Question

Your patient is a 52-year-old male with a history of smoking and alcohol abuse. He presents to the ED with complaints of "my skin looks yellow, my stomach hurts, and I feel nauseous". He is taken to CT and a tumor near the pancreas is observed. It appears to be blocking the common bile duct. Develop a plan of care for the patient. Use the attached concept map

Possible Medications (Minimum of 2 medications needed)

Clinical Manifestations Subjective: Objective:

Possible Nursing Diagnosis           (Minimum of 2 needed)

Medical Diagnosis Cirrhosis and Liver Cancer

Patient Data/Risk Factors

Medical Interventions

Pathophysiology

Nursing Interventions (Minimum of 4 needed)

Diagnostic Data (Minimum of 1 needed)

Patient Education

Answer 1

Plan of care Cirrhosis and liver cancer

Possible medications:- Regorafenib inhibit angiogenesis.

Avastin :- it is an immunotherapy drug which is given to patients with metastatic hepatocellular cancer.

Clinical manifestations:-

Subjective:- weight loss,liver failure, weakness,fever, ascitis, breathlessness.

Objective:- abdominal pain, nausea, vomiting,loss of appetite, yellowish discolouration of the skin and eyes,dark coloured urine and stool, confusion, redness in the palm, swelling in the feet.

Nursing diagnosis: -

1)Imbalanced nutrition less than body requirement related to loss of appetite evidenced by weight loss.

2)Risk for skin integrity related to accumulation of bile salts under the skin.

Medical diagnosis:-

Cirrhosis and liver cancer

Risk factors:-

1) Gender:- Men are more prone for liver cancer than women.

2) Cirrhosis:- Patients with cirrhosis have the higher chances of liver cancer.

3)Viral diseases of liver such as hepatitis B and C has the highest risk of liver cancer.

4) Alchohol abuse lead to fatty liver which further causes liver cancer.

5) Obesity causes fat to be deposited in the liver and can cause liver cancer further.

6) Environmental factors such as consuming aflatoxin which is found in warm moist food particles stored long-term has the risk of cancer .

7)Type 2 diabetes mellitus lead to obesity which further risk the chances of having liver cancer.

Medical interventions:-

Medical management of cirrhosis includes treatment of underlying cause.

1) Treatment for alcohol abuse

2) Management for weight loss.

3) Treatment for viral hepatitis.

Treatment for liver cancer includes radiation therapy, chemotherapy, percutaneous ethanol injection, immunotherapy.

Pathophysiology:-

Cirrhosis:-The etiology of cirrhosis such as viral hepatitis, alcohol abuse causes hepatocellular injury which lead to fibrosis and scaring of liver cells.This cause liver cirrhosis and one of the complication of liver cirrhosis is liver failure.

Nursing interventions

1) Monitor weight daily.

2) Encourage small frequent meals.

3) Provide adequate nutritional supplements.

4) Turn the patient every 2 hourly and encourage deep breathing and coughing exercise.

5) Monitor the patient for hypovolemia.

Diagnostic data:-

USG guided liver biopsy

Patient education:-

* Avoid alcohol

*Take medication as directed.

*Advise to take diet as instructed .

* Monitor for complications.