Case study 2 Liver Cirrhosis

Case study 2 Liver Cirrhosis

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Overview/history

Mr. S. is a 50-year-old man. He is the CEO of a large real estate company. He lives with his wife in an upscale suburban neighborhood outside of Toronto. His job is very stressful and he deals with this by drinking 2 or 3 bottles of beer, and several glasses of wine each evening. Frequently, he has business lunches where several alcoholic drinks may be consumed, however he never appears to be impaired during business hours. He states he feels he has balanced his responsibilities quite well, but his lifestyle does not allow him to fully abstain from drinking.

Unfortunately, his cirrhotic liver has never fully recovered from 25 years of heavy drinking. Although he has been diagnosed with cirrhosis, he has not been compliant with follow-up visits to his health care provider.

Past Medical History:  Admitted to the hospital four times in the past 24 months, with a diagnosis of G.I. bleed. He has a 30-year history of smoking.

Reason for this admission to Hospital

Mr S. has been coughing on and off for the past several days. His wife informs that this morning he coughed up “bright red blood” but he was quite irritable and refused to come to the hospital. His wife did call 911 earlier this evening when he began vomiting large amounts of bright red blood. He is admitted to your medical floor.

Your Initial Assessment:

He is awake, alert, and answers questions appropriately. His vital signs are

B/P 114/66

HR: 84

RR 19 & SpO2 97% R/A

Vitals remain within normal range from those recorded earlier in the emergency department.  You observe that he is jaundiced, has gynecomastia, and multiple ecchymotic areas on his body. The site for the maintenance IV has fresh bloodstains noted on the dressing but otherwise infusing well.

Case study 2 Liver Cirrhosis

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Later in the same shift:

As you are doing rounds, Mr. S. comes out of the room distraught.  You quickly enter his room and observe a large amount of blood all over his gown and bed linen. He looks terrified, appears confused and states I feel nauseated and dizzy. Vital signs are:

B/P 86/54, HR 122, RR 24 SpO2 95 room air.

Physical Exam Findings at this time:

Neurological:  awake, alert, orientated to time, but not to place, irritable and confused.

HEENT:  Epistaxis noted; Yellow sclera

Respiratory: lung lobes clear bilaterally, breath sounds diminished to bases, complaining of shortness of breath

Cardiac:  normal S1 S2, no S3 or S4.  Heart rhythm regular, Pulse weak HR 122.  BP 86/54 mmHg, feels fatigued & lethargic

Abdomen: abdomen firm and distended, bowel sounds hyperactive to 4 quadrants, abdominal discomfort, vomiting large amounts of bright red blood

GU:  normal urinary output, gynecomastia

MSK:  some mild tremors in both hands

Skin:  pale, jaundiced, multiple ecchymotic areas on his body

Lab values:

• Hemoglobin 70 mmol/L (normal for males: 140 – 180 mmol/L)
• Hematocrit 0.27
• AST 260 u/L (normal: 0 – 35 u/L)
• Ammonia level of 117 mcmol/L, (normal: 6 – 47 mcmol/L)
• INR 3 (INR 0.81- 1.2)

Treatment / Interventions ordered

• Packed RBCs to be infused 2Units over 2 hours each
• Second PIV insertion
• Octreotide
• IV fluid 0.9 Nacl at 25mls/hr
• Albumin 25% 5g to be infused after RBCs completed
• Ɓeta adrenergic blocker
• Spironolactone
• Lactulose
• When stabilized sclerotherapy for bleeding varices

Case study 2 Liver Cirrhosis

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Questions: answers to be adapted to a concept map:

1. List the subjective and objective nursing assessment data?

2. Cluster the relevant cues (data). Identify the inter-relationships between/among them. Explain what each cluster infer/suggest. (3 clusters)

3. Identify one data gap for each cluster and explain how this data would further inform the cluster or nursing diagnosis. (Support your work)

4. Formulate 3 Potential Nursing Diagnosis from the data (cue) clusters, and from those identify what one is the Priority Nursing Diagnosis. Briefly explain why this is the priority for Mr. S.

5. Identify SMART goal for the Priority Nursing Diagnosis? Ensure that the goal aligns with the Priority Nursing Diagnosis and follows the SMART format.

6. Apply the four metaparadigms to this case study. Describe how you would consider Mr. S in relation to the 4 metaparadigms.

7. Choose 1 Pattern of Knowing (Except Empirical). Briefly but concisely explain how you anticipate this Way of Knowing will guide your care.

What will be included in your nursing management that

demonstrates/supports this Way of Knowing?

Case study 2 Liver Cirrhosis

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By admin in Essays on December 6, 2022