Question

You have reviewed EPIC for Mr. Jackson and found that he was admitted to the hospital 2 days ago with the diagnosis of liver cirrhosis. He is 64 years old, 5’7”, and 155 lbs. He has a history of CHF and atrial fibrillation, has a saline lock, O2at 2 LPM and is able to be up in room as tolerated. He is on a 2-gram sodium diet. HOB up at least 30 degrees. Mr. Jackson is experiencing some swelling in his feet and ankles and is complaining of being short of breath.

Medications:

Amiodarone 200mg PO twice a day

Lisinopril 10 mg PO each morning

Metoprolol succinate 50 mg each morning

Furosemide 20 mg PO each morning

Warfarin 5mg PO each evening

Digoxin 0.25 mg PO each morning

Labs

Alanine aminotransferase (ALT) – 90 Units/L

Aspartate aminotransferase (AST) – 300 Units/L (5-30 U/L)

Albumin - 1.8 g/L

Sodium – 156 mEq/L

What is the rationale for the bed to be up at least 30 degrees for this patient?

What electrolyte needs to be monitored based on the medications this patient is taking?

What vital signs would need to be monitored based on the medications this patient is taking?

Answer 1

ANSWERS:-

1) Rationale for the bed to be up atleast 30° for this patient is-

*CIRRHOSIS OF LIVER (is a chronic liver disease characterized by fibrotic changes and the formation of dense connective tissue within the liver, subsequent degenerative changes, and loss of functioning cells) produce PORTAL HYPERTENSION ( obstructed blood flow through the damaged liver results in increased pressure in the portal venous system) and ASCITES ( accumulation of fluid in the peritoneal cavity ) causing increased intra abdominal pressure and pushing diaphragm upward reducing thoracic space.

CHF(chronic or congestive heart failure ) also produce increased pulmonary and systemic hypertension, increased pulmonary pressure cause pulmonary edema and breathing difficulty.

SO POSITIONING THE BED 30° up HELPS TO REDUCE COMPRESSION OVER LUNGS AND IMPROVE BREATHING AND INCREASE INTRA THORACIC SPACE FOR LUNG EXPANSION

** What are the electrolytes and vital signs need to be monitored?

Medications	Electrolytes	Vital signs
Amiodarone	AST and ALT(metabolised in liver and excreted via bile)	Heart rate and Blood pressure ( can cause bradycardia and hypotension )
Lisinopril	BUN, creat, alkaline phosphatase, bilirubin, potassium, AST and ALT.(May increase) *Sodium-may decrease.	Blood pressure - may cause hypotension
Metoprolol	Liver function and renal functions.	BP and heart rate - may produce hypotension and bradycardia.
Furosemide	sodium, potassium ( cause hyponatremia and hypokalemia)	Blood pressure (may produce hypotension
Warfarin	platelet count, AST and ALT (metabolized in liver)	Blood pressure( can cause bleeding and hypotension )
Digoxin	liver and renal functions	Heart rate(decreases)