Ascites and/or fluid retention |
Advise dietary modifications, eg, sodium reduction to <2 g/24 h
Withhold diuretics
Therapeutic paracentesis to control volume/avoid tense ascites
Antibiotic prophylaxis to avoid infections, especially for low-protein ascites fluid or history of prior SBP
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Hepatic encephalopathy |
Treat triggering event (eg, infection, GI bleeding, kidney dysfunction)
Prevent recurrence by reducing toxins; treat with lactulose and/or rifaximin
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Esophageal varices/GI bleeding treated with beta blockers |
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Diabetes |
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Malnutrition and/or debility |
Advise a high-protein diet
Considerations for other dietary changes, such as diabetic diet, low sodium/fluid restriction (if ascites and/or hyponatremia), renal diet
Nutrition consultation plus physical or occupational therapy to increase strength and reduce sarcopenia/malnutrition
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Hyponatremia |
Monitor for hyponatremia
Monitor for decline in kidney function/end-stage renal disease; initiate RRT
Advise dietary changes, ie, fluid restriction or renal diet if applicable
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Attend nutritional consultation if advised
Dietary adherence; fluid restriction
Monitor urination; report reduced frequency
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Hypotension |
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Polypharmacy |
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Overall patient care |
Nurse navigator/coordinator to advise patient and/or clinical team regarding changes in health status or treatments, especially starting/stopping medications
Patient/caregiver education on ways to prevent renal injury (ie, avoidance of certain medications, monitoring of weight fluctuations, noting if increase or decrease in urine output, minimize risk for dehydration or risk for infections)
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