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