Question

CASE STUDY

Mrs. Glutton, a 58 year-old female (weight:120 kg),   smoking history: 25 years (two packs per day). She has been drinking alcohol every day since she was 20. She had hepatitis- B when she was 50 years old. She has a sedentary life because she is obese. Mrs. Glutton; was brought to the hospital with complaints of pain in the left upper quadrant, jaundice, itching, nausea, weakness and indigestion. After physical examination and laboratory examinations (blood and urine), she was admitted to hospital for surgery. Her operation is planned under general anesthesia.

a) What can be the preliminary diagnosis of the patient?

b) What is your reason for making this pre-diagnosis?

c) What might be the significant changes in the laboratory findings of this patient?

BLOOD TEST	URINE TEST

d) What are the risks factors in your patient for general anesthesia? Explain how do effect of these risk factors on patient.

e) What can be major problems during surgery for this patient?

f) For Mrs. Glutton, in postoperative care, which complications can be occurred in respiratory system? What should be your nursing interventions to prevent this complications?

g) For which nursing diagnoses or collaborative problems common in postoperative patients has ambulation been found to be an appropriate intervention? (select and explain one by one)

• Impaired skin integrity related to incision
• Impaired mobility related to decreased muscle strength
• Risk for aspiration related to decreased muscle strength
• Ineffective airway clearance related to decreased respiratory excursion
• Constipation related to decreased physical activity and impaired gastrointestinal (GI) motility
• Venous thromboembolism related to dehydration, immobility, vascular manipulation, or injury

h) Plan the postoperative care and discharge training of Mrs. Glutton

Nursing diagnosis	Goals and outcome	interventions	Evaluation

i) Is organ transplantation possible for this patient? Explain the reason of your answer

Answer 1

a.The preliminary diagnosis for the patient can be spleenomegaly or cirrhosis of liver

b.The reason for making this pre diagnosis is the patient's history of chronic alcoholism which can damage the liver overtime.Along with this the symptoms like pain in left upper quadrant (typical sign) jaundice, itching,nausea, weakness, indigestion .This could have affected the liver and subsequently the spleen

c.The significant changes are

• Blood:elevated liver enzymes (SGOT, SGPT, AST,ALT,bilirubin)
• increased WBC as a sign of infection, anemia
• Decreased protein and albumin level
• Antinuclear antibody
• Antimitochondrial antibody
• Smooth muscle antibody
• HBsAg positive

Urine

• Presence of urobilinogen
• Dark colored urine

d.The risk factors in patient for general anesthesia are risk to develop sleep apnea due to obesity.It can weaken the immune system ,slow the recovery process, need increased dose of anesthesia due to chronic alcoholism.