Question

please complete the entire case study pertaining to cirrhosis and nursing, thank you.

3 Cirrhosis John Richards, 45 years old Primary Concept Nutrition Interrelated Concepts (In order of emphasis) I. Fluid and Electrolyte Balance 2. Perfusion 3. Cognition 4. Addiction 5. Clinical Judgment 6. Patient Education 7. Communication 8.Collaboration O 2016 Keith Rischer/www.KeithRN.com

Answer 1

RELEVANT Data from Present Problem:	Clinical Significance
* abdominal pain, and increasing nausea and vomiting the past 3 days that has not resolved. *He is also feeling more fatigued and has had a poor appetite.	*To rule out the reasons for the symptoms showing
RELEVANT Data from Social History:	Clinical Significance
heroin use/abuse in the past John is currently unemployed and has no health insurance.	*To know the baseline regarding his habits and priority for the treatment

What is the RELATIONSHIP between your patient’s past medical history (PMH) and current meds?

PMH	Home Medicts:	Pharmacological classification	Expected outcome
*Hepatitis C–past history of IV drug abuse *ETOH abuse x 25 years	Ibuprofen 600 mg PO prn for HA	nonsteroidal anti-inflammatory drugs (NSAIDs).	Relieve from headache

One disease process often influences the development of other illnesses. Based on your knowledge of pathophysiology, (if applicable), which disease likely developed FIRST that then initiated a “domino effect” in their life?

* ETOH abuse x 25 years

*He is addicted to methanol for the last 25 years and has a past history of Iv drug abuse these all problems lead to liver damage in the later life and shown as Hepatitis

What VS data is RELEVANT that must be recognized as clinically significant to the nurse?

Relevant VS Data	Rationale
T: 100.5 (oral) P: 110 (regular)	Here we can see a raising of temperature and pulse indicates some infection

What assessment data is RELEVANT that must be recognized as clinically significant to the nurse?

RELEVANT Assessment Data:	Rationale
In the physical assessment Abdomen large–rounded–firm to touch, the sclera of eyes light yellow in color, lips and oral mucosa tacky dry	This indicates that the patient is having some gastrointestinal system and the yellowish color of the sclera indicates of hepatitis and he is suffering from acute dehydration

Clinical Reasoning

1. What is the primary problem that your patient is most likely presenting with?

The patient is suffering from Hepatitis and having abdominal pain, and increasing nausea and vomiting. He is also feeling more fatigued and has had a poor appetite.

2. What is the underlying cause/pathophysiology of this concern?

Due to the alcohol and drug abuse in the past and that primarily affect the liver and he is now presently suffered from nausea, vomiting and also the assessment indicates that he is progressing to the stage of Cirrhosis of liver

3. What nursing priority(s) will guide your plan of care? (if more than one-list in order of PRIORITY)

1.Acute Pain

2.Fluid volume deficit

3.Imbalanced nutrition less than body requirements

4.Fatigue

4. What interventions will you initiate based on this priority?

Nursing intervention	Rationale	Expected outcome
*Assess for the pain and vital signs *Measure dietary intake by calorie count. * Encourage patient to eat; explain reasons for the types of diet. Feed patient if tiring easily, or have SO assist patient. Include patient in meal planning to consider his/her preferences in food choices. *Encourage patient to eat all meals including supplementary feedings. *Give small, frequent meals. *Restrict intake of caffeine, gas-producing or spicy and excessively hot or cold foods. *Promote undisturbed rest periods *Recommend cessation of alcoholism	*To obtain the baseline data *Provides important information about intake, needs, and deficiencies. *Improved nutrition and diet is vital to recovery. The patient may eat better *Patient may pick at food or eat only a few bites because of loss of interest in food or because of nausea, generalized weakness, malaise. *Poor tolerance to larger meals may be due to increased intra-abdominal pressure *Aids in reducing gastric irritation and/or diarrhea and abdominal discomfort that may impair oral intake. *Conserving energy reduces metabolic demands on the liver *It may result in worsening of the condition	*No complaints of pain *Maintain the nutritional status *Maintain the fluid balance *Maintain the adequate weight

5. What body system(s) will you most thoroughly assess based on the primary/priority concern?

The maint system it will affect is the Gastrointestinal system/Hepatic system

6. What is the worst possible/most likely complication to anticipate?

The most complication that is most likely to occur due to his past history and present medical condition is Cirrhosis of liver

7. What nursing assessment(s) will you need to initiate to identify this complication if it develops?

There is a large abdomen–rounded–firm to touch and suffering from abdominal pain and the yellowish discoloration of sclera

Medical Management: Rationale for Treatment & Expected Outcomes:

Care Provider Orders:	Rationale:	Expected Outcome:
Establish peripheral IV NS 0.9% bolus of 1000 mL prochlorperazine (Compazine) 10 mg IV push Orthostatic BP’s Complete blood cell count (CBC) Basic metabolic panel (BMP) Liver function test (LFT) INR	*Maintain the normal skin turgor and prevent dehydration *To control nausea and vomiting *Some times the enlarged liver /enlarged large round abdomen may push the heart and results in orthostatic hypertension. *may be ordered to evaluate a person's red and white blood cells and platelets.platelets are often decreased with cirrhosis *A basic metabolic panel is a blood test that measures your sugar (glucose) level, electrolyte and fluid balance, and kidney function *While blood tests can detect liver injury, there is no single test that can be used to diagnose cirrhosis. ... Alanine aminotransferase (ALT) – an enzyme found mainly in the liver. Values are increased with all types of liver injury, including cirrhosis. *A normal INR is 1.0. ... INR is related to the prothrombin time (PT). If there is serious liver disease and cirrhosis, the liver may not produce the normal amount of proteins and then the blood is not able to clot normally.	*Maintains the adequate balance *Control nausea and vomiting *To prevent the progression of the disease *To maintain the normal B.P