Question

Mr. W. is a 58-year-old male admitted to the critical care unit with a diagnosis of cirrhosis. Mr. W. has been experiencing nausea and vomiting for the past 5 days, shortness of breath, and low-grade fever. The morning of admission, he had an episode of passing bright red stools.

Mr. W. is drowsy but responsive to both verbal and painful stimuli. His wife stated that he had not been eating well and had difficulty sleeping for several nights.

On assessment, Mr. W.'s vital signs are oral temperature 100.5° F, blood pressure 105/60 mm Hg, pulse 102 beats/min, respirations 28/min, and oxygen saturation (SpO₂) 94% on 2 liters/min by nasal cannula. Lying supine, his SpO₂ dropped to 88%.

Mr. W. also has severe abdominal distention, is positive for jaundice, and has flapping tremors on his right hand. His past medical history includes alcohol (ETOH) dependency, hepatitis C, upper gastrointestinal bleeding, hypertension, and depression. Mr. W.'s initial laboratory results are as follows:

Sodium – 136 mEq/L
Potassium – 3.2 mEq/L
Blood urea nitrogen (BUN) – 28 mg/dL
Creatinine – 1.4 mg/dL
Bilirubin – 3.3 mg/dL
Platelets – 80,000 cells/microliter
Prothrombin time (PT) – 14 sec
Partial thromboplastin time (PTT) – 35.6 sec
Ammonia – 62 mcg/dL
Glucose – 75 mg/dL
White blood cell count – 11,000/microliter
Hemoglobin (Hgb) – 9.1 g/dL
Hematocrit (Hct) – 28.4%
Albumin – 3.0 g/dL

• What procedures and treatments would you anticipate for Mr. W.?

Answer 1

A patient with liver cirrhosis may develop clotting defects or haemorrhage ,Hepato renal syndrome ,ascitis , portal hypertension , haematological problem, gastrointestinal problems,jaundice, and reproductive disorders may occur.

Mr,w suffering all the above problems

• First we provide comfortable position.
• Fever : To reduce the body temperature by giving tepid sponge.,to give antipyretic.
• To give antibiotics to prevent infection
• Monitor saturation
• Administer oxygen as per his saturation rate.
• Provide lying down position to reduce breathing difficulty and it requires less oxygen.
• Weight the patients on admission and daily to measure fluid retention.
• Check the patients vital signs to detect breathing difficulty to detect fluid overload.
• Assess the level of patients consciousness increased ammonia level cause disturbed sleep , depression.
• Monitor gastric secretion ,stool, to detect bleeding,
• Low platelets count can manage by platelets infusion, surgical splenectomy.
• Anemia is one of the risk of heavy drinking.Anemia can trated by providing iron supplementation and blood transfusion.
• Vomiting: to give antiemetic drug.
• Betabolckers
• Diuretic
• Ammonia reducer
• Haemodialysis to be done to purify blood in case of kidney failure.
• Tremor:loss of brain function occurs due to liver is unable to remove toxins from blood.it affects mood,speech,sleep.movement it can trated by remove toxins in. the blood