Treatment Of Cirrhosis Of The Liver Nursing Essay

preaching Of cirrhosis of the coloured-colored Of The Liver Nursing EssayJo is a 23-year-old undergraduate student. She is in truth sociable and admits to enjoying a drink fairly frequently. Six months ago she got complicated in a scuffle while push through and ended up in her local AE department. While there she had a blood shew which showed abnormal coloured function. Follow up tests revealed she had cirrhosis of the colored but with save a small part of the liver affected at present.Consequently, Jo has been cognizant to quit tipsiness completely and has been referred to her local community alcoholic drink team. notwithstanding, she has non attended either sessions with them. She did go to one session with the AA which she engraft out slightly on the Web but did not return as she felt the people attending were so unlike her Im not an strong.Recently, Jo has been to jut out her GP and said that, as her condition is so mild, and is not causation her any probl ems at present, she doesnt see why she should totally give up drinking. She cl stations to have reduced her drinking slightly going out simply 4 nights a week and reducing the alcohol she drinks at home, and deals that this is enough. She admits to not telling any of her family or friends about her diagnosis. Her GP has now referred her to her local psychology service to see if you back tooth make her see sense. How energy a wellness psychologist go about assisting Jo?IssuesJo has been diagnosed with having cirrhosis of the liver and has been advised by her GP to stop drinking alcohol. During early stages of cirrhosis there can be very few symptoms (Wright, 2009), and Jo does not bet to have experienced any forcible aggravation that would indicate problems with her liver function. Therefore her diagnosis initially seemed inconceivable for Jo to comprehend. After a inveterate disease is diagnosed, patients can be in a state of crisis and mental disequilibrium (Taylor, 2006). Moos and Schaefer (1984, cited in Bennet, 2000) suggested that pursuance a diagnosis of a chronic complaint an individual can feel that their future plans, social identity and sustain network is threatened. She has decided not to tell her friends or family, and is avoiding the implication of her wellness through denial (Taylor, 2006) until she is more accustomed to the diagnosis.After prolonged redness of the liver due to excessive alcohol abuse Jo has cirrhosis on the liver. This is when normal healthy liver cells are misused and replaced by abrasion tissue, reducing the number of cells remaining to perform its many substantial functions (Wright, 2009). Cirrhosis is the final stage of alcoholic liver disease, which is an incurable, progressive and potentially grim (Wright, 2009). Alcoholic cirrhosis is a multi-f pieceorial disease and is not just now a result of high dependance to alcohol (alcoholism) (Addolorato et al, 2009 Day, 2009). Research have found a low dependen cy of alcohol in patients with cirrhosis (Smith, 2006 cited in Addolorato et al, 2009), and it is known that gender, genetic and nutritional factors can influence the disease advancement to cirrhosis (Addolorato et al, 2009). Therefore alcoholic cirrhosis could develop in vulnerable individuals whose life style of heavy alcohol abuse has predisposed them to their complaint. Jos dependency to alcohol impart be established and considered throughout her preaching branch, as this could affect the distance and stringency of the treatment approach to achieve the crush response (Kadden, 1998).Due to the progressive nature of liver cirrhosis in is imperative that Jo eliminates her alcohol use, as this would worsen her condition (Wright, 2009). The ability to handle self-control from alcohol requires a kind in lifestyle, accepting the business of ones actions and being assured of the consequences of drinking deportment (Farid, Clark Williams, 1997). Once Jo establishes this b elief and takes indebtedness that her demeanour influences her health, she entrust hold an national locus of control (Farid et al, 1997). However currently believing that she has reduced her alcohol consumption to an adequate level, and doesnt believe her behaviour has an influence on her health status, she currently ender an external locus of control. Without acknowledgment of this link to her health, Jo might lack the motivation to stop drinking (Farid et al,1997). To falsify and educate Jos current beliefs the information and advice given will destiny to match the appropriateness for her needs (Brunt, 1993).After her diagnosis Jo could be olfaction a great deal of anxiety, fear and uncertainty (Berry, 2003), which would make the treat of advice and treatment information difficult. There is a danger that the individual can be left uneducated, which then adversely affects her have a go at it methods and adherence to treatment (Silverman, 