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INTRODUCTION

Chronic Liver Disease

Cirrhosis is defined histologically as a diffuse hepatic process characterized by fibrosis


and conversion of the normal liver architecture into structurally abnormal nodules. The
progression of liver injury to cirrhosis may occur over weeks to years.

Cirrhosis is when scar tissue replaces healthy liver tissue. This stops the liver from working
normally. Cirrhosis is a long-term (chronic) liver disease. The damage to your liver builds up
over time. The liver is your body’s largest internal organ. It lies up under your ribs on the right
side of your belly. The liver does many important things including: Removes waste from the
body, such as toxins and medicines, Makes bile to help digest food, Stores sugar that the body
uses for energy, makes new proteins. When you have cirrhosis, scar tissue slows the flow of
blood through the liver. Over time, the liver can’t work the way it should.In severe cases, the
liver gets so badly damaged that it stops working. This is called liver failure.

Signs and symptoms

Some patients with cirrhosis are completely asymptomatic and have a reasonably normal life
expectancy. Other individuals have a multitude of the most severe symptoms of end-stage liver
disease and a limited chance for survival. Common signs and symptoms may stem from
decreased hepatic synthetic function (eg, coagulopathy), portal hypertension (eg, variceal
bleeding), or decreased detoxification capabilities of the liver (eg, hepatic encephalopathy).

Portal hypertension

Portal hypertension can have prehepatic, intrahepatic, or posthepatic causes. Budd-Chiari


syndrome, a posthepatic cause, is characterized by the following symptoms:
 Hepatomegaly
 Abdominal pain
 Ascites
Ascites is suggested by the following findings on physical examination:
 Abdominal distention
 Bulging flanks
 Shifting dullness
 Elicitation of a "puddle sign" in patients in the knee-elbow position

Additional signs and symptoms

Many patients with cirrhosis experience fatigue, anorexia, weight loss, and muscle wasting.
Cutaneous manifestations of cirrhosis include jaundice, spider angiomata, skin telangiectasias
("paper money skin"), palmar erythema, white nails, disappearance of lunulae, and finger
clubbing, especially in the setting of hepato pulmonary syndrome.

Statistics

Studies show by Department of health that Liver cirrhosis and Liver cancer is the 3rd
leading sites for both sexes. It rank 2nd among males and 9th among females. In 1998, an
estimated 5,249 new cases, 3,906 cases in males and 1,343 cases in females, and about 4,403
deaths are expected to occur every year. The incidence in males is practically 2 ½ that of
females. Incidence increases at age 40.

Global world observatory shows that Alcohol consumption is estimated to cause from
20% to 50% of cirrhosis of the liver, epilepsy, poisonings, road traffic accidents, violence and
several types of cancer
We, the 4AN1 Nursing students, from the University of Makati, College of Allied Health
Studies-Center of Nursing had a clinical rotation at the Ospital ng Makati last for 2 weeks
and we decided to choose this case Chronic liver disease, which typically means a diffuse
hepatic process characterized by fibrosis and conversion of the normal liver architecture
into structurally abnormal nodules. This case will give us a broad knowledge regarding
said diagnosis. This study will also enable us to provide proper nurse-client interaction.
During our surgery ward exposure, we were able to collate data and build rapport to our
client. This study will not be possible without the collaboration, teamwork, hard work
and patience of each member of the group, as well as with the aid of our clinical
instructors. We assure that all the combined ideas that we learned and gathered for and
from this said study will be a benefit for all of us. This said study will be our avenue for
honing our skills and will be a preparation for us in becoming a globally competitive
nurse in the future.
OBJECTIVES

General Objective:
The case study aims to acquire information about chronic liver diseases and to apply such
knowledge for optimum level of nursing care practice.

Specific Objectives:
Knowledge:

 Know the signs and symptoms of chronic liver disease.


 Be aware of the diagnostic exams and treatment of chronic liver disease.
 Improve the use of the nursing process that would include assessment, diagnosis,
planning, implementation and evaluation into a more useful and more effective in doing
the patient’s nursing care plan.
Skills:

 Assess the condition of the patient by establishing rapport, gathering all vital information
and determining client’s past and present health history.
 Prioritize things that are essential in assessing and developing proper interventions in
treating or alleviating the illness.
 Perform nursing interventions in an accurate and sequential manner.

Attitude:

 Apply the core and fundamental systematic approach of the nursing profession in
promoting health unto the clients.

 Apply virtues or positive traits as a health care provider, to think and act in ways that are
good and to do what is morally right.
DISCHARGE INSTRUCTIONS:

Seek care immediately if:


 You have pain during a bowel movement and it is black or contains blood.
 You have a fast heart rate and fast breathing.
 You are dizzy or confused.
 You have severe pain in your abdomen.
 You have trouble breathing.
 Your vomit looks like it has coffee grinds or blood in it.

Contact your healthcare provider if:


 You have a fever.
 You have red or itchy skin.
 You are in pain and feel weak.
 You have questions or concerns about your condition or care.

Medicines::
 Antiviral medicine may be needed if your cirrhosis is caused by hepatitis. Antiviral
medicine may prevent or decrease swelling and damage to your liver.
 Blood pressure medicine is used to treat high blood pressure in the portal vein (the vein
that goes to your liver).
 Diuretics decrease extra fluid that collects in a part of your body, such as your legs and
abdomen. Diuretics can also decrease your blood pressure. You will urinate more often
when you take this medicine.
 Antibiotics help prevent or treat a bacterial infection.
 Take your medicine as directed. Contact your healthcare provider if you think your
medicine is not helping or if you have side effects. Tell him or her if you are allergic to
any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the
amounts, and when and why you take them. Bring the list or the pill bottles to follow-up
visits. Carry your medicine list with you in case of an emergency.

Do not drink alcohol:

Alcohol will cause more damage to your liver.

Manage cirrhosis:
 Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause blood
vessel and lung damage. Ask your healthcare provider for information if you currently
smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine.
Talk to your healthcare provider before you use these products.
 Eat a variety of healthy foods. Healthy foods include fruits, vegetables, whole-grain
breads, low-fat dairy products, beans, lean meat, and fish. Ask if you need to be on a
special diet.
 Reach or maintain a healthy weight. You may develop fatty liver disease if you are
overweight. Ask your healthcare provider for a healthy weight for you. He can help you
create a safe weight loss plan if you are overweight.
 Limit sodium (salt). You may need to decrease the amount of sodium you eat if you have
swelling caused by fluid buildup. Sodium is found in table salt and salty foods such as
canned foods, frozen foods, and potato chips.
 Drink liquids as directed. Ask how much liquid to drink each day and which liquids are
best for you. For most people, good liquids to drink are water, juice, and milk. Liquids
can help your liver work better.
 Ask about vaccines. You may have a hard time fighting infection because of cirrhosis.
Vaccines help protect you against viruses that can cause diseases such as the flu or
hepatitis. Viral hepatitis is caused by a virus that leads to inflammation of the liver. You
may need a hepatitis A or B vaccine. You may also need a pneumonia vaccine. Always
get a flu vaccine each year as soon as it becomes available.
 Ask about medicines. Some medicines can harm your liver. Acetaminophen is an
example. Talk to your healthcare provider about all your medicines. Do not take any
over-the-counter medicine or herbal supplements until your healthcare provider says it is
okay.
EVALUATION
Through the assessment and data gathering, certain problems and needs of the client were
identified. Nursing care plan was established to improve client’s status and recovery. Information
and health teaching not only to the client who is suffering from this condition but also to the
significant other who is interested to be aware in different conditions were imparted which lead
to increase client/ people awareness and knowledge with regards to her condition. We, as student
nurses gained additional information about hemorrhagic stroke including diagnostic examination
and medical management needed and as well as the factors affecting the condition which may
help the group and different people in handling properly this kind of condition that we may
possible encounter again.