinks due to progressive fibrosis. Often caused by alcohol.
2. Macronodular (pascanekrotik cirrhosis) is less common and is characterized by a band of fibrosis that is rough and irregular and has a normal architecture and large regenerative nodules. This type is believed to usually occur after viral hepatitis accompanied by extensive necrosis. The liver enlarges and the shape is not very regular due to the size of the nodules.
3. Billiary cirrhosis is more rare and is characterized by a widening of the fibrosis around the intrahepatic duct. May occur after chronic cholangitis and biliary obstruction, or idiopathic (primary).
4. Primary biliary cirrhosis progresses damage to the duct
intrahepatic biliary. Especially (90%) regarding women between 40-60 years, and the main complaint is signs of choleastatis: pruritus, jaundice, accompanied by pale stools, dark urine, and steatorrhoea, pigmentation, and xanthelasma.

Usually patients complain of pruritis, dark urine, size
waist circumference increases, decreases appetite and decreases
weight, jaundice (yellow on the skin and eyes) appears
later.

Classic signs that are often encountered include: red palms, blood vessel dilation, gynecomastia is not a specific sign, increased prothrombin time is a more typical sign, hepatic encephalopy with acute fulminant hepatis can occur in a short time and the patient will feel sleepy, delirium , convulsions, and coma within 24 hours, the onset of hepatic encephalopathy with chronic liver failure is slower and weaker (Elin, 2009 cited by Nurarif & Kusuma, 2015).

Current Health History
Usually the client complains of weakness, weak muscles, anorexia (difficulty eating), nausea, bloating, the patient feels bad stomach, decreased weight, complains that the stomach is getting bigger, bleeding in the gums, urination disorders (urinary incontinence), defect disorder (constipation / diarrhea), also shortness of breath.

Previous Medical History
Is there a history of alcohol consumption?
Is there a history of chronic hepatitis before?
Is there a history of left / right heart failure?
Is there a history of drug use, smoking?

Childhood Health History
Ask if there are family members who suffer from hepatitis / cirrhosis?

Physical Examination
Assess for lethargy, ascites, dyspnea, assess for hepatic enlargement (hepatomegaly), assess for edema in the entire body, assess for dry and jaundiced skin, assess for gums bleeding. Assess for palmar erythema, pruritus, tremor, spider nevi, caput medusae, esophageal varices, hematemesis and melena, testicular atrophy, gynecomastia (Wijaya, 2013).

7 Nursing Diagnosis and Intervention for Cirrhosis