50333852 Liver Cirrhosis

8/18/2019 50333852 Liver Cirrhosis

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I. INTRODUCTION

Liver Cirrhosis (alcoholic)

Cirrhosis of the liver is a chronic disease that causes cell destruction andbrosis (scarring) of heatic tissue. !ibrosis alters nor"al liver structure andvasculature# i"airing blood and l$"h %o& and resulting in heaticinsu'cienc$ and h$ertension in the ortal vein. Co"lications includeh$onatre"ia# &ater retention# bleeding esohageal varices. Coaguloath$#sontaneous bacterial eritonitis# and heatic encehaloath$.

Cirrhosis is a otentiall$ lifethreatening condition that occurs &hen scarring

da"ages the liver. This scarring relaces health$ tissue and revents theliver fro" &oring nor"all$. Cirrhosis usuall$ develos after $ears of liverin%a""ation. *hen chronic diseases cause the liver to beco"e er"anentl$in+ured and scarred# the condition is called Cirrhosis. Cirrhosis har"s thestructure of the liver and blocs the %o& of blood. The loss of nor"al livertissue slo&s the rocessing of nutrients# hor"ones# drugs# and to,ins b$ theliver. -lso# the roduction of roteins and other substances "ade b$ the liveris suressed. eole &ith cirrhosis often have fe& s$"to"s at rst. Theerson "a$ e,erience fatigue# &eaness# and e,haustion. Loss of aetiteis usual# often &ith nausea and &eight loss. -s liver function declines# &ater"a$ accu"ulate in the legs and the abdo"en (ascites). - decrease in

roteins needed for blood clotting "aes it eas$ for the erson to bruise#bleeding or infection. In the later stages of cirrhosis# +aundice ($ello& sin)"a$ occur# caused b$ the buildu of bile ig"ent that is assed b$ the liverinto the intestines. The liver of a erson &ith cirrhosis also has troublere"oving to,ins# &hich "a$ build u in the blood. Drugs taen usuall$ areltered out b$ the liver# and this cleansing rocess also is slo&ed do&n b$cirrhosis. eole &ith cirrhosis often are ver$ sensitive to "edications andtheir side e/ects. The doctor often can diagnose cirrhosis fro" the atient0ss$"to"s and fro" laborator$ tests. During a h$sical e,a"# the doctorcould notice a change in ho& $our liver feels or ho& large it is. If the doctorsusects Cirrhosis# $ou &ill be given blood tests. The urose of these tests

is to nd out if liver disease is resent. In so"e cases# other tests that taeictures of the liver are erfor"ed such as the co"uteri1ed a,ialto"ograh$ (C-T) scan# and ultrasound. The doctor "a$ decide to conr"the diagnosis b$ utting a needle through the sin (bios$) to tae a sa"leof tissue fro" the liver. In so"e cases# cirrhosis is diagnosed during surger$&hen the doctor is able to see the entire liver.

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II. O234CTI546

7eneral ob+ectives8

This case stud$ focuses on the advance"ent of "$ sills in "anagingand ad"inistering the e,tensive range of "$ intervention to "$ client&ith Liver Cirrhosis. This stud$ &ill further hel "e to e,and "$no&ledge about the said disease.

6ecic ob+ectives8

9. To established good raort to the client and to get the h$sical

assess"ent.

:. To dene &hat is Liver Cirrhosis.

;. To trace the athoh$siolog$ of Liver Cirrhosis

r. @>

-ge8 ale

6tatus8 *ido&ed

Nationalit$8 !iliino

Religion8 Catholic Christian

2lood t$e8 2


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-ddress8 B 9r. @># ale 9r. @> is a non s"oer and an

alcoholic beverages driner.

>r. @> &as ad"itted to 7->>C on !ebruar$ :A# :99

9:89=a" in the "orning. ?e &as ad"itted due to enlarge"ent of his lo&er

e,tre"ities.

?I6TORG O! R464NT ILLN466

One &ee rior to ad"ission the atient had e,erienced fast

enlarge"ent of his lo&er e,tre"ities because of ede"a then he &as

brought to the 4R of 7->>C.

!->ILG >4DIC-L ?I6TORG

(H) ?$ertension

LI!4 6TGL4

-. ersonal ?abit

The atient does not s"oe but drins alcoholic beverages.

2. Diet

?e eats three ti"es a da$ and drins


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?is taling &ith his friends outside the house during his free

ti"e after he had nish the household choirs. 6o"eti"es he la$

basetball.

D. 6lee and Rest

?e said that he sends F hours of slee ever$ night and he taes

nas if he had free ti"e. ?e usuall$ slees at 998 in the evening

and &aes u at =8 in the "orning he said that it is continuous

and he feels refrehed after &aing u.

