LIVER CIRRHOSIS

A Case Study Presented by Group 4 (ThFS) of Level III of College of Nursing and Midwifery BATAAN PENINSULA STATE UNIVERSITY

Group 4 (ThFS Group) Bugay, Clarisse Malimban , Krissle Jade Margallo, Carole Miguel, Monaliza Pare a, Alyssa Kent Santos, Ajim Elizar Santos, Adria Darlene Sulangi, Alyssa Tutol, Faye Margarett Yere, Carizza May

Table of Contents

I. II. III. IV. V. VI. VII. VIII. IX. X. XI. XII. XIII. XIV.

Introduction Patient s Profile/Personal Data Personal-Social History Past Medical History Present Medical History Family Medical History Theoretical Framework Patterns of Daily Living Physical Assessment Laboratories/Diagnostic Procedure Anatomy and Physiology Pathophysiology Nursing Care plan Drug Study

I.

Introduction

Cirrhosis is scarring of the liver that involves the formation of fibrous (scar) tissue associated with the destruction of the normal architecture of the organ. It is the result of longstanding injury most commonly due to alcohol in excess but there are a number of other important causes. The destruction of the normal architecture and the loss of liver cells prevent the liver from functioning normally. It plays an important part in digestion of food but it also has a major role in metabolising drugs and making proteins, including those that help the blood to clot. Cirrhosis is a serious condition. Only 30 per cent of patients with this problem will survive five years after diagnosis and the outlook is worse if the cause is alcohol and the patient continues to drink. The portion of the liver chiefly involved in cirrhosis consists of the portal and the bile canaliculi of each lobule communicate to form the liver bile ducts. These areas become the sign of inflammation ,and the bile ducts become occluded with inspissated (thickened bile and pus).The liver attempts to form new bile channels; hence, there is an overgrowth of tissue made up of largely of disconnected, newly formed bile ducts and surrounded by bile tissue. The causes the inflammation that leads to cirrhosis of the liver. First is Alcohol excess: the rate of cirrhosis in a country is directly related to the average alcohol consumption in that country. Half of all cases of cirrhosis are due to alcohol excess. Chronic viral hepatitis: the two important viruses are hepatitis B and hepatitis C. Cirrhosis due to hepatitis B is common in Africa and Asia. Hepatitis C is increasing in importance both in Europe and the US. Hepatitis A (infectious hepatitis) does not cause cirrhosis. Primary biliary cirrhosis: this is an uncommon disease mainly affecting women. It is not due to alcohol. For some reason the body mounts an attack on the liver in patients with primary biliary cirrhosis. Autoimmune chronic active hepatitis: another uncommon condition that results in the body's immune system attacking and destroying liver cells. Drugs and chemicals: a number of drugs and chemicals can cause liver damage but few cause cirrhosis. Certain specialised drugs need monitoring for their effect on the liver. Metabolic and inherited disorders: These are a number of uncommon conditions that allow the accumulation of toxins in the liver. The commonest is haemochromatosis, which causes excess deposits of iron in the liver. The person who are at risk of Liver Cirrhosis are the more alcohol a person drinks, the more likely they are to develop cirrhosis. Women seem to be more susceptible than men. It is therefore advisable to restrict alcohol consumption to 28 units a week for men and 21 units a week for women (a unit of alcohol is a single measure of spirits, a half pint of ordinary beer or lager or a standard size glass of wine).Patients who have ongoing infection with hepatitis B or hepatitis C virus. Patients with primary biliary cirrhosis or autoimmune chronic active hepatitis. Patients with metabolic or inherited disorders.

Liver Cirrhosis can be prevented by limiting the intake of alcohol and precautions should be taken to avoid getting hepatitis and if it is contracted it is important that it is treated.Avoid contact with toxic chemicals at work.

II.

