In: Nursing
1. Cirrhosis - Mr. Garcia is a 43-year old male who presented to the ED complaining of nausea and vomiting x 3 days. The nurse notes a large, distended abdomen and yellowing of the patient’s skin and eyes. The patient reports a history of IV drug use and alcohol use.
Mr. Garcia’s vitals are stable, BP 100/58, bowel sounds are active but distant, and the nurse notes a positive fluid wave test on his abdomen. The patient denies itching but is constantly scratching at his chest. He is oriented to person only and his brother at the bedside reports he has not been himself today. He keeps trying to get out of bed.
The provider places orders for the following:
Keep SpO2 > 92%
Keep HOB > 30 degrees
Insert 2 large bore PIV’s
500 mL NS IV bolus STAT
100 mL/hr NS IV continuous infusion
Hydrocodone/Acetaminophen 5-500 mg 1 tabs q4h PRN for moderate pain
Hydrocodone/Acetaminophen 5-500 mg 2 tabs q4h PRN for severe pain
Diphenhydramine 25 mg PO q8h PRN itching
Ondansetron 4 mg IV q6h PRN nausea
Lactulose 20 mg PO q6h
Mr. Garcia’s LFT’s and Ammonia level are elevated. He is extremely confused, agitated and appears somewhat short of breath. The patient’s current vital signs are as follows:
HR 82 RR 22
BP 94/56 SpO293%
Temp 98.9°F
The provider calls to tells you he wants to perform a paracentesis on Mr. Garcia. He will be gathering the supplies and will be at the bedside in 10 minutes.
In two days, Mr. Garcia’s condition has improved. His wife is at the hospital and is inquiring about how to care for him at home.
Mrs. Miller presented to the emergency room with complaints of epigastric pain of 10/10 with nausea and vomiting. She is obese, a heavy smoker, and drinks alcohol. Mrs. Miller is being admitted with a diagnosis of acute pancreatitis.
Mrs. Miller is scheduled for a KUB asks “What is the test I am having done today?”
Identify 3 priority nursing diagnoses for a patient with acute pancreatitis
1 [A] Accumulation of fluid is the most common complication of cirrhosis and is a frequent cause of seeking attention, either in emergency room or in day care settings. Fluid accumulates in the extracellular space, particularly the peritoneal and pleural cavities and interstitial tissue of the legs, causing ascites, pleural effusion, and leg edema, respectively. The intensity of symptoms is related to the severity of fluid retention. Ascites may cause abdominal discomfort, pleural effusion may lead to dyspnea, and leg edema may impair walking capacity because of “heavy legs.” Actually, leg edema is one of the most important factors in the impairment of health‐related quality of life in patients with cirrhosis.The main roles of nurses in the assessment of patients with cirrhosis and ascites/edema are to evaluate patients’ history, check current status of ascites and edema, and plan future care to prevent recurrence.
[B}
Laboratory findings and imaging studies that are characteristic of cirrhosis include:
[A] yes. Paracentesis may help alleviate ascites.
[B]Lactulose 20 mg PO q6h. It helps to reduce Amonia level.
[A[Acute pancreatitis is sudden inflammation of the pancreas that may be mild or life threatening but usually subsides. Gallstones and alcohol abuse are the main causes of acute pancreatitis.
[B]
Acute pancreatitis signs and symptoms include:
Diagnosis