Cirrhosis

1. Abdominal girth

2. Increased Bilirubin

3. Monitor

3.1. Blood pressure

3.2. Skin

3.2.1. Edema

3.2.2. jaundice

3.2.3. pruritis

3.3. Intake & Output; Daily Weight

3.4. Any bleeding

4. Teach

4.1. Diet

4.1.1. Low Sodium

4.1.2. Avoid Alcohol

4.1.2.1. Referal to AA

4.1.3. High Carbs/Low-Moderate Fat

4.2. Activity

4.2.1. Allow pt rest periods

4.3. Be alert for complications

4.3.1. Hematemesis

4.3.2. drug interactions

4.3.3. S/S hepatic encephalopathy

4.3.4. Ascites

5. Assess

5.1. Jaundice

5.2. fatigue

5.3. abdominal distention and/or pain

5.4. crackles in lungs

5.5. V/S, I&O

5.6. Pt physical history, Medications, Allergies, etc

6. Labs

6.1. Liver Enzymes

6.1.1. AST

6.1.2. ALT

6.1.3. alkaline phosphatase

6.2. Decreased Serum Total Protein, Albumin

6.3. Prolonged Prothrombin Time

6.4. serum electrolytes

6.5. CBC, decreased hgb, hct, rbcs

7. Interventions

7.1. Medication

7.1.1. rifaximin (Xifaxan)

7.1.1.1. reduces bacterial flora to reduce ammonia

7.1.2. lactulose

7.1.2.1. helps eliminate ammonia

7.1.3. PPI

7.1.3.1. reduces gastric acidity

7.1.4. Diuretics

7.1.4.1. Lasix

7.1.4.2. Monitor Renal function

7.1.4.3. Aldactone

7.1.4.3.1. Monitor serum K+, Na+, Cl-, HC3O

7.1.4.3.2. Bed in SF/Fowlers to help breathing

7.2. Comfort

7.2.1. Allow Rest Periods and conserve strength

7.2.2. Protect edematous skin from breakdown

8. Gastric/Esophageal Varices