a. Assess for Fluid Retention. 

(1) Weigh daily.

(2) Measure abdominal girth daily.

(3) Observe and record accurate intake and output.

(4) Observe for the presence of edema.

b. Observe for Bleeding Tendencies. 

(1) Monitor vital signs frequently.

(2) Assess for anxiety, weakness, or abdominal fullness that may indicate internal bleeding.

(3) Observe and test stool, urine, and emesis for the presence of blood.

(4) Observe the gums for evidence of bleeding.

(5) Observe the skin for petechiae and bruising.

c. Manage Bleeding Tendencies. 

(1) Provide a safe environment to prevent injuries.

(2) Implement the use of a soft bristle toothbrush.

(3) Implement the use of an electric razor for shaving instead of a blade razor.

(4) Use small gauge needles for drawing blood and starting IVs.

(5) Caution the patient against forceful nose blowing to prevent epistaxis.

d. Provide Skin Care. 

(1) Use gentle cleansers to decrease skin irritation.

(2) Use soothing lotions to control the itching that occurs as a result of bile salt retention.

(3) Administer prescribed medications for pruritis.

(4) Keep the patient’s fingernails short to prevent scratching the skin.

e. Observe and Assess for Indications of Hepatic Encephalopathy. 

(1) Arouse the patient at intervals and assess level of consciousness and orientation to place and time.

(2) Observe for personality changes or mental changes.

(3) Observe for signs of increasing lethargy.

(4) Observe for signs of neuromuscular dysfunction.

(5) Observe for evidence of hallucinations.

f. Provide Emotional Support. 

(1) The patient will experience fatigue and malaise as a normal consequence of the illness. Assure him that this is normal and will eventually resolve.

(2) Educate the patient and his family about the nature of the illness so that they will be better able to cope.