Elsevier

The Journal for Nurse Practitioners

Volume 8, Issue 10, November–December 2012, Pages 816-821
The Journal for Nurse Practitioners

Role of Nurse Practitioners in the Management of Cirrhotic Patients

https://doi.org/10.1016/j.nurpra.2012.08.016Get rights and content

Abstract

Patients with end-stage liver disease (ESLD) often suffer from complications that require ongoing management with outpatient providers. Complications include ascites, hepatic encephalopathy, hyponatremia, pulmonary vascular complications, and esophageal varices. Patients with cirrhosis need to be referred to a hepatologist to establish care and potential evaluation for liver transplantation. Nurse practitioners (NPs) involved in the care of cirrhotic patients are well positioned to provide supportive care, improve symptom management, and prevent complications associated with further decompensation. This article discusses the role of NPs in the management of patients with cirrhosis.

Section snippets

Diagnosis of Cirrhosis

While a liver biopsy is the gold standard for cirrhosis diagnosis, the procedure has its risks and benefits and is not always necessary. Limiting factors associated with obtaining a liver biopsy include procedural invasiveness and the fact that biopsy samples represent only about 1/50,000 of the liver parenchyma, yielding chances of sampling error.4

In the past few years, a great deal of effort has been devoted to the development of noninvasive methods of detecting significant fibrosis. Among

Model for ESLD and Liver Transplantation

The presence of cirrhosis alone does not warrant the need for liver transplantation (LT) unless there are complications, such as development of hepatocellular carcinoma (HCC), worsening PH, and hepatic synthetic dysfunction. The Model of End Stage Liver Disease (MELD) score is based on objective values, including serum bilirubin, international normalized ratio (INR), and serum creatinine.6 The MELD score has been proven to be an excellent predictor of mortality in patients with cirrhosis and is

The Nurse Practitioner Role in Patient Management

The management of cirrhosis has improved over the past decade. Progress in the treatment of decompensating events such as variceal bleeding, spontaneous bacterial peritonitis, HCC, and HE have led to significant improvement in survival rates, reduction in hospitalizations, and improvement of quality of life.7 Nurse practitioners (NPs) who are involved in the management of patients with cirrhosis are well positioned to provide supportive care, improve symptom management, and prevent

Conclusion

Patients with cirrhosis are at high risk for many life-threatening complications that can often be managed or detected early in the outpatient setting. The role of the NP as an agent for continuity of care and as a coordinator among multidisciplinary team members is vital to improve survival and quality of life. Once a patient is diagnosed with cirrhosis, the NP should refer him or her to a hepatologist for timely LT evaluation. It is important for the NP to make sure that the patient with

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Cited by (7)

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In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.

1

Kristina Tuesday Werner, DNP, FNP-C, is a nurse practitioner and instructor of medicine at Mayo Clinic in Phoenix, AZ.

2

Shari Terese Perez, MSN, ANP-C, is an adult nurse practitioner with Transplant Hepatology at Mayo Clinic Hospital in Phoenix, AZ.

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