Liver Failure Nursing Diagnosis and Nursing Care Plan

Liver Failure Nursing Care Plans Diagnosis and Interventions

Liver Failure NCLEX Review and Nursing Care Plans

The liver is an important body organ that carries out a variety of crucial tasks, such as:

• Production of blood proteins that support the immune system, deliver oxygen, and help in blood coagulation
• Bile production which aid in food digestion
• Glucose storage in the form of glycogen
• Removal of hazardous elements from the bloodstream, such as alcohol and narcotics, from the body
• Cholesterol production and saturated fat breakdown

Liver failure happens when the liver is incapable of carrying out the above functions. Liver failure is a potentially fatal emergency that must be treated immediately.

Elevated liver biochemistry, coagulopathy, and hepatic encephalopathy without underlying chronic liver disease are the hallmarks of acute liver failure (ALF).

Less than 10 cases of ALF occur annually per million people in the developed world. Each year, there are roughly 2800 new cases of ALF in the United States. Young individuals are frequently affected by acute liver failure. It ais also more common in developing nations.

Signs and Symptoms of Liver Failure

Liver failure symptoms may include:

• nausea
• appetite loss
• fatigue
• diarrhea
• jaundice (as manifested by yellow discoloration of skin and eyes)
• weight loss
• easy bleeding or bruising
• pruritus
• edema (as manifested by leg swelling)
• ascites (abdominal fluid accumulation)

These symptoms are nonspecific to hepatic failure and may be associated with other conditions. Some patients with liver failure are asymptomatic until it has progressed to a fatal stage which can manifest as feeling disoriented, drowsy, or slipping into a coma.

Jaundice is also a common clinical presentation. Encephalopathy can also occur secondary to toxin accumulation in the brain and can manifest as impaired cognitive ability, sleepiness, and lack of concentration. Possible complications include splenomegaly, renal failure, gastrointestinal bleeding, and hepatic carcinoma.

Types of Liver Failure

1. Acute Liver Failure. In acute liver failure or ALF, the decline in liver function occurs suddenly in weeks or even days without warning. Drug-induced liver injury is the most frequent cause of acute liver failure in the United States and Western Europe, but viral hepatitis is still the most common cause in underdeveloped nations. About 2800 cases of ALF are reported each year in the US, with acetaminophen serving as the primary trigger.
2. Chronic Liver Failure. Compared to acute liver failure, chronic liver failure or CLF occurs more gradually. Before the patient experience any symptoms, it could take months or even years. Cirrhosis, which develops when normal liver tissue is replaced with scar tissue, frequently leads to chronic liver failure. Cirrhosis is most frequently brought on by hepatitis C infection, excessive alcohol consumption, or nonalcoholic fatty liver. Scar tissue formation is secondary to an inflammatory process happening in the liver, thereby gradually losing its function.

Risk Factors to Liver Failure

The group of people most at risk for liver failure includes:

• Those who have chronic hepatitis caused by Hepatitis B or C
• Chronic alcoholics
• Those who have an underlying or acquired medical conditions that increase the risk of liver failure, such as:
  • Hemochromatosis (in which the body absorbs excessive amounts of iron from food)
  • Non-alcoholic fatty liver disease (NAFLD)
  • Autoimmune disease (condition where autoantibodies attack the liver)
  • Wilson disease (condition wherein the body is incapable of copper removal).

  Causes of Liver Failure

  1. Causes of Acute Liver Failure

  Acute liver failure, also known as fulminant hepatic failure, can occur in the absence of pre-existing liver disease. Acetaminophen overdose is the most frequent cause of abrupt liver failure in the United States. Acute liver failure can also result from:

  • certain prescription drugs
  • a few dietary supplements
  • Hepatitis viruses, including hepatitis A, B, and C, are viral illnesses.
  • toxins
  • specific autoimmune conditions
  • Existing hereditary liver disease
  1. Causes of Chronic Liver Failure

  Long-term inflammation that results in the scarring of healthy liver tissues (fibrosis) causes chronic liver failure. The majority of healthy liver tissues are replaced by scar tissue, which is known as cirrhosis.