2005). Careful consideration must be made to their treatment of individuals who get under ones skin from alcohol related illness as they tend to differ in their ability to function due to clinical depression (Bianchi et al, 2005), raised anxiety (Bolden, 2009 Kim et al, 2005) and run down (Blackburn et al, 2007 Sogolow et al, 2007). There are also multiple psychological factors that contribute to this release such(prenominal) as elevated levels of stress, inadequate get by mechanisms and reinforcement of alcohol use from other drinkers (Bolden, 2009 Bianchi, 2005 Constant, 2005). Psychological take for could champion Jo overcome any avoidant coping style and associated psychological distress stay freshing adverse response to illness (Taylor, 2006). As this could have a detrimental effect on the advancement of liver disease (Jin-Cai Xu-Ru, 2002) and act as a predictor for depression (Bianchi, 2005).Majority of the side effects for cirrhosis are treatable with adequate checkup management of the patients af fected by alcoholic cirrhosis (Addolorato, 2009). Despite damage to the liver, the liver can still perform some of its functions. Jo currently only has a small part of her liver affected and complete abstinence of alcohol is the only way to prevent gain ground damage that could chasten to the gradual recovery of liver function (Addolorato, 2009). However it is likely that end-stage liver failure will result in the patient being assessed for a liver transplant (Georgiou, 2003). Therefore, it is imperative that Jo has documented evidence of the length of prison term she has been abstinence from alcohol, has sound psychological wellbeing and a strong support network, imperative whilst on the waiting list for a replacement liver (Georgiou, 2003 Pereia, 2000) all in which are considered to reduce the risk of relapse some(prenominal) before and after the liver transplantation.A health psychologist can serving Jo to employ effective strategies into different aspects of her life to pre vent further alcoholic liver damage. Her current psychological wellbeing will be considered as she is adapting to various lifestyle salmagundis, and therefore psychological interposition will help avoid or reduce psychological suffering (Blackburn, 2007 Kim, 2005). A health psychologist will educate Jo to tackle her current beliefs and develop effective coping mechanisms (Taylor, 2006). Having a wider support network would greatly benefit her treatment process (Georgiou, 2003), which would require her to quest family and friends for extra social support. Together with suitable nutritional advice (Merli et al, 2009) and exercise programme (Petrides et al, 1997) could reduce the effect of liver cirrhosis and could convey to the gradual recovery of liver function.InterventionFrom the start of the intervention it is issueant that Jo feels like she is being treated like an individual and that her health psychologist understands the usurpation of having diagnosed with liver cirrhosis will have on her life (Kadden, 1995), and that they whitethorn feel that their identity will be defined by their handicap (Charmaz, 1995). A proficient patient-doctor relationship is important for the adherence and success of the intervention (Kadden, 1995). To establish a good rapport Jos health psychologist must demonstration empathy and belief with good interpersonal skills (Kadden, 1996). He or she must be familiar with the material and function as an active teacher to import the skills successfully (Kadden, 1995). To further authorizationen a positive patient-doctor relationship Jo must be encouraged to be involved in the decision-making of her treatment, as this could development the likelihood of Jo being motivated to comply (Longabaugh, 1999).Jo will complete a Patient Knowledge Questionnaire (PKQ) to assess the knowledge of her disease, and also a cage in screening test for alcohol dependency (Kadden, 1995), which will set a guide line for the health psychologist of the problems being addressed. Her current beliefs and perceptions of how her illness will affect her life can be further be explored by using open-ended questions (Kadden, 1995). Together with constant emotional support (Kadden, 1995) would reform her psychological wellbeing. Once Jos beliefs have been established, meaningful information can be given and educational programs can be incorporated. Jo requires learning necessary skills to change her problem behaviour, for this reason the information should be given alongside cognitive behavioural therapy (CBT), which views alcohol abuse as a learned behaviour which can be reversed (Lonabaugh Morgenstern, 1999).Jo will need to be aware that any negative feelings towards the diagnosis are normal and reassured that following the intervention she will learn adequate coping skills that will help her take control of her illness (Taylor, 2006). The first part will advance acceptance of