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CIRRHOSIS OF THE LIVER - CIRRHOSIS OF THE LIVER Cirrhosis...

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CIRRHOSIS OF THE LIVER Cirrhosis is a chronic disease of the liver characterized by alteration in structure, degenerative changes and widespread destruction of hepatic cells, impairing cellular function and impeding blood flow through the liver. Causes include malnutrition, inflammation (bacterial or viral), and poisons (e.g., alcohol, carbon tetrachloride, acetaminophen). Cirrhosis is the fourth leading cause of death in the United States among people ages 35 to 55 and represents a serious threat to long-term health. CARE SETTING May be hospitalized on a medical unit during initial or recurrent acute episodes with potentially life-threatening complications. Otherwise, this condition is handled at the community level. RELATED CONCERNS Alcohol: acute withdrawal Substance dependence/abuse rehabilitation Fluid and electrolyte imbalances Psychosocial aspects of care Renal dialysis Renal failure: acute Total nutritional support: parenteral/enteral feeding Upper gastrointestinal/esophageal bleeding Patient Assessment Database Data depend on underlying cause of the condition. ACTIVITY/REST May report: Weakness, fatigue, exhaustion May exhibit: Lethargy Decreased muscle mass/tone CIRCULATION May report: History of/recent onset of HF, pericarditis, rheumatic heart disease, or cancer (causing liver impairment leading to failure) Easy bruising, nosebleeds, bleeding gums May exhibit: Hypertension or hypotension (fluid shifts) Dysrhythmias, extra heart sounds (S 3 , S 4 ) JVD; distended abdominal veins Jaundiced skin, sclera ELIMINATION May report: Flatulence Diarrhea or constipation; gradual abdominal enlargement May exhibit: Abdominal distention (hepatomegaly, splenomegaly, ascites) Decreased/absent bowel sounds Clay-colored stools, melena Dark, concentrated urine; oliguria (renal failure) FOOD/FLUID May report: Anorexia, food intolerance/ingestion Nausea/vomiting May exhibit: Weight loss or gain (fluid) Tissue wasting Edema generalized in tissues
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Dry skin, poor turgor Halitosis/fetor hepaticus, bleeding gums NEUROSENSORY May report: SO(s) may report personality changes, depressed mentation May exhibit: Changes in mentation, confusion, hallucinations, coma Slowed/slurred speech Asterixis (involuntary jerking movements of hands/tongue/feet associated with hepatic encephalopathy) PAIN/DISCOMFORT May report: Abdominal tenderness/RUQ pain Itching Pins/needles sensation, burning pain in extremities May exhibit: Guarding/distraction behaviors Self-focus RESPIRATION May report: Dyspnea May exhibit: Tachypnea, shallow respiration, adventitious breath sounds Limited thoracic expansion (ascites) Hypoxia SAFETY May report: Severe itching of the skin/dryness May exhibit: Fever (more common in alcoholic cirrhosis) Jaundice, ecchymosis, petechiae Spider angiomas/telangiectasis, palmar erythema SEXUALITY May report: Menstrual disorders (women), impotence (men) May exhibit: Testicular atrophy, gynecomastia, loss of hair (chest, underarm, pubic) TEACHING/LEARNING
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CIRRHOSIS OF THE LIVER - CIRRHOSIS OF THE LIVER Cirrhosis...

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