Cirrhosis Case Study (45 min)
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Outline
Mr. Garcia is a 43-year-old male who presented to the ED complaining of nausea and vomiting x 3 days. The nurse notes a large, distended abdomen and yellowing of the patient’s skin and eyes. The patient reports a history of alcoholic cirrhosis.
Mr. Garcia’s vitals are stable, BP 100/58, bowel sounds are active but distant, and the nurse notes a positive fluid wave test on his abdomen. The patient denies itching but is constantly scratching at his chest. He is oriented to person only and his brother at the bedside reports he hasn’t been himself today. He keeps trying to get out of bed The provider places orders for the following: Keep SpO2 > 92% Keep HOB > 30 degrees Insert 2 large bore PIV’s 500 mL NS IV bolus STAT 100 mL/hr NS IV continuous infusion Hydrocodone/Acetaminophen 5-500 mg 1-2 tabs q4h PRN moderate to severe pain Diphenhydramine 25 mg PO q8h PRN itching Ondansetron 4 mg IV q6h PRN nausea Lactulose 20 mg PO q6h Mr. Garcia’s LFT’s and Ammonia level are elevated. He is extremely confused and agitated and appears somewhat short of breath. The patient’s current vital signs are as follows: HR 82 RR 22 BP 94/56 SpO2 93% Temp 98.9°F The order is changed to Fentanyl 25 mcg IV q4h PRN moderate to severe pain. The provider notes somewhat shallow breathing and severe ascites and requests for you to set up for paracentesis. At this time, you express your concern that the patient is extremely confused and agitated and trying to get out of bed. You do not feel that he will be still enough for the procedure. The provider agrees and plans to postpone the paracentesis for now, but orders for you to report any signs of respiratory depression or hypoxia. After 6 doses of lactulose, Mr. Garcia is much more calm and cooperative. He is oriented times 2-3 most times. The provider performs the paracentesis and is able to remove 1.5 L of fluid. The patient’s shortness of breath is relieved, and his breathing is less shallow. Ultrasound of the liver showed severe scarring on the liver. Mr. Garcia’s condition continues to improve, and the plan is to discharge him home tomorrow.
200% NCLEX Pass Guarantee. What initial nursing assessments should be performed?
What diagnostic testing do you anticipate for Mr. Garcia?
Which finding is most concerning and needs to be reported to the provider? Why?
What further diagnostic and lab tests should be ordered to determine Mr. Garcia’s priority problems?
Which order should be implemented first? Why?
Which order should be questioned? Why?
Why is Mr. Garcia so confused and agitated?
What is the rationale for performing a paracentesis for Mr. Garcia?
What discharge teaching should be included for Mr. Garcia, including nutrition?
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Concepts Covered:
- Cardiovascular
- Circulatory System
- Gastrointestinal
- Renal
- Respiratory Disorders
- Cardiac Disorders
- Acute & Chronic Renal Disorders
- Disorders of the Adrenal Gland
- Disorders of the Thyroid & Parathyroid Glands
- Labor Complications
- Substance Abuse Disorders
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- Hematologic Disorders
- Emergency Care of the Cardiac Patient
- Studying
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- Pregnancy Risks
- Cardiovascular Disorders
- Shock
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- Noninfectious Respiratory Disorder
- Liver & Gallbladder Disorders
- Renal Disorders
- Basics of NCLEX
- Endocrine and Metabolic Disorders
- Medication Administration
- Vascular Disorders
- Disorders of Thermoregulation
- Disorders of Pancreas
- Eating Disorders
- Concepts of Population Health
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- Sexually Transmitted Infections
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