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Liver cirrhosis is a chronic disease characterized by progressive fibrosis, altered liver architecture, and the formation of regenerative nodules. Although it develops slowly, cirrhosis often leads to serious complications such as ascites, variceal bleeding, jaundice, and hepatic encephalopathy. According to the Global Burden of Disease Study 2019, cirrhosis is among the leading causes of death worldwide, with more than 1.4 million deaths annually. In Indonesia, the prevalence of cirrhosis is reported at 0.4% (Riskesdas, 2021) and shows an increasing trend over the years. This case study aims to describe the application of comprehensive nursing care in a patient diagnosed with liver cirrhosis using the nursing process approach. The research design was a case study conducted on Mr. R, who was admitted to Dahlia Ward at RSUD dr. Soeselo, Tegal. Data collection was carried out through interviews, observations, physical examinations, and medical record reviews. The results revealed that the main nursing problems identified were ineffective peripheral perfusion, ineffective breathing pattern, and knowledge deficit. Nursing interventions provided included positioning the patient in semi-fowler, monitoring vital signs, educating the patient about low-sodium diet and fluid restriction, and collaborating in the administration of diuretics and albumin. After three days of nursing care, the evaluation indicated clinical improvement, evidenced by reduced edema, decreased shortness of breath, and increased patient understanding of his disease and treatment plan. In conclusion, nursing care with a comprehensive process approach has a significant positive impact on the condition of patients with liver cirrhosis. Nurses play an essential role in assessment, planning, implementation, evaluation, and providing health education to prevent complications and improve patients’ quality of life.

Hepatic cirrhosis (SH) is a disease/group of diseases that infects the liver, characterized by loss of liver lobular architecture due to fibrosis and damage to parenchymal cells and their regeneration which ultimately forms a nodular structure. According to its clinical manifestations, this disease has a long latent period but is followed by sudden abdominal swelling, abdominal pain, hematemesis, edema and jaundice. In the next phase, the most prominent symptoms include jaundice, ascites, portal hypertension, and central nervous system abnormalities that end in coma. SH is infecting the whole world. SH is the eleventh leading cause of mortality and the fifteenth leading cause of morbidity worldwide. There are many things that have been proven to cause SH, including infections, toxins, hereditary conditions, and even autoimmune processes. Some of the complications that arise from SH include gastroesophageal varices (affecting the stomach and esophagus), hypersplenism (affecting the splenic organs), hepatorenal syndrome (affecting the kidneys) and even hepatic encephalopathy (affecting the central nervous system).

Chronic renal failure is a progressive and continuous destruction of kidney structures. Chronic renal failure occurs in susceptible individuals, analgesic nephropathy, destruction of renal papillae associated with daily use of analgesic drugs for years. Whatever the cause, there is a progressive deterioration of kidney function which is characterized by a progressive decrease in the Glomelurus Filter Rate (GFR) (Corwin, 2009). Chronic kidney failure is a failure of kidney function to maintain metabolism and fluid and electrolyte balance due to progressive destruction of kidney structures with manifestations of accumulation of residual metabolites (uremic toxicants) in the blood (Muttaqin & Sari, 2011). as well as electrolytes and acid-base composition of body fluids, removing metabolic wastes that are no longer needed by the body, regulating blood pressure and hormonal function. Chronic Kidney Disease (CKD) is the final stage of chronic kidney failure where GFR <15 ml/min/1.73m2 so that the body fails to maintain metabolism and fluid and electrolyte balance, causing uremia, namely retention of urea and other nitrogenous wastes in the blood (Smeltzer et al. al, 2008; National Kidney Foundation in Kallenbach, et al, 2005). With the increasingly real decline in kidney function or worsening of symptoms of uremia, renal replacement therapy is required for survival, namely dialysis and organ transplantation. There are two methods of dialysis, one of which is Hemodialysis (Potter, 2005; Smelzer, 2008).