4. -ctivities of Dail$ Living

The atient doesn0t &or ever$da$# ever$ *ednesda$ and !rida$

he is serving the church cause his a church &orer. 4ver$ &eeend

he allotted ti"e to rest and to have bonding &ith his fa"il$. 2ut in

night ti"e of his &eeend he send a lot of ti"e drining beers &ith

his "ale friends.

-TI4NT06 6OCI-L ?I6TORG

-. !a"il$ Relationshi and !riends

The atient0s fa"il$ is e,tended t$e together &ith his "other

and one son and one daughter. -ccording to hi" he has a good

relationshi &ith each "e"ber of hi" fa"il$ and also &ith hi"

friends. ?e allotted ti"e to bond &ith hi" fa"il$.

2. Occuational ?istor$

The atient is a church server&orer.

C. 4cono"ic ?istor$

-ccording to the atient hi" being a church server&orer is an

additional inco"e to the" and it satises their needs.

I5. ?G6IC-L -66466>4NT

-ctual !indings Nor"al !indings Interretation


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?ead

• 6ull

• 6cal

• ?air

• !ace

•

4$es

• 4$ebro&s

• 4$elahes

• 4$elids

Nor"ocehalicNo lu"s

No nits# lice and dandru/ no baldness

6traight# 2lac &ith &hite

hair# oil$ hair

6$""etrical &ith"ove"ent4,ressions aroriateto situations

6$""etricalNo cloudinessNo Lacri"ation

6$""etrical

4uall$ distributed

Curved slightl$ out&ard

6in intactNo dischargeNo discolorationLids close s$""etricall$aro,i"atel$ 9=:involuntar$ blins er

Nor"ocehalic6"oothNo lu"s-bsence of "odules or

"assesNo area of tenderness6$""etrical &ithrotrusions on the lateralart of arietal foreheadand occiital bone.

*hitishNo nits# lice and dandru/ no baldness

2lac or bro&n in color?air is evenl$ distributedNo area of baldnessThic!ineCurl$in$straightDr$oil$shin$ hair

6$""etrical &ith"ove"ent

4,ressions aroriateto situations

6$""etricalNo rotrusionsDear or no CloudinessNo e,cessive Lacri"ation

>oves s$""etricall$?air evenl$ distributed6in Intact

4uall$ distributedCurved slightl$ out&ard

6in intactNo dischargeNo discolorationLids close s$""etricall$

Nor"al

Nor"al

Nor"al

Nor"al

Nor"al

Nor"al

Nor"al

Nor"al


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• Lid "argins

• Lo&er

alebralcon+unctiva

• 6clera

• Iris

• uils

• 4$e

>ove"ent

• !ield of

visionJ5isual acuit$

"inuteK bilateral blining

No secretionsNo er$the"aNo redness

in# shin$# &ith visibleblood vesselsNo discharges

*hite in colorClear No redness

!lat2ro&nRoundTransarent6hin$

4RRL-

>oves in unisoncoordinated

6a"e as the color of thefaceNo s&elling

?ell shae

*a,$ ceru"enresence of cilia

aro,i"atel$ 9=:involuntar$ blins er"inuteK bilateral blining

No scaling

No secretionsNo er$the"aNo redness

in# shin$# &ith visibleblood vesselsNo discharges

*hite$ello&ish in blac-"ericans

Clear# No cloudinessNo redness

!lat2ro&nlight bro&n and $ello&ish6$""etricalRoundTransarent6hin$

4RRL-(uils 4uall$

Round# Reactive to Light -cco""odation

>oves in unisoncoordinated

7ood eriheral vision:: in both e$es

arallel &ith outercanthus of the e$es6a"e as the color of thefaceNo s&ellingNo tenderness

Nor"al

Nor"al

Nor"al

Nor"al

Nor"al

Nor"al

Nor"al

Nor"al


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• 4ar

• ?earing

acuit$

• 4ar Canal

• Lis

• 7u"s

• Teeth

• Tongue

• !renulu"

*ith good hearing acuit$in both ears

No lesionsresence of cilia

Darer lis-bilit$ to urse lis

in# "oistNo s&elling

No tendernessNo discharges

&hite

in# even# rough dorsal

surface and "oist

>idlineinish*ith visible veins

in# "oist# no

?ell shae!ir" cartilage

Gello&ishDr$&a,$ ceru"en

resence of ciliaNo foreign bod$

*ith good hearing acuit$in both ears

6$""etric and straightNo discharge or %aringUnifor" colorNo tenderness

No lesionsresence of cilia

Unifor" incolor(darer# e.g#2luishhue# in >editerraneangrous and darsinnedclients)6oft# "oist# s"oothte,ture6$""etr$ of contour

-bilit$ to urse lisNo tenderness

in# "oistNo s&ellingNo tendernessNo dischargesNo retraction(lo&er anduer)

