Restrict intake of caffeine, gas-producing or spicy and excessively hot or cold foods. Aids in reducing gastric irritation and/or diarrhea and abdominal discomfort that may impair oral intake.
Suggest soft foods, avoiding roughage if indicated. Hemorrhage from esophageal varices may occur in advanced cirrhosis.
Encourage frequent mouth care, especially before meals. Patient is prone to sore and/or bleeding gums and bad taste in mouth, which contributes to anorexia.
Promote undisturbed rest periods, especially before meals. Conserving energy reduces metabolic demands on the liver and promotes cellular regeneration.
Recommend cessation of smoking. Provide teaching on the possible negative effects of smoking. Reduces excessive gastric stimulation and risk of irritation and may lead to bleeding.
Monitor laboratory studies: serum glucose, prealbumin and albumin, total protein, ammonia. Glucose may be decreased because of impaired gluconeogenesis, depleted glycogen stores, or inadequate intake. Protein may be low because of impaired metabolism, decreased hepatic synthesis, or loss into peritoneal cavity (ascites). Elevation of ammonia level may require restriction of protein intake to prevent serious complications.
Maintain NPO status when indicated. Initially, GI rest may be required in acutely ill patients to reduce demands on the liver and production of ammonia and urea in the GI tract.
Refer to dietitian to provide diet high in calories and simple carbohydrates, low in fat, and moderate to high in protein; limit sodium and fluid as necessary. Provide liquid supplements as indicated. High-calorie foods are desired inasmuch as patient intake is usually limited. Carbohydrates supply readily available energy. Fats are poorly absorbed because of liver dysfunction and may contribute to abdominal discomfort. Proteins are needed to improve serum protein levels to reduce edema and to promote liver cell regeneration. Note: Protein and foods high in ammonia (gelatin) are restricted if ammonia level is elevated or if patient has clinical signs of hepatic encephalopathy. In addition, these individuals may tolerate vegetable protein better than meat protein.
Provide tube feedings, TPN, lipids if indicated. May be required to supplement diet or to provide nutrients when patient is too nauseated or anorexic to eat or when esophageal varices interfere with oral intake.