RISK FOR IMPAIRED LIVER FUNCTION
At risk for liver dysfunction
• Hepatotoxic medications (e.g.,
• Viral infection (e.g., hepatitis
A, B, or C, Epstein-Barr)
• HIV coinfection
• Chronic biliary obstruction
• Substance abuse (e.g., alcohol,
• Nutritional deﬁciencies
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Risk management
• Pharmacological function
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
• 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
SUGGESTED NOC OUTCOMES
Health-Promoting Behavior; Risk Control—Alcohol; Risk Control—
Drug Use; Safe Home Environment; Substance Addiction
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.
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
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: