Question

Case Study: Cirrhosis Patient Profile old female is being evaluated for a new onset ascites and lower extremity edema. She has been hospitalized for 2 weeks for an upper GI bleed. She had an EGD for varices. J.B. was on naproxen 220 mg TID for lower back pain for two and weeks prior to her hospitalization. She was discharged on omeprazole 20 mg BID. A review of symptoms shows that she is forgetful, does not sleep well, is drowsy fatigued during the day which prevents her from working full-time. She has no complaints of abdominal pain. J.B. has a 10-yer history of type 2 diabetes mellitus, hypertension and hypercholesterolemia. No complaints of chest pain and no history of coronary heart disease. She drank alcohol moderately heavy in her 20s and currently drinks less than 3 drinks per week. She does not smoke and her family history is unremarkable. Her BP is 132/82; Pulse 88 bpm, Temp 99.0°F, weights 235 lbs. She is alert to person and place but not time, her abdomen is distended with mild tenderness upon palpation, 2" edema to mid-calf and pedal pulses barely palpable, she is positive for asterixis, and her skin had a few spider veins on her face and upper chest. BUN 8mg/dL creatinine 1 .0 mg/dL; AST 68 IU/mL; ALT 46 IU/mL; albumin 2.5 g/dL; K. 3.8 mEq/dL. iscussion Questions nswer the following questions: 1. What is the appropriate diagnostic test for clients with cirrhosis? 2. What is the nursing management for a client who undergoes a paracentesis? 3. How should the nurse monitor for asterixis? 4. What is the common cause of 5. What is the treatment of clients experiencing chronic liver cirhosis? disorientation in clients with chronic liver cirrhosis?

Answer 1

ANSWER

1.Liver function tests is used as an appropriate diagnostic test

   for patient with liver cirrhosis.

Liver function tests are

                  * SGPT.

                  *SGOT.

                  *Serum alkaline phosphatase.

                  * Albumin.

                  * Bilirubin (Total,direct)

                  * Protein (Total).

2. Nursing management of client undergo paracentesis.

           * Nurse should measure the abdominal girth and weight

             of the patient before doing the procedure to get a baseline

             information about the current status.

         * Instruct the patient to urinate ten minutes before the procedure

              to eliminate the risk of injury to bladder.

           * Place the patient in semi fowlers position or sit in the chair with

              leg supported to shift the fluid down.

           * Sudden drop in blood pressure may occur during the procedure so

             continously monitor the blood pressure to detect abnormalities.

           * Follow aseptic techniques when assisting the physician for paracentesis

              to prevent transmission of infection.

           * After withdrawing enough fluid from the abdominal cavity apply a tincture

             seal and sterile dressing over the punctured area.

           * Use a pressure bandage to cover the dressing site to prevent leakage of fluid

              from the abdominal cavity.

           * Assess the dressing site for any leakage and if any complication occur inform

              the physician immediately.

3. Monitoring asterixis.

           * Asterixis is the flapping tremor of the hands seen in patient

              with hepatic encephalopathy.

           * Nurse can monitor asterixis by instruct the patient write or draw

              something in a paper.

           * Patients with asterixis can not write or draw properly in a paper.

4. Disorientation in patient with chronic liver cirrhosis.

        * Patient with chronic liver cirrhosis has increased level of ammonia

          in the blood.

        * Increased level of ammonia in the systemic circulation precipitate

           hepatic encephalopathy.

        * Hepatic encephalopathy result in neurological changes in the brain

          which leads to disorientation.

5. Treatment of chronic liver cirrhosis.

        Treatment of chronic liver cirrhosis include management of symptoms

         and avoid complications.

       * Colchicine is used a drug of treatment for reduce ammonia level in

                patient with mild and moderate cirrhosis.

           * Pottasium sparing diuretics used to control ascites occur in patient

               with hepatic cirrhosis.

             * Vitamin and nutritional supplements used to maintain electrolyte level

                in the blood.

             * Antibiotic therapy used to control ammonia producing bacteria level in

               the colon.