Nursing diagnosis – RISK FOR IMPAIRED LIVER FUNCTION

RISK  FOR  IMPAIRED  LIVER  FUNCTION

DEFINITION

At risk for liver dysfunction

RISK FACTORS

• Hepatotoxic medications (e.g.,

• Viral infection (e.g., hepatitis

acetaminophen, statins)

A, B, or C, Epstein-Barr)

• HIV coinfection

• Chronic biliary obstruction

• Substance abuse (e.g., alcohol,

and infection

cocaine)

• Nutritional deficiencies

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Risk management

• Pharmacological function

• Fluids/electrolytes

EXPECTED OUTCOMES

The patient will

• State effects of environmental and ingested chemicals and

substances on their health and liver function.

• Work with industry managers and with public health officials to

lower or eliminate the presence of environmental chemicals and
substances in their work or living environment.

• Have liver function indicators within normal limits.

• Modify lifestyle and risk behaviors to avoid behaviors leading to

hepatic dysfunction and inflammation.

• Maintain long-term follow-up for chronic illness with healthcare

provider.

• Manage concurrent disease processes that impact hepatic function.

• Optimize nutritional intake for needs.

• Acknowledge the impact of medications on hepatic function.

• Observe measures to avoid the spread of infection to self and to

others.

SUGGESTED NOC OUTCOMES

Health-Promoting Behavior; Risk Control—Alcohol; Risk Control—

Drug Use; Safe Home Environment; Substance Addiction

Consequences

INTERVENTIONS AND RATIONALES

Determine: Assist patient and family to assess workplace and home

environments for potential hepatotoxic substances to increase

patient’s awareness of hazards in the environment and to lower

potential for hepatic injury.

Monitor for clinical manifestations of hepatic inflammation and

dysfunction to notify physician in order to initiate treatment if liver

function is compromised. Clinical manifestations may include

fatigue, depression or mood changes, anorexia, RUQ tenderness,

pruritis, jaundice, bruising, or nontraumatic bleeding.

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Monitor customary clinical laboratory tests to alert the healthcare

provider of the status of the immune/inflammatory response, the

degree of hepatic metabolic dysfunction, and the impact of concur-

rent disorders on liver function. Clinical laboratory tests include

complete blood cell (CBC) count:   lower red blood cell count,

elevated WBC (increased immunocyte and inflammatory responses);

basic metabolic panel—altered electrolyte balance, elevated glucose,

elevated blood urea nitrogen and creatinine level, elevated HbA1c;

hepatic plasma markers: elevated liver enzymes (alanine aminotrans-

ferase, aspartate aminotransferase, and    -glutamyltranspeptidase);

positive immunoassays for pathogen and viral antigens; elevated

ammonia; elevated bilirubin; low coagulation factors; low total

protein/albumin; elevated lipid panel.

Perform: Carry out postprocedure measures, as ordered, to identify

and/or minimize complications.

Inform: Teach patient about the following: perform hand hygiene

before and after personal hygiene and care; cover draining and non-

healing wounds; report to care provider; inform others of infectious

condition so that each observes barrier precautions; adhere to

prescribed plan of care and treatment with immune system modifiers

(antibiotics, antivirals, interferon, others); maintain a balanced nutri-

tional diet intake. These measures minimize patient’s risk for self-

infection and spread of infection and allow the patient to help modify

lifestyle to maintain optimum health level for self and for others.

Along with healthcare team, prepare the patient for and later evaluate

the results of liver biopsy and provide explanation to patient and family.

The patient and family need understanding of purpose for and

implications of results obtained from a liver biopsy. This support and

education helps the patient understand rationale for plan of treatment

and genetic counseling for genetically linked hepatic disorders.

Attend: Provide a nonjudgmental attitude toward patient’s lifestyle

choices to promote feelings of self-worth.

Manage: Refer patient to counseling and therapy to address lifestyle

choices and risk behaviors. Modification of behaviors will provide

risk avoidance for drug and alcohol abuse and exposure to body-

substance pathogen infection.

SUGGESTED NIC INTERVENTIONS

Behavioral Modification; Environment Risk Protection; Infection

Protection; Risk Identification; Risk Identification—Genetic; Self-

Modification Assistance; Sports Injury Prevention; Surveillance

Reference

McCance, K. L., & Huether, S. E. (2006). Pathophysiology: The biologic basis

for disease in adults and children (5th ed., pp. 1413–1428). St. Louis, MO:
Elsevier-Mosby.

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