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Cirrhosis Nursing Care Plan and Interventions

Cirrhosis nursing care watches for bleeding, ascites, infection and confusion from rising ammonia. Assist with paracentesis, give diuretics safely and teach the client to avoid alcohol and follow the diet plan.

Checked against OpenStax nursing textbooks· Updated Oct 2026· Sources

Care plan What it is Assessment Red flags Priority Interventions Teaching NCLEX traps Try a question FAQ

Cirrhosis nursing care plan

Nursing problem	Goal	Key interventions
Risk for bleeding	No bleeding; clotting labs trended.	Cirrhosis labs Bleeding risk
Excess fluid volume (ascites)	Abdominal girth and weight trending down; breathing comfortable.	Ascites Ascites treatment Diuretic safety in ascites Paracentesis
Risk for infection and confusion	Fever, belly pain or mental status changes reported early.	Complications to watch Spontaneous bacterial peritonitis
Health maintenance: needs teaching	Avoids alcohol and follows diet advice.	Cirrhosis teaching Diet and protein

Problem wording is plain-language nursing diagnosis style. Your program may require NANDA-I labels and your own assessment data.

What it is

Cirrhosis

Years of liver injury replace healthy cells with scar. Scar blocks blood flow through the liver, and the liver loses its jobs. ^1,2

Main causes: alcohol, chronic hepatitis B or C, and fatty liver disease.

Portal hypertension

Scar resists blood coming from the gut, so pressure backs up in the portal vein. Result: varices, ascites and a big spleen. ^1,2

Backed-up gut blood also detours around the liver, so ammonia reaches the brain.

Assessment: what you will see

Cirrhosis cues

Jaundice, ascites, leg edema, itching, bruising, muscle wasting, spider angiomas, red palms and changes in mental status. ^1,2

Report new or worsening jaundice to the provider.

Cirrhosis labs

ALT and AST may rise, bilirubin rises, albumin falls, PT and INR lengthen, and platelets drop. ^1,2

Low albumin and a long PT mean the liver can no longer make proteins well.

Ascites

Fluid in the belly from high portal pressure, low albumin and kidneys holding sodium. A large amount pushes up on the diaphragm. ^2,1

Track daily weight and abdominal girth. Report a rising girth or new dyspnea.

Complications and red flags

Complications to watch

Variceal bleeding, hepatic encephalopathy, infection, hepatorenal syndrome (kidney failure) and liver cancer. ¹

Falling urine output can mean the kidneys are failing. Report it.

Spontaneous bacterial peritonitis

Infected ascites. Suspect it with fever, belly pain or tenderness, new confusion, or an unexplained decline. ²

Expect a diagnostic paracentesis and IV antibiotics. Ascitic neutrophils over 250/mcL confirm it.

Priority: what the nurse does first

Bleeding risk

The liver makes fewer clotting factors and the big spleen traps platelets, so the client bleeds easily. ^2,3,1

Soft toothbrush, electric razor, nothing sharp. Check gums, stool and old IV sites.

Nursing interventions and treatment

Ascites treatment

First, limit sodium to 2,000 mg a day. If that fails, add spironolactone, usually with furosemide. ²

Fluid restriction is only for serum sodium under 125 mEq/L.

Diuretic safety in ascites

Spironolactone holds potassium; furosemide wastes it. Check potassium, sodium, creatinine and BP. Aim to lose about 0.5 kg a day. ²

Overdiuresis can injure the kidneys and drop potassium, which can trigger hepatic encephalopathy.

Paracentesis

A needle drains ascitic fluid. Before: the client voids and sits up in bed. After: check BP and the site for leaking. ²

If more than 5 L comes off, expect IV albumin to help prevent a BP drop.

Client teaching

Cirrhosis teaching

No alcohol at all. Ask before any new medicine, including OTC. Keep a low-sodium diet. Get hepatitis A and B vaccines if not immune. ²

Even small amounts of alcohol worsen the outlook.

Diet and protein

Many clients with cirrhosis are malnourished and losing muscle. Give normal protein and enough calories; do not restrict protein. ^2,4

Old teaching cut protein for confusion. Current guidance does not.

NCLEX traps

Hepatitis vs cirrhosis

Hepatitis is liver inflammation; it may clear or become chronic. Cirrhosis is lasting scar after years of injury. ^1,5,2

Chronic liver disease runs inflammation, fibrosis, cirrhosis, then end-stage liver disease.

Try a cirrhosis question

NCLEX-style, approved by a licensed RN. Pick an answer, check it, then read the rationale.

Question 1 · Physiological Adaptation

A client with cirrhosis has a rising ammonia level and increasing confusion. The client is prescribed lactulose. Which finding indicates the medication is working effectively?

A. The client has 6 to 8 watery stools per dayB. The client reports no change in bowel movementsC. The client has 2 to 3 soft stools per day and improved mentationD. The client develops severe abdominal cramping with no stool output

Show answer and rationale

Answer: C. Lactulose for hepatic encephalopathy is titrated to 2 to 3 soft stools per day; it traps ammonia in the colon and clears it in the stool, so this stool pattern together with clearer mentation shows the drug is working. Having 6 to 8 watery stools a day means the dose is too high and risks fluid loss, hypokalemia and hypernatremia, so the dose needs adjusting. No change in bowel movements means the dose is too low to clear ammonia. Severe abdominal cramping with no stool output is not a therapeutic response and is reported promptly, because it can signal ileus or bowel obstruction.

Checked against: ncbi.nlm.nih.gov

Keep studying cirrhosis in NurseLingo Pro

Pro has 26 cirrhosis questions like these, with a rationale for every answer. Everything for cirrhosis in one place. A free account gets 5 free opens of any condition; Pro opens all 277.

Practice questions26 questions · 9 Next Gen Inside the body3D walkthrough, narrated Podcast6 min Concept mapSee how it all connects Flashcards20 cards with spaced review

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Test yourself: free med-surg practice questions with answers and rationales.

Frequently asked questions

What are the priority nursing diagnoses for cirrhosis?

Common nursing problems for cirrhosis include risk for bleeding; excess fluid volume (ascites); risk for infection and confusion; health maintenance: needs teaching. Choose the ones your assessment supports and rank airway, breathing and circulation problems first.

What does the nurse do first for cirrhosis?

The liver makes fewer clotting factors and the big spleen traps platelets, so the client bleeds easily.

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Sources

For study only, not medical advice. Follow your program, your facility's policies and the provider's orders.