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Introduction

Thor Jones is a 50 year-old male who is married to his wife of 26 years. He was born in Ireland and is Buddhist. He works as a construction worker and his wife is a preschool teacher. Mr. Jones was in a fraternity in college and on average drank about 42 drinks a week. He continued this pattern of drinking into middle adulthood. It is common for him to drink one case of beer after work. He has a family history of hypertension, diabetes, hyperlipidemia, obesity, and alcohol abuse. He enjoys football, playing golf, eating junk food and watching Netflix with his wife.

History of Present Illness

On February 9, 2018 Mrs. Jones brought him into the emergency room and he presented with fever, nausea and coffee ground emesis that persisted for 5 days. He has a background of hypertension , hyperlipidemia, and obesity. The ED nurse assessed Mr. Jones and he was oriented times 3, lethargic, PERRLA, calm, cooperative, and with equal grip strength. His vitals were T 101.5, HR 80-90s, BP 145-150/89, RR 18-20, O2 sat of 98-100, and rated his pain of 6/10 in his abdomen. He was NSR, breathing on room air without signs of distress. His abdomen was firm, distended, tender upon palpation, with active bowel sounds in all quadrants. He reported decreased appetite and weight loss of 55 pounds over the last 6 months. He vomited three times in the ER. He described his last BM today as small, formed, clay colored stool. His oral mucosa was pink, moist, and intact. He has yellowing of skin, bruising, and a musty odor to his breath. He reported frequent nose bleeds, itching, altered sleep, and weakness.

Nursing Care

His :abs revealed ALT 45, AST 43, GGT 55, total bilirubin 1.9, albumin 2.6, globulin 4, PT 20 seconds, INR 2, RBC 3.5, Hgb 9, Hct 30%, plt 100,000, and ammonia 65. The ultrasound and CT revealed ascites, hepatomegaly, and biliary obstructions. He was prescribed diuretics for excess fluid in the body, beta blockers for varices to prevent bleeding, and lactulose to excrete ammonia. He had a paracentesis to relieve ascites and a liver biopsy that confirmed chronic liver failure.

The nursing interventions included monitoring respiratory status, skin integrity, fluid balance, vital signs, neuro statsu, GI status, pain, and labs. The nurse educated him on the importnce of high calorie, moderate-fat, low sodium, low protein, and vitamin enriched diet. She encouraged him to eat small, frequent balanced meals. The nurse referred him to social services, AA, and dietary

Conclusion

Mr. Jones was discharged from the hospital and verbalized three different balanced meal plans for three weeks. He verbalized he was motivated to eat healthy and abstain from alcohol to prevent progression of his disease process. Unfortunately, he fell back into the same pattern of drinking and unhealthy diet. He developed hepatic encephalopathy, portal hypertension, esophageal varices, and worsening clinical manifestations. Him and his wife decided to transition to palliative care and he passed away peacefully in the comfort of his house.

References

Cheever, H. K., & Hinkle L, J. (2013). Brunner and suddarth’s textbook of medical-surgical nursing. Philadelphia, PA: Wolters Kluwer

MacLeod, E. C., & Perrin O. K. (2018). Understanding the essentials of critical care nursing. New York City, NY: Pearson.

Mayo Clinic Staff (2018). Liver Disease. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/diseases-conditions/liver-problems/doctors-departments/ddc-20374509

Registered Nurse RN. (n.d). Cirrhosis NCLEX Questions. Retrieved from: http://www.registerednursern.com/cirrhosis-nclex-questions/

Sommer, S., Johnson, J., Roberts, K., Redding, S. R., Churchill, L., Davila, L. Knippa, A. (2013). RN adult medical surgical nursing (10th ed.). Retrieved from https://www.atitesting.com

Quizlet. (n.d). NCLEX practice questions: liver, biliary and pancreatic disorders. Retrieved from: https://quizlet.com/147684078/nclex-practice-questions-liver-biliary-and-pancreatic-disorders-flash-cards/