Patients Profile

Name: Age: Gender: Room Number: Address: Birth date: Civil Status: Occupation: Religion: Admission Date: Admission Time: Attending Physician: Chief Complaint: Clinical Finding:

Mark Menor Manalo 30 Male 304 Orion, Bataan May 22, 1980 Single Construction Worker Roman Catholic June 21,2010 1:35 pm Dr. Alfonso Abdominal Pain Massive ascites decompensated liver cirrhosis of Hepa B and Hepa C infection

III.

Personal / Social History

Mark Menor Manalo, is a 30 year old male, he had worked for more than two years, working as construction worker. According to the client, he is single and then raised by her parents. Mark Menor Manalo claimed that he usually sleeps at 7:00 pm and wakes up at 6:00 in the morning for his work.

IV.

Past Medical History

According to the mother of Mr. Mark Menor Manalo, he has received complete immunization.She also stated that she had not know any allergies experienced by her son from any food nor drugs.

The patient stated that he hasnt experienced any major kind of illnesses aside from cough and colds that he treated with over the counter medications.Mr. Manalo also stated that he hasnt previous hospitalization.

V.

Present Medical History

On 21st day of June 2010 at exactly 1:35 pm, a 30 year old male client was admitted through ER with chief complaint of abdominal pain. The client has initial vital signs of T= 37C, PR =93, RR= 22 and BP= 90/60. He has undergone in ultrasound on June 2010 that lasted 5-10 minutes. The results are: The liver is written normal size with coarsed and increase in echopattern. The intra and extra hepatic ducts are not dilated. No fecal mass seen. Spleen is enlarged in size with homogenous echopattern. Massive petvoabdominal ascitis seen. Gallbladder is undistended and within normal size with free echo lumen. The wall is not thicken. The common duct is not dilated. Pancreas is obscured by overlying gas. Right kidney measures 11.2 x 5.4 cm CT 1.9 cm, left kidney measures 10.9 x 6.2 cm CT 1.5 cm. Both kidneys are within normal in size with homogenous echopattern, configuration, and cortical differentiation. The calyces are not dilated. There are no echogenic structures nor shadowing seen. He also undergone XRay procedure on June 18, 2010. The findings are negative for pneumoperitoneum. Distended bowel loops of the mix type. Bulging of the . Bones intact. Impression: Ileus related on intraperitoneal fluid. Examination such as HBSAG (screening) which results as reactive, RPR, VDRL, and HIV which is negative. The pathologist concerned is Gabriel J. Cruz. After the procedure, the client was transferred to the medical ward by means of wheel chair accompanied by his mother. His attending Physician, Dr. Alfonso ordered PNSS 1L KVO, ranitidine 1 am IV q8 PNSS 1L plus 40 mEqs KCL and a DAT diet. The orders made by Dr. Alfonso were carried out by means of gauge 22 IV cannula and an IVF of PNSS 1L hooked on client infusing well at right arm regulated 10 gtts. The nurse provided appropriate health care management for Mr. Mark M. Manalos condition. On June 21,2010 at 6:00 am, we started to handle the client, and observed the following data: weak and pale in appearance, enlarged abdomen and bipedal edema.

VI.

Family Medical History

The client started that in his Fathers side of the family, there were histories of diabetes, while in his Mothers side of the family, theres none. His Father and Mother are alive.

VII.

Theoretical Framework Self-Care Deficit Theory of Nursing By: Dorothea Orem

Self-care is an activity that promotes a persons well-being. It is performed by persons who are aware of the time frames on behalf of maintaining life, continuing personal development and a healthy functional living. Self-Care Requisites Self-care requisites are insights of actions or requirements that a person must be able to meet and perform in order to achieve well-being. These are reasons for any actions of self-care that must be undertaken. The two elements of self-care requisites are: a) The factor to be controlled or managed to keep as aspect(s) of human functioning and development within the norms compatible with life, health, and personal well-being and, b) The nature of the required action. These are universally set goals that must be undertaken in order for an individual to function In scope of a healthy living. The eight self-care requisites common in men, women, and children are as follows: Maintenance of a sufficient intake of air, maintenance of a sufficient intake of food, maintenance of a sufficient intake of water, provision of care associated with elimination, maintenance of balance between activity and rest, maintenance of balance between solitude and social interaction, prevention of hazards to human life, human functioning and human well-being, and promotion of human functioning and development. In relation to our clients case, our client needs a lot of care, since we know that the cause of his disease is the intake of contaminated foods, foods which are not properly prepared and because of encountering some chemicals in his work. Being a care provider to our client we must help and teach him in order to achieve well-being. We help our client to establish or identify the ways to perform self-care activities. He needs to maintain sufficient intake of clean foods, and sufficient intake of water. He also need to have good elimination and urination. Maintenance of balance between activities and rest and avoid hazards to human life, human functioning, and human well-being.

