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 right 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 URİNE TEST

----------------------------------------------------------------------------------------------------------------

-------------------- ---------------------

-------------------- --------------------

-------------------- --------------------

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

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

f) For Mrs. Glutton, in postoperative care, which complications can be occured 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 gastrointenstinal (GI) motility

• Venous thromboembolism related to dehydration, immobility, vascular manipulation, or injury

EXPLAİN HERE:

------------------------------------------------------------------------------------------------------------------------------

------------------------------------------------------------------------------------------------------------------------------

------------------------------------------------------------------------------------------------------------------------------

-------------------------------------------------------------------------------------------------------------------------------

--------------------------------------------------------------------------------------------------------------------------------

--------------------------------------------------------------------------------------------------------------------------------

--------------------------------------------------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------------------------------------

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

Nursing Diagnoses

Goals and Outcomes

Interventions

Evaluation

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

Answer 1

1. Preliminary diagnosis is what we made with patient symptoms before doing any investigation. Based on the given data about patient we may suspect that patient may have Liver cirrhosis .

2. Reasons for this pre diagnosis with this history. Organs present in right upper quadrent is Liver,parts of intestine, gall bladder,pancreas. Pain indicates any of these organs diseases. Nausea,jaundice,weakness ,indigestion present in liver diseases. Patient had history of alcoholism,and smoking .Theses two are main causes for liver. Cirrhosis . So we can made pre diagnosis Liver cirrhosis.

3.Significant changes in the condition : Elevated Liver enzymes ,Elevated bilirubin level in blood and urine,change in urine clour to Yellow. Increase levels of Alanine trans aminase, Aspartate transaminase,Hama glutamyl transaminase(Liver function test).

4.General anesthesia is Contraindicate in obese patient ,because generally general anesthesia cause sleep apnea. Obese patient are at high risk with sleep apnea. Patient had history of smoking due to this lungs are at high risk for apnea. These are the risk factor for this patient.

5. Surgery needed for patient with liver cirrhosis is liver transplantation. In liver transplantation mechanical ventilation is needed. Due damage of lungs mechanical ventilation causes risk. Due to obese general anesthesia is risk .These may arise complications like not maintain respiratory function.

6.After surgery (with mechanical ventilation )due to continues smoking history patient lungs con not able to maintain respiratory function due to thick secretions in the trachea and bronchioles . Nursing intervention needed is therapeutic suction of tracheo bronchial secretion and need to maintain Fowler's position.

7.Constipation related to impaired physical mobility. This problem will be relieved by ambulation. Because ambulation improve gasrto intestinal mobility by this constipation may relieved.