;: in nu"ber

*hiteUer teeth overrideslo&er teeth

in# even# rough dorsalsurface and "oist

Nor"al

Nor"al

Nor"al

Decreaseofo,$gensul$

Nor"al

Nor"al

Nor"al

Nor"al


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• 6oft alate

• ?ard alate

• Uvula

• Tonsils

Nec

Uer

4,tre"ities

• 6in

• Nails

s&ellingNo tenderness

2on$# Light in in color#"oist

>idline "oves &hen theclient sa$s M-ah

inishNo dischargeNo in%a""ation

6a"e as the sin colorNo l$"hs# No "ass

No abrasions or otherlesions*hen inched# sinsrings bac to reviousstate &ith ede"a

Conve, curvature

>idlineinish*ith visible veins

in# "oist# nos&ellingNo tenderness

2on$# Light in in color#"oist

in# "oist>idline "oves &hen the

client sa$s M-ah

inishNo dischargeNo in%a""ation

4rect "idline6a"e as the sin color

No tendernessNo l$"hs# No "ass6$""etrical>uscles eual in si1eKhead centeredCoordinated# s"ooth"ove"ents &ith nodisco"fort

5aries fro" light to deebro&nK fro" rudd$ in tolight inK fro" $ello&overtones to oliveNo ede"aNo abrasions or otherlesions!recles# so"e

Nor"al

Nor"al

Nor"al

Nor"al

Nor"al


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Chest and bac

• osterior

Thora,

• -nterior

Thora,

-bdo"en

&hite

No tendernessNo "asses

!ull e,ansionTach$nea

Unble"ihed sinUnifor" color

birth"ars# so"e %at andraised nevi*hen inched# sinsrings bac to reviousstate

Conve, curvature6"ooth te,ture?ighl$ vascular and inin lightsinned clientsKdarsinned clients "a$have bro&n or blac

ig"entation inlongitudinal streasIntact eider"isro"t return of in orusual color(generall$ lessthan < seconds)

Chest s$""etric6in IntactK unifor"te"erature

Chest &all intactNo tendernessNo "asses!ull and s$""etric cheste,ansion5esicular andbronchovesicular sounds

uiet# rh$th"ic# ande/ortless resirations!ull s$""etric e,cursion2ronchial and tubularbreath sounds in thetrachea5esicular and

accu"ulation ofe,cess%uid

DecreaseO:sul$

Nor"al

Di'cult$ofbreathin

g


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Lo&er

e,tre"ities

• 6in

• Nails

>otor

functions8

2ro&n in color &ith ede"a No abrasions or other

lesions &ith ede"a

Concave curvature2ro&n ig"entation in

longitudinal streas

Reeatedl$ and

rh$th"icall$ touches thenose Raidl$ touches eachnger to thu"b &ith eachhand Can readil$ deter"inethe osition of ngers andtoes

bronchovesicular breathsounds

Unble"ihed sinUnifor" color

6ilver&hite striae orsurgical scars!lat# rounded(conve,)#orscahoid (concave) 6$""etric "ove"entscaused b$ resiration -udible bo&el sounds No tenderness Rela,ed abdo"en &iths"ooth# consistenttension

5aries fro" light to deebro&nK fro" rudd$ in to

light inK fro" $ello&overtones to olive No ede"a No abrasions or otherlesions !recles# so"ebirth"ars# so"e %at andraised nevi &hen inched# sinsrings bac to reviousstate

Concave curvature 6"ooth te,ture highl$ vascular and inin lightsinned clientsKdarsinned clients "a$have bro&n or blacig"entation in

Nor"al

accu"ulation ofe,cess%uid

Nor"al

Nor"al


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longitudinal streas Intact eider"is ro"t return of in orusual color (generall$less than < secs.)

?as uright osture andstead$ gait &ith oosingar" s&ingK &als unaided#"aintaining balance >a$ s&a$ slightl$ but isable to "aintain urightosture and foot stance.

>aintain stance for atleast = secs "aintains heeltoe&aling along straight line Reeatedl$ andrh$th"icall$ touches thenose Raidl$ touches eachnger to thu"b &ith eachhand Can readil$ deter"ine

the osition of ngers andtoes

7ORDOND6

2efore

hositali1atio

n

During

hositali1atio

n

Interretation -nal$sis

a. activit$e,erciseattern

hobbies

-ccording tohi" he doesthehouseholdchoirs and atthe sa"e

During hishositali1ation he is inco"lete bedrest.

?e &as notable toerfor" theactivitiesbecause ofthe disease

4,ercise isver$i"ortant toour bod$because itro"otes


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4li"inationattern

6lee andrest attern

Cognitiveercetualattern

6elf Percetionand selfconcetattern

ti"e it is her&a$ ofe,ercisingand he canerfor"

di/erentactivities.

rior tohositali1ation hedefecatesever$ da$.