VIII.

Patterns of Daily Living ADL Before Hospitalization >According to Mr. Manalo, he eats 3 meals everyday. He takes his breakfast between 78 am, lunch at 12 pm, and dinner at 6 pm. During Hospitalization >During his confinement in the hospital, he eats 3 meals a day. The client was under DAT diet.

NUTRITION a. Time ( meals) b. Frequency (feeding) c. How much food

ELIMINATION (Bowel) a. Color b. Odor c. Shape d. Frequency

(Urine) a. Color b. Odor c. Frequency

HYGIENE a. Skin Care b. Eye Care c. Nose Care d. Oral Care e. Nail Care REST AND SLEEP a. Routine

>The client bathes onces a day >Clients mother assists him in taking bathes everyday. >Brushes his teeth after meals

>Mr. MMM usually sleeps around 7 pm and wakes up early around 6:00 am because of his works.

>The client sleeps and rests.

>The client often lies on bed, but is ambulatory with assistance.

IX.

Physical Assessment GENERAL SURVEY

Vital Signs:     Temperature Cardiac Rate Respiratory Rate Blood Pressure >37 C >92 beats per minute >22 breaths per minute >90/60 mmHg >Normal >Normal >Normal >Abnormal

>With abdominal pain

>Due to inflammation of the left spleen.

>Weak and pale in appearance

>Due to progressive disease.

ongoing presence

and of

>With enlarged abdomen

>Due to inflammation of the spleen.

>With bipedal edema

>

BODY PARTS Head (face and neck)

TECHNIQUE Inspection

FINDINGS >symmetrical >smooth

INTERPRETATION >Normal

Scalp

Inspection

>round >symmetrical

>Normal

Skin

Inspection

>pale >without lesions >without pain and sensitivity

>Abnormal >Normal

Eyes Sclera Pupils Eyebrows Eyelashes

Inspection Inspection Inspection Inspection Inspection

>symmetrical >white in color >round and equal >equally distributed >evenly distributed and turned outward >eyelids cover the sclera and iris when closed

>normal >normal >normal >normal >normal

Eyelids

Inspection

>normal

Ears

Inspection

>symmetrical without deformitic

>normal

Nose

Inspection Palpation

>symmetrical without nasal flaring >no tenderness or masses

>normal >normal

Mouth

Inspection

>moisted oral mucosa

>normal

Lips

Inspection

>pale in color >symmetrical >dry

>abnormal >normal >abnormal

Gums

Inspection

>pale >without swelling nor abnormal discharge >light yellow in color >without dental

>abnormal >normal

Teeth

Inspection

>normal >normal

Tongue

Inspection

carries >moist >positioned medially >pale

>normal >normal >abnormal

Abdomen

Inspection

>enlarged abdomen >collateral veins visible on abdominal wall >pale in color >pain sensation

>abnormal >abnormal >abnormal >abnormal

XI.

Anatomy and Physiology

The liver is a large, meaty organ that sits on the right side of the belly. Weighing about 3 pounds, the liver is reddish-brown in color and feels rubbery to the touch. Normally you can't feel the liver, because it's protected by the rib cage. The liver has two large sections, called the right and the left lobes. The gallbladder sits under the liver, along with parts of the pancreas and intestines. The liver and these organs work