Monitor vital signs, intake and output and electrolyte levels to determine fluid volume status.
Maintain some periods of rest with legs elevated to mobilize edema and ascites. Alternate rest periods with ambulation.
To assess fluid retention, measure and record abdominal girth every shift. Weight the patient daily and document his weight.
Administer diuretics, potassium and protein or vitamin supplements as ordered.
Restrict sodium and fluid intake as ordered.
Observe and document for bleeding gums, ecchymoses, epistaxis, petechiae and degree of sclerae, skin jaundice. Remain with the patient during the hemorrhagic episodes.
Inspect stools for amount, color and consistency. Test stools and vomitus for occult blood as ordered.
Watch for signs of anxiety, epigastric fullness, restlessness and weakness.
Observe closely for signs of behavioral or personality changes. Report increasing stupor, lethargy, hallucinations or neuromuscular dysfunction. Arouse the patient periodically to determine level of consciousness. Watch for asterixis, a sign of developing encephalopathy.
Allow the patient to express his feelings about having cirrhosis. Offer psychological support and encouragement, when appropriate.
Warn the patient against taking nonsteroidal anti-inflammatory drugs, straining to defecate and blowing his nose or sneezing vigorously to minimize the risk of bleeding. Suggest using an electric razor and a soft toothbrush.
Advise the patient that rest and good nutrition conserve energy and decrease metabolic demands on the liver. Urge him to eat frequent, small meals.
Teach him to alternate periods of rest and activity to reduce oxygen demand and prevent fatigue.
