What are the initial nursing interventions for patients with elevated liver enzymes?

From the Guidelines

Initial nursing interventions for patients with elevated liver enzymes should focus on comprehensive assessment, monitoring, and supportive care, prioritizing the patient's morbidity, mortality, and quality of life. The most recent and highest quality study, 1, published in 2021 in the Journal of Clinical Oncology, provides guidance on the management of immune-related adverse events, including hepatitis. According to this study, monitoring patient for abnormal liver blood tests, such as AST, ALT, and bilirubin, before each infusion and/or considering weekly monitoring if grade 1 LFT elevations are present, is crucial.

Key Interventions

• Obtain a detailed health history, including medication use, alcohol consumption, and recent illnesses, to identify potential causes of liver enzyme elevations
• Monitor vital signs regularly, with particular attention to signs of liver dysfunction, such as jaundice, ascites, or mental status changes
• Implement frequent laboratory monitoring of liver function tests (ALT, AST, alkaline phosphatase, bilirubin) as ordered to track progression or improvement
• Ensure proper nutrition with a balanced diet, and provide small, frequent meals if nausea occurs
• Administer medications cautiously, avoiding hepatotoxic drugs when possible, and properly timing medications that require hepatic metabolism
• Maintain fluid and electrolyte balance through careful intake and output monitoring, daily weights, and assessment for fluid retention
• Patient education should include explanation of the condition, importance of follow-up testing, medication adherence, and lifestyle modifications, such as alcohol abstinence, as recommended by 1.

Additional Considerations

• Review medications and supplements that may cause hepatotoxicity, and rule out abnormal liver enzymes from development or progression of liver metastases, as suggested by 1
• Consider liver biopsy if the patient is steroid-refractory or if concern for other differential diagnoses that would alter medical management, as recommended by 1 and 1
• For grade 2 or higher elevations, workup for other causes of elevated liver enzymes, such as viral hepatitis, alcohol history, iron studies, thromboembolic event, or potential liver metastasis from primary malignancy, should be considered, as suggested by 1.

From the Research

Initial Nursing Interventions for Elevated Liver Enzymes

The initial nursing interventions for patients with elevated liver enzymes involve a comprehensive approach to manage the underlying cause and prevent further liver damage. Some key interventions include:

• Monitoring liver function tests and other laboratory results to assess the severity of liver damage 2
• Providing education on lifestyle modifications, such as weight loss, healthy diet, and regular exercise, to manage conditions like non-alcoholic fatty liver disease (NAFLD) 2
• Assessing for signs and symptoms of liver disease, such as jaundice, fatigue, and abdominal pain, and reporting any changes to the healthcare team 3
• Collaborating with other healthcare professionals to develop a plan of care that addresses the patient's physical and emotional needs 3

Lifestyle Interventions

Lifestyle interventions, such as moderate-intensity lifestyle counseling, have been shown to be effective in improving liver function and reducing liver enzymes in patients with elevated liver enzymes 2. These interventions may include:

• Encouraging patients to engage in regular physical activity, such as walking or other aerobic exercises, to improve insulin sensitivity and reduce liver fat 2
• Providing guidance on healthy eating habits, such as a balanced diet that is low in saturated fats and high in fruits and vegetables, to support weight loss and improve liver health 2
• Supporting patients in achieving and maintaining a healthy weight, as excess weight is a major risk factor for liver disease 4

Nursing Care for Patients with Cirrhosis

For patients with cirrhosis, nursing care involves a comprehensive approach to manage the underlying condition and prevent complications. Some key interventions include:

• Monitoring for signs and symptoms of complications, such as ascites, variceal bleeding, and hepatic encephalopathy, and reporting any changes to the healthcare team 3
• Providing education on self-care strategies, such as avoiding alcohol and managing stress, to support liver health and prevent further liver damage 3
• Collaborating with other healthcare professionals to develop a plan of care that addresses the patient's physical and emotional needs and supports their overall well-being 3

Emergency Department Management

In the emergency department, patients with elevated liver enzymes require prompt evaluation and management to prevent further liver damage. Some key interventions include:

• Assessing the patient's clinical presentation and laboratory results to determine the underlying cause of elevated liver enzymes 5
• Developing an algorithmic approach to interpret abnormalities in liver function tests and guide further evaluation and management 5
• Providing education on self-care strategies and follow-up care to support liver health and prevent further liver damage 5