  While some of the causes of hepatic inflammation are associated with underlying medical disorders, other causes of hepatic inflammation can be more challenging to identify. These might include the following:

  • Hepatitis C infection
  • Excessive alcohol consumption
  • Nonalcoholic fatty liver disease

  Complications of Liver Failure

  1. Complications of Acute Liver Failure
     • Cerebral edema (a surplus of fluid in the brain). Excess hydration can lead to pressure buildup in the brain leading to seizures, severe mental confusion, and disorientation.
     • Bleeding and clotting disorders. One of the liver’s functions is to produce clotting factors that aid in coagulation. With an impaired liver function, these clotting factors are insufficiently produced thereby making the individual susceptible to developing bleeding disorders (e.g., gastrointestinal bleeding).
     • Infections. Acute liver failure patients are more susceptible to infections, especially those of the hematologic, respiratory, and urinary systems.
     • Renal failure. Acetaminophen overdose impairs both the liver and kidneys. Liver failure is subsequently followed by renal failure.
  2. Complications of Chronic Liver Failure
     • Variceal bleeding
     • Ascites and spontaneous bacterial peritonitis (SBP)
     • Hepatic encephalopathy
     • Hepatorenal syndrome
     • Hepatopulmonary syndrome
     • Hepatocellular carcinoma (HCC)

  Diagnosis of Liver Failure

  1. Comprehensive history taking and Physical examination. Identify any history of alcohol abuse, genetic irregularities, or other medical conditions.
  2. Liver function tests. Liver function tests are blood tests used to monitor and identify liver damage or illness by measuring the levels of specific proteins and enzymes in the blood.
  3. Biopsy. To assess liver disease, a biopsy is frequently utilized as a test wherein a small portion of the liver is extracted as a sample, processed, and examined in the laboratory

  Treatment for Liver Failure

  1. Treatment for Acute Liver Failure

  These individuals frequently pass away from the complications of acute liver failure, which is a complicated condition. Patient management in the intensive care unit is required before moving them to a facility with liver transplant capabilities. Along with the diagnostic process, treatment should start as soon as possible.

  • Medications. The treatment must target the underlying cause; for instance, N-acetylcysteine (NAC) should be given for acetaminophen poisoning, antivirals for acute hepatitis B, steroids for autoimmune flare-ups, penicillamine for Wilson’s disease, and penicillin for mushroom poisoning. NAC has also demonstrated efficacy in non-acetaminophen acute liver failure. Dextrose infusion should be used to avoid hypoglycemia in patients with ALF.
  • Prevention of cerebral edema. Regardless of the cause, preventing cerebral edema is the cornerstone of ALF treatment. To do this, one can use head elevation, mannitol, hyperventilation, and cerebro-protective techniques.
  • Close monitoring. Intracranial pressure (ICP) monitoring with pressure monitors is employed in some cases of liver failure. Renal failure, metabolic acidosis, coagulopathy, and hypoglycemia are further complications of liver failure that need to be closely monitored. Coagulopathy should only be treated if the patient requires an invasive operation or there is ongoing bleeding. In order to prevent multiorgan failure until recovery or liver transplant, ALF is managed with strong supportive treatments.
  1. Treatment for Chronic Liver Failure

  The aim of treatment in CLF is to halt the spread of the illness and its complications, and this calls for a multidisciplinary strategy. The major management tenets include the elimination of underlying causes, control of portal hypertension, and individualized therapy for each condition. Most patients with chronic liver disease have one of the consequences upon presentation. These may include:

  1. Esophageal varices. Bleeding from varices is one of the fatal consequences of CLF, and treatment involves vigorous fluid resuscitation, vasopressors (octreotide, terlipressin), and endoscopy. The standard treatments for variceal bleed in an emergency are endoscopic band ligation and injectable sclerotherapy.
  2. Hepatic encephalopathy. The main goal of treatment for hepatic encephalopathy is to deal with the contributing variables. With the help of rifaximin and lactulose, patients with hepatic encephalopathy typically experience improvements.
  3. Hepatorenal syndrome. To reverse acute kidney injury in CLF, the main objective is to address the underlying causes. The intensity and location of the patient influence the treatment options. Norepinephrine, terlipressin, midodrine, and octreotide with albumin infusion are all possible treatment options.
  4. Hepatocellular carcinoma (HCC). The management of HCC is based on the Barcelona clinic’s stage approach for liver cancer, which includes:
     • Resection and ablation at the initial stage (single HCC lesion)
     • Transarterial chemoembolization and radio-embolization are intermediate stages
     • Sorafenib for metastatic illness

  Nursing Considerations on Liver Failure

  Supporting body systems, controlling symptoms of decreasing liver function, providing emotional support, and avoiding the worsening of cerebral edema are the main nursing care goals for patients with liver failure.

