Cirrhosis Case Study (45 min)
Included In This Lesson
Study Tools For Cirrhosis Case Study (45 min)
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.
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?
Katies NCLEX
Concepts Covered:
- Test Taking Strategies
- Medication Administration
- Adult
- Emergency Care of the Cardiac Patient
- Microbiology
- Anxiety Disorders
- Depressive Disorders
- Nervous System
- Gastrointestinal Disorders
- Fundamentals of Emergency Nursing
- Dosage Calculations
- Understanding Society
- Circulatory System
- Concepts of Pharmacology
- Studying
- Newborn Care
- Adulthood Growth and Development
- Respiratory Disorders
- Pregnancy Risks
- Neurological
- Postpartum Complications
- Substance Abuse Disorders
- Bipolar Disorders
- Learning Pharmacology
- Psychotic Disorders
- Prenatal Concepts
- Tissues and Glands
- Factors Influencing Community Health
- Concepts of Population Health
- Community Health Overview
- Developmental Considerations
- Communication
- Legal and Ethical Issues
- Cardiovascular
- Emergency Care of the Neurological Patient
- Emergency Care of the Respiratory Patient
- Emergency Care of the Trauma Patient
- Delegation
- Multisystem
- Health & Stress
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Trauma-Stress Disorders
- Developmental Theories
- Concepts of Mental Health
- Gastrointestinal
- Newborn Complications
- Labor Complications
- Fetal Development
- Terminology
- Labor and Delivery
- Postpartum Care
- Prefixes
- Suffixes
- Proteins
- Statistics
- Med Term Basic
- Med Term Whole
- Cardiac Disorders
- Preoperative Nursing
- Intraoperative Nursing
- Vascular Disorders
- Noninfectious Respiratory Disorder
- Upper GI Disorders
- Central Nervous System Disorders – Brain
- Shock
- Immunological Disorders
- Postoperative Nursing
- Perioperative Nursing Roles
- Hematologic Disorders
- Disorders of Pancreas
- Neurological Trauma
- Neurological Emergencies
- Musculoskeletal Trauma
- EENT Disorders
- Peripheral Nervous System Disorders
- Respiratory Emergencies
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of the Thyroid & Parathyroid Glands
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Respiratory
- Acute & Chronic Renal Disorders
- Disorders of the Adrenal Gland
- Documentation and Communication
- Oncology Disorders
- Female Reproductive Disorders
- Cognitive Disorders
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Integumentary Disorders
- Urinary Disorders
- Integumentary Disorders
- Musculoskeletal Disorders
- Disorders of Thermoregulation
- Basics of NCLEX
- Integumentary Important Points
- Urinary System
- Neurologic and Cognitive Disorders
- Central Nervous System Disorders – Spinal Cord
- Renal and Urinary Disorders
- Respiratory System
- Infectious Disease Disorders
- EENT Disorders
- Eating Disorders
- Personality Disorders
- Psychological Emergencies
- Somatoform Disorders
- Prioritization
- Hematologic Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Endocrine and Metabolic Disorders
- Oncologic Disorders
- Behavior
- Emotions and Motivation
- Growth & Development
- Intelligence and Language
- Psychological Disorders
- State of Consciousness
- Basics of Sociology
- Note Taking
- Basics of Human Biology