I'm not quite sure what you are meaning by a "standard assessment". To me a standard assessment is either a head to toe or body systems physical exam. However, I have a feeling that what you are meaning is what you want to specifically look for what is abnormal in the patient with cirrhosis or hepatitis, right?
One of the nicest care plan books that I have that does this is
Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span, 7th edition, by Marilynn E. Doenges, Mary Frances Moorhouse and Alice C. Murr. Both conditions are listed in it. I will quote you what is in the book about assessment only for cirrhosis and hepatitis. I am not including the abnormal lab and test information because I am getting tired: "CIRRHOSIS (pages 453-454) Data depends on the underlying cause of the condition. ACTIVITY/REST May report: Weakness, fatigue, exhaustion
May exhibit: Lethargy
Decreased muscle mass/tone
CIRCULATION May report: History of/recent onset of heart failure, pericarditis, rheumatic heart disease, or cancer (causing liver impairment leading to failure)
Easy bruising, nosebleeds, bleeding gums
May exhibit: Hypertension or hypertension (fluid shifts)
Dysrhythmias, extra heart sounds (S3, S4)
Jugular venous distension (JVD), distended abdominal veins, spider angiomas/collateral circulation
Ecchymosis, petechiae
anemia, leukopenia, thrombocytopenia, coagulation disorders, splenomegaly
ELIMINATION May report: Flatulence
Diarrhea or constipation; gradual abdominal enlargement
May exhibit: Abdominal distension (hepatomegaly, splenomegaly, ascites)
Decreased/absent bowel sounds
Clay-colored stools, melena
Hemorrhoidal varices
Dark, concentrated urine; oliguria (hepatorenal syndrome/failure)
FOOD/FLUID May report: Anorexia, food intolerance/indigestion
Nausea/vomiting, hematemesis
May exhibit: Weight loss or gain (fluid)
Tissue wasting, delayed wound healing
Edema generalized in tissues
Dry skin, poor turgor
Halitosis/fetor hepaticus. bleeding gums
Hypoalbuminemia
NEUROSENSORY May report: Significant other(s) may report personality changes, depressed mentation
May exhibit: Changes in mentation, confusion, hallucinations, coma
Slowed/slurred speech
Asterixis (involuntary jerking movements of hands/tongue/feet associated with hepatic encephalopathy)
PAIN/DISCOMFORT May report: Abdominal tenderness/RUQ pain
Severe itching
Pins/needles sensation, burning pain in extremities (peripheral neuropathy)
May exhibit: Guarding/distraction behaviors
Self-focus
RESPIRATION May report: Dyspnea
May exhibit: Tachypnea, shallow respiration, adventitious breath sounds
Limited thoracic expansion (ascites)
Hypoxia
SAFETY May report: Itching/dryness of skin
May exhibit: Fever (more common in alcoholic cirrhosis)
Jaundiced skin and sclera, pruritis
Spider angiomas, telangiectasis, palmar erythema
Confusion progressing to delirium and coma (hepatic encephalopathy)
Unsteady or shaky/jerking movements
SEXUALITY May report: Menstrual disorders (women), impotence (men)
May exhibit: Testicular atrophy, gynecomastia, loss of hair (chest, underarm, pubic)
TEACHING/LEARNING May report: History of long-term alcohol or IV drug use/abuse, alcoholic liver disease. use of drugs affecting liver function
History of biliary disease, hepatitis, exposure to toxins, liver trauma, complications of portal hypertension (e.g. episodes of bleeding esophageal varices and hepatorenal syndrome)"
"HEPATITIS (pages 443-444) Data depends on the cause (type of hepatitis) and severity of liver involvement/damage. ACTIVITY/REST May report: Fatigue, weakness, general malaise, muscle aches
CIRCULATION May exhibit: Bradycardia (severe hyperbilirubinemia)
Jaundiced sclera, skin, mucous membranes
ELIMINATION May report: Dark urine
Diarrhea/constipation, clay-colored stools
current/recent hemodialysis
FOOD/FLUID May report: Loss of appetite (anorexia), weight loss or gain (edema)
Nausea/vomiting
May exhibit: Ascites
NEUROSENSORY
May exhibit: Irritability, drowsiness, lethargy, asterixis, headache
PAIN/COMFORT May report: Abdominal cramping, right upper quadrant (RUQ) tenderness
Myalgias, arthalgias; headache
Itching (pruritis)
May exhibit: Muscle guarding, restlessness
RESPIRATION May report: Distaste for/aversion to cigarettes (smokers)
Recent flu-like URI signs and symptoms
SAFETY May report: Transfusion of blood/blood products in the past
May exhibit: Fever
Urticaria, maculopapular lesions, irregular patches of erythema
Exacerbation of acne
Spider angiomas, palmar erythema, gynecomastia in men (sometimes present in alcoholic hepatitis)
Splenomegaly, posterior cervical node enlargement
SEXUALITY May report: Lifestyle/behaviors increasing risk of exposure (e.g. sexual promiscuity, sexually active homosexual/bisexual male)
TEACHING/LEARNING May report: History of known/possible exposure to virus, bacteria, or toxins (contaminated food, water, needles, surgical equipment or blood), carriers (symptomatic or asymptomatic), recent surgical procedure with halothane anesthesia, exposure to toxic chemicals (e.g. carbon tetrachloride, vinyl chloride)
History of known/possible exposure to hepatotoxic prescription (e.g. sulfonamides, phenothiazides, isoniazid) or OTC drug use (e.g. acetaminophen)
Use of herbal supplements associated with hepatotoxicity, (e.g. chaparral, JinBuHuan, germander, comfrey, mistletoe, skullcap, margosa oil, pennyroral)
Use of street injection drugs or alcohol
Travel to/immigration from China, Africa, Southeast Asia, Middle East (hepatitis B [HBV] and C [HBC] are endemic in these areas)
Concurrent diabetes, heart failure, malignancy, or renal disease"
Jun 2, '08 by DaytoniteI'm not quite sure what you are meaning by a "standard assessment". To me a standard assessment is either a head to toe or body systems physical exam. However, I have a feeling that what you are meaning is what you want to specifically look for what is abnormal in the patient with cirrhosis or hepatitis, right?
