Nursing care of patients with cirrhosis requires careful assessment and monitoring of the patient’s nutritional status.

The nutritional therapy ordered by the physician must be strictly enforced in order to maintain an optimum physiologic state that will facilitate recovery.

a. The diet should be high in calories. Total food intake should not be used to replace energy requirements.

(1) The patient should be kept at a level of minimum activity to conserve energy.

(2) Nutrient consumption is necessary for the healing process to take place.

b. The amount of protein in the diet should be limited to that which the liver is able to handle.

(1) The liver is the body’s major organ of protein catabolism.

(2) Protein catabolism yields ammonia, which is normally converted by the liver to the nontoxic substance called urea. (Urea is carried by the blood from the liver to the kidneys, where it is excreted in the urine.)

(3) Ammonia that cannot be converted to urea by the diseased liver will escape into the circulatory system. Excess blood ammonia can be very toxic to the brain.

(4) Blood ammonia levels are monitored by the physician, who determines dietary protein allowances accordingly.

c. The patient should be instructed to avoid table salt, salted butter and margarine, salty foods, and processed foods, which are generally high in sodium.

(1) “Salt substitutes” such as lemon juice, herbs, and spices should be used to enhance food flavor.

(2) Commercial salt substitutes must be approved by the physician before being used.

d. If fluid retention (manifested by edema or ascites) occurs, the physician may order dietary restrictions such as:

(1) Sodium restrictions.

(2) Fluid restrictions.

e. Intake of substances that are toxic to the liver must be stopped.

(1) Alcohol.

(2) Drugs.

f. A patient with cirrhosis will experience anorexia, and will require encouragement and even enticement to eat the prescribed, well-balanced diet.

(1) Consider individual patient preferences, and ask the dietician to use preferred foods in the menu.

(2) Small, frequent meals may be better tolerated than three large meals.

(3) Make meal times as pleasant and leisurely as possible.

g. Ensure that the patient takes the prescribed supplementary vitamins. A diseased liver cannot effectively store or activate vitamins. Supplementary vitamins prescribed may include the following:

(1) Vitamin K. Vitamin K, known as the anti-hemorrhagic vitamin, is a fat-soluble vitamin normally stored in the liver. It is essential for the synthesis of prothrombin, a substance necessary for normal blood clotting.

(2) Thiamine. Thiamine, also known as vitamin B1, is a water-soluble vitamin not stored in the body. It must be consumed in food or in supplement form. Thiamine is required for normal carbohydrate metabolism and nerve conduction. Deficiencies lead to the syndromes of beriberi and polyneuritis.

(3) Folate. Folate (folic acid) is a water-soluble vitamin necessary for the normal production of white and red blood cells. Folate deficiency anemia is the usual result of insufficient folic acid.

(4) Iron. Although iron is a mineral and not a vitamin, it is included in this discussion because it is often prescribed along with folic acid to combat anemia in-patients with cirrhosis.

(5) Vitamin C. The exact mechanisms of vitamin C are not fully understood, but it has been proven that vitamin C is effective in helping the body to fight infection and to speed healing.