  • Monitor the signs and symptoms, blood pressure, volume status, coagulation tests, and level of consciousness.
  • Maintain a 30-degree elevation in the bed’s head while the patient’s head is in a neutral position.
  • Reduce stimulation, such as repeated suctioning.
  • Assess for the presence of hypoxia and hypercapnia; treat these symptoms as directed and appropriate.
  • Use a cooling blanket, fan, or both to aggressively combat fever.
  • Monitor for infection-related symptoms and possible sepsis; give antibiotics as directed.
  • Continue to closely monitor the patient’s blood glucose levels for any signs of hypo- or hyperglycemia.
  • Deliver nutritional assistance as directed.

  ICP monitoring is necessary for patients whose acuity level necessitates it (such as those in an intensive care unit with grade 3 or 4 hepatic encephalopathies).

  Nursing Diagnosis for Liver Failure

  Liver Failure Nursing Care Plan 1

  Nursing Diagnosis: Excess Fluid Volume related to compromised regulatory system [e.g., syndrome of inappropriate antidiuretic hormone (SIADH), decreased plasma proteins, malnutrition, and excessive fluid/sodium intake secondary to liver failure as evidenced by weight increase, anasarca and edema, increases in urine specific gravity, oliguria, and intake that is higher than output, dyspnea, pleural effusion and adventitious breath noises, changes in BP and CVP, positive hepatojugular reflex or JVD, altered amounts of electrolytes, alteration in mental state, and excessive fluid/sodium intake

  Desired Outcome: The patient will demonstrate a stable fluid volume, balanced I&O, stable weight, vital signs within the patient’s normal range, and absence of edema.

  Liver Failure Nursing Care Plan 2

  Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to inability to metabolize or digest foods due to an inadequate diet, early satiety, anorexia, nausea/vomiting, indigestion (ascites), and abnormal bowel movements secondary to liver failure as evidenced by weight loss, alterations in bowel movements and sounds, atrophy or poor muscular tone, and imbalances in nutritional studies

  • The patient will demonstrate progressive weight gain toward the desired outcome using patient-appropriate laboratory value normalization,.
  • The patient will no longer exhibit any signs of malnutrition.

  Liver Failure Nursing Care Plan 3

  Nursing Diagnosis: Ineffective Breathing Pattern related to collection of intra-abdominal fluid (ascites), reduced lung expansion, the buildup of secretions, reduced energy, and weariness secondary to liver failure

  Desired Outcome: The patient will maintain an efficient breathing pattern, be free of cyanosis and dyspnea, and have satisfactory ABG and vital capacity readings.

  Liver Failure Nursing Care Plan 4

  Nursing Diagnosis: Disturbed Body Image related to biophysical modifications or altered appearance, prognosis uncertainty and modifications to role function, individual susceptibility, and a self-destructive attitude (alcohol-induced disease) secondary to liver failure as evidenced by expression of lifestyle modification or restriction, apprehension of others’ judgment or response, negative thoughts regarding one’s appearance or ability, and the sensation of being helpless, despairing or powerless.

  • The patient will declare their acceptance of changes and of themselves in the here and now.
  • The patient will determine their feelings and coping mechanisms for a negative self-perception.

  Liver Failure Nursing Care Plan 5

  Nursing Diagnosis: Deficient Knowledge related to lack of awareness/recall, incorrect information interpretation, and lack of experience with information sources secondary to liver failure as evidenced by questions, information requests, and statements of misconceptions, incorrect execution of instructions or the emergence of avoidable difficulties.

  • The patient will explain his/her understanding of the disease’s course, prognosis, and complications.
  • The patient will link the symptoms to the underlying causes.
  • The patient will determine/start the necessary lifestyle modifications, and take part in the care.

  Nursing References

  Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon

  Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

  Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon

  Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon

  Disclaimer:

  Please follow your facilities guidelines, policies, and procedures.

  The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

  This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

  Anna Curran. RN-BC, BSN, PHN, CMSRN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.