Editing Medical-Surgical Nursing (section)

=== Liver Disease ===

Cirrhosis is diffuse fibrosis with loss of hepatocyte function and portal hypertension. Findings include jaundice, ascites, splenomegaly, caput medusae, spider angiomas, palmar erythema, easy bruising and prolonged prothrombin time from impaired clotting factor synthesis, hypoalbuminemia with edema, and hepatic encephalopathy with asterixis and altered mentation from accumulated ammonia.

Nursing interventions: monitor abdominal girth and daily weight, restrict sodium, give lactulose titrated to produce two to three soft stools per day to eliminate ammonia, protect fragile skin, monitor for bleeding, avoid hepatotoxic drugs including acetaminophen beyond prescribed limits and alcohol, and assist with paracentesis, checking that the bladder is emptied first and monitoring for hypotension afterward.

Nursing application: esophageal varices are the most dangerous complication. Sudden hematemesis with hypotension and tachycardia is a life-threatening hemorrhage requiring immediate airway protection, large-bore intravenous access, volume resuscitation, and emergent endoscopy. Teach the patient to avoid straining, coughing forcefully, and heavy lifting.

Viral hepatitis A and E spread by the fecal-oral route; hepatitis B, C, and D spread by blood and body fluids. Hepatitis B has a vaccine and is a required occupational health protection for nurses; hepatitis C has no vaccine but has highly effective antiviral treatment.