Other Medication: To remedy itching, an antihistamine can be administered. If a patient has nausea and vomiting, antiemetics may be prescribed. Use caution when administering antiemetics and acetaminophen to patients with liver damage because many medications are cleared through the liver.
Nursing considerations in the cirrhotic patient are to avoid infection and circulatory problems. Turn the patient and encourage coughing and deep breathing every 2 hours to prevent pneumonia.
Because bleeding can occur, monitor the patient closely for signs of hypovolemia. Test any stool and emesis for blood. Follow closely any break in the patient's skin integrity for increased bleeding, and apply pressure to injection sites. Warn the patient against straining at stool, blowing her or his nose, or sneezing too vigorously. Suggest the patient use a soft toothbrush and an electric razor.
Because of fatigue, muscle atrophy, and wasting, the patient needs to rest. Plan activities to include regular rest periods. To prevent breakdown of the skin, place the patient on an egg-crate or air mattress. Avoid using soap to bathe the patient; use moisturizing agents or lubricating lotion. Use pressure-reducing mattresses or specialty beds to prevent skin breakdown. Apply lotion and massage areas of the skin that are potential breakdown sites.
Encourage the patient to verbalize questions, anxieties, and fears. In conversation, note any behavioral or personality changes, including increasing stupor, lethargy, or hallucinations. Arouse the patient periodically to determine his or her level of consciousness. Emotional and psychological support for the patient and family are important to eliminate anxiety and poor self-esteem. Involve the family members in the patient's care as a means of improving the patient's morale.
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