the purpose, content and plan of the therapy. Informa tion will be presented about the severity of her liver disease, and abstinence of alcohol clearly identified as the desired goal. The patient should elect a person (family member, friend) willing to act as a source of support. A motivational interviewing style should be used to throughout to promote self-efficiency and better understanding in a nonthreatening fashion (Georgiou et al, 2003). Secondly it is important to identify and develop sufficient coping skills and plan how they can occupy their time with social activities that do not involve alcohol. Potential high-risk situations for drinking will have been identified, and the trey part of the therapy would require the individual to identify how they will avoid and cope with relapse.Jos psychologist should use the PKQ and CAGE results as a guideline to predict the length and stringency of the treatment (3-12 weeks), depending on level of alcohol dependance (Kadden, 1995), which should be constantly reviewed. Jo has shown posi tive response to cope with her diagnosis by smell for support on the internet. This provides support for the CBT approach as the success of this therapy will require active participation from the patient (Kadden, 1995). Jo did not enjoy the AA conflux she attended, and may have had difficulty comprehending their belief that an individual is unable to alter their drinking behaviour without the aid of religious intervention (Longabaugh Morgenstern, 1999). This would provide further support for the CBT approach having an be assumption that it is within the individuals power to change (Longabough Morgenstern, 1999). Attendances to alternative support gathering will be encouraged as researches have associated this with positive drinking outcomes (Longabough, 1999). Jo might benefit from a group who share the underlying assumption that alcohol is learned maladaptive behaviour that they can change (SMART cited in Longabough, 1999).Total alcohol abstinence represents the almost effec tive strategy for alcoholic patients affected by cirrhosis (Tilg Day, 2007 cited in Addolorato, 2009). Even low doses of daily alcohol intake are associated with change magnitude risk of cirrhosis. Continuing alcohol abuse can lead to compilations such as hepatocellular carcinoma (Addolorato, 2009). Consequently, achieving total alcohol abstinence should be the main aim in the management of Jos liver cirrhosis. This could become complex if Jo is diagnosed with alcohol dependence (Sussman, 2004). Medical recommendations and/or brief interventions may not be sufficient to achieve and maintain alcohol abstinence when a diagnosis of dependence is present. There may be a need to add pharmacologic approaches, like naltrexone, acamproste and bacolfen which have been shown to reduce alcohol craving and intake (Addolorato, 2009), to prevent relapse and further damaging Jos liver.Malnutrition is frequently present in cirrhotic patients, and considered to be a predictive factor for increase d morbidity and mortality (Merli et al, 2009). ferment and nutritional intervention could improve and prevent inter-related conditions such as obesity, diabetes and insulin bulwark (Catalano, 2008), which may worsen her condition. Good nutrition has been shown to improve liver regeneration, recommending an intake of about 2000 calories per day to correct deficiencies and promote hepatic repair (Addolorato, 2009). It is generally assumed that patients with chronic liver disease should be encouraged to go in exercise, as this will maintain or improve their physical well-being. This could have beneficial effects on body composition, muscle strength (Andersen et al, 1998) and glucose tolerance (Petrides, 1996) and may reduce symptoms of depression (Rot et al, 2009) and hold out (Blackburn, 2007 Sogolow, 2008). However backbreaking exercise is not recommended as this might increase risk of internal bleeding (Petrides, 1996). There arent many researches available on the long-term f unctional outcome of nutritional and physical well being, however malnutrition (Merli, 2009), depression (Bianchi, 2005) and fatigue (Blackburn, 2007) have been shown to increases complications in liver disease.In conclusion forming a good report with the health professional throughout the sessions will promote the underlying success of the intervention. Jos determinants and high risk situations that are likely to lead to alcohol will be assessed. It is important to incorporate healthy interests to her lifestyle and involve her friends and family throughout the cognitive behavioural treatment, where Jo will learn the necessary coping-skills to unlearn old habits associated with alcohol abuse. She should receive psychological support counselling for a long as required and be encouraged to maintain nutritional and physical well-being, which will overall reduce disability and psychological distress.