6he urinatesnor"al a"ount andnor"al color.urinates

2efore heslees Fhours ever$da$

The atient isa :nd $earhigh schoolundergraduate. he isliterate.

!or the eriodof

hositali1ation his

defecationdoes not var$but her urine

outut

decreases.

Throughouthishositali1ation slees 9:hours andcan taenas.

6a"e

During her

rocess.

The atient0seli"inationatternchangedduringhositali1atio

n becauseshe is under"edication.

Due toconne"entthe atienthas noroble" &ithhis slee.

Due toconne"ent

the atienthas noroble" &ithunderstanding

good healthand hels usbuild and"aintainhealth$

"uscles#bones# and +oints and itreducesderessionand an,iet$.

7oodeli"inationattern

reduces theris of havingcancer. Ithels us todeto,if$&aste in ourbod$ to freeourselvesfro"co"lications

4nough andgood sleeand restattern canreduce stress#

hels us tothin better.

7oodeducation isi"ortant tooverco"e


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Rolerelationshiattern

Coingstresstoleranceattern

?ealth

ercetion

rior tohositali1ation he is not

that cheerfulandaroachable.

The atient0s

fa"il$ ise,tendedt$e. The$are < in thefa"il$. The$are < in thefa"il$ tobond. ?e issociable toever$one.

4ver ti"e heencounters

di'culties heassguidance andhel fro"7od.

hositali1ation he isirritableinside thehosital.

Throughouthishositali1ation his fa"il$ is&ith his side

at all ti"es tosuort his.

During hishositali1ation she +ustra$s ever$ti"e she0s inain.

During hishositali1ation he stillbelieves thathealth is

Due toconne"enthe changed.

Due to hishositali1ation the fa"il$beco"escloser to one

another andbeco"estronger.

?er coingstress is thesa"e as &hatshe is doingbefore.

?is healthercetion isthe sa"e as&hat shebelieves

overt$.

7ood selfercetionand selfconcetattern helsus tooverco"eroble"s andtrials.

7oodrelationshito each"e"ber ofthe fa"il$creates unit$and co"actrelationshi&ith each

other. 7oodrelationshi&ith othereole cangain trust#accetance#suort# andso"eone toCall On *hen Gou Need a?and.

?aving agood coingto stress canoverco"e


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6e,ualit$reroductiveattern

5alues belief attern

-ccording tohi" health isver$i"ortantbecause it is

&ealth.

?e don0t &antto tal aboutit.

Ro"anCatholic.

The$ go tochurch ever$ Thursda$ and6unda$.

&ealth.

6a"e

During hishositali1ation herhusband andher al&a$sra$s for herhealth.

before.

N-

?is valuesbelief atterndoes notchange andher faith to7od beco"estronger.

stressors andderessions.

7ood healthercetioncan "aintainhealth# thebod$ canfunctionroerl$ andit acts asersonalstrength.

7oodse,ualit$reroductivecan easil$deter"ine thefertili1ationand canrevent

cancers inreroductives$ste".

6trongvaluesbeliefshel us tooverco"edi'culties

and trials.

5. -N-TO>G


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The liver is located in the upper right-hand portion of the abdominal cavity, beneath the

diaphragm and on top of the stomach, right kidney and intestines. The liver, a dark reddish-

brown organ that weighs about 3 pounds, has multiple functions.

There are two distinct sources that supply blood to the liver:

oxygenated blood flows in from the hepatic artery

nutrient-rich blood flows in from the portal vein

The liver holds about one pint (3 percent! of the body"s blood supply at any given moment.

The liver consists of two main lobes, both of which are made up of thousands of lobules. These

lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic

duct. The hepatic duct transports the bile produced by the liver cells to the gallbladder andduodenum (the first part of the small intestine!.

5I. -T?O?G6IOLO7G


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5II. L-2OR-TORG


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IQ. Discharge lan

Clients &ith Uer 7astrointestinal 2leeding are instructed to tae the

follo&ing lan for discharge.

> >edications should be taen regularl$ as rescribed# on e,act dosage#

ti"e# freuenc$# "aing sure that the urose of "edications is full$

disclosed b$ the health care rovider.

• !e6o< H !olic acid TID

• Trane,a"ic acid =g"ca TID

• O"era1ole


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Drug stud$

Universit$ of eretual ?el College of >anila

:9< 5 Concecion 6treet 6a"aloc >anila

Case 6tud$8 Uer 7astrointestinal 2leeding


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6ub"itted to8 >s. >a. 4vel$n Lu"io 6ub"itted b$8

*illia" Ro$ -goncillo -;D

7r. 9 >*

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50333852 Liver Cirrhosis

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