1. Dietary care: 1) It is advisable to consume high calorie, high-quality, high protein, and vitamin rich foods that are easy to digest. Patients with high blood ammonia levels or signs of liver coma should be given a low protein diet, mainly plant-based protein, and alcohol should be avoided. 2) Low salt diet. For those with ascites, the daily intake of water should be limited to 1000ml. For those with hyponatremia, the intake should be limited to 500ml or less. 3) For those with esophageal and gastric varices, soft foods such as vegetable puree and minced meat should be provided. Chew slowly during meals and avoid foods with thorns, bones, roughness, or spiciness. Medications should be ground into powder to prevent esophageal and gastric varices from rupturing and bleeding.
2. Rest and activity: Patients in the compensatory period can participate in light work or activities, increase their sleep time appropriately, and avoid fatigue; Patients in the decompensated period mainly rest in bed, lying flat or on the right side, to increase liver blood flow and facilitate the recovery of liver function.
3. Nursing of medication treatment: 1) For those who use diuretics, closely observe the volume and color of urine, and accurately record the 24-hour fluid intake and output. 2) Monitor serum electrolytes and observe for electrolyte imbalances such as drowsiness, cold expression, mental lethargy, and seizures. 3) When urinating frequently, potassium rich foods such as bananas, oranges, tomatoes, apples, etc. can be chosen.
4. Disease observation: 1) Observe the signs of hepatic encephalopathy, such as emotions, personality, behavior, etc. 2) Observe bleeding tendencies, such as vomiting blood, black stool, subcutaneous bleeding, etc. 3) Observe the effectiveness of diuretic use, maintain water and electrolyte balance, record 24-hour urine output, measure abdominal circumference and weight daily, and ensure that the daily weight loss does not exceed 0.5Kg.
5. Other: 1) Psychological care: Establish an information communication platform, listen to and explain patients' questions, and establish confidence in treating diseases. 2) Nursing of ascites: a. Patients with mild ascites should rest in bed as much as possible, while those with large ascites should adopt a semi recumbent position and be given oxygen inhalation if necessary. b、 Prevent and avoid factors that increase abdominal pressure, such as coughing, sneezing, and straining during bowel movements. c、 Strengthen skin care: Keep the skin clean and moisturized, take warm water baths daily, avoid excessive water temperature, and avoid using irritating soaps. Keep the bed flat and dry, assist in turning over, and use an air mattress for those with severe edema; Shorten the patient's nails to prevent scratches and abrasions. d、 Observing the growth and decline of ascites: Patients who are absolutely bedridden should adopt a supine position at the same time and in the same location every day, and measure changes in abdominal circumference; Patients who are able to get up and move around should have their weight measured every morning and on an empty stomach after urinating, and keep relevant records. 3) Nursing of ascites puncture and drainage: Preoperative urination, emptying of bladder to avoid puncture, and explanation of precautions to patients; Observe changes in the patient's condition during surgery; After surgery, use a abdominal belt and pay attention to whether there is any overflow at the puncture site. At the same time, observe for electrolyte imbalance, protein loss, and secondary infection signs. 4) Nursing of complications: a. Upper gastrointestinal bleeding: ① For patients with a history of gastrointestinal bleeding or esophageal and gastric varices, the key is to strengthen food and drink management, mainly soft food, and instruct them to chew slowly when eating, avoid eating hard, prickly, rough food, and avoid foods that are too fiber rich, fried, greasy, etc. ② Closely observe for signs of bleeding, such as nausea, vomiting, abdominal distension, loss of appetite, vomiting blood, black stool, etc. ③ Patients with positive fecal occult blood should be given light, non irritating liquid food. b、 Hepatic encephalopathy: Preventive measures: ① Daily calorie intake of 5. 02 to 6. 69Cal， Maintain positive nitrogen balance and avoid protein breakdown in the body. ② Protein: In the late stage of liver cirrhosis, due to factors such as gastrointestinal congestion, edema, digestive and absorption disorders, and dysbiosis of the gut microbiota, patients often exhibit decreased appetite, bloating, nausea, etc. Therefore, appropriate amounts of protein, calories, vitamins, and easily digestible light diet should be given. Provide fresh fruits and vegetables, as well as small and frequent meals, to ensure a balanced intake of nutrients. ③ Individuals with significant liver function impairment, elevated blood ammonia levels, or signs of hepatic encephalopathy should limit or fast protein intake. ④ Keep bowel movements unobstructed and reduce the absorption of toxins in the intestine. c、 Infection: Preventive measures: ① Eat reasonably and increase nutrition. ② Engage in appropriate exercise to enhance physical fitness. ③ Guide patients to effectively cough and expel respiratory secretions to prevent lung infections. d、 Hepatorenal syndrome: The key to nursing is to prevent disturbances in water, electrolytes, and acid-base balance.
6. Health education and discharge guidance: 1) Establish confidence in treating diseases, maintain a happy mood, and ensure sufficient rest and sleep. 2) When taking a shower, pay attention not to the water temperature being too high, and do not use irritating soaps and body wash. After taking a shower, use gentle moisturizing products. For those with itchy skin, give anti itch treatment. Patients are advised not to scratch with their hands to avoid skin rupture. 3) Pay attention to warmth and personal hygiene to prevent infection. 4) Follow the principles of dietary therapy and arrange a nutritious diet. 5) Guide family members to understand and care for patients, provide emotional support and daily care, observe carefully, and identify changes in the condition early.