For a client with hepatic cirrhosis who has altered clotting mechanisms, which intervention would be most important?
A. Allowing complete independence of mobility
B. Applying pressure to injection sites
C. Administering antibiotics as prescribed
D. Increasing nutritional intake
Correct Answer: B. Applying pressure to injection sites.
The client with cirrhosis who has altered clotting is at high risk for hemorrhage. Prolonged application of pressure to injection or bleeding sites is important. Instruct patient/SO of signs and symptoms that warrant notification of health care provider: increased abdominal girth; rapid weight loss/gain; increased peripheral edema; increased dyspnea, fever; blood in stool or urine; excess bleeding of any kind; jaundice.
Option A: Complete independence may increase the client’s potential for injury, because an unsupervised client may injure himself and bleed excessively. Instruct SO to notify health care providers of any confusion, untidiness, night wandering, tremors, or personality change. Changes (reflecting deterioration) may be more apparent to SO, although insidious changes may be noted by others with less frequent contact with the patient.
Option C: Antibiotics are important to promote liver regeneration. However, they are not most important for a client at high risk for hemorrhage. Some drugs are hepatotoxic (especially narcotics, sedatives, and hypnotics). In addition, the damaged liver has a decreased ability to metabolize all drugs, potentiating cumulative effect and/or aggravation of bleeding tendencies.
Option D: Encourage the patient to eat; explain reasons for the types of diet. Feed the patient if tiring easily, or have SO assisted the patient. Include the patient in meal planning to consider his/her preferences in food choices. Improved nutrition and diet are vital to recovery. The patient may eat better if the family is involved and preferred foods are included as much as possible.
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