Role of Nurse Practitioners in the Management of Cirrhotic Patients
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)
The Role of Liver Function in the Setting of Cirrhosis with Chronic Infection and Critical Illness
2017, Critical Care Nursing Clinics of North AmericaCitation Excerpt :Depending on the findings of the examination, additional diagnostic testing and/or procedures maybe warranted including an abdominal paracentesis. The primary care NP works closely with the hepatologist and interdisciplinary team to ensure that the risks of disease-related complications are minimized and treated promptly.2,17 Recurrent variceal bleeding has a role in infection and is often a signifying event of disease progression.
Development and evaluation of a self-care smartphone application for cirrhotic patients
2019, Evidence Based Care JournalRole development of nurse practitioners and physician assistants in liver transplantation
2016, Progress in TransplantationNursing assessment tool for people with liver cirrhosis
2016, Gastroenterology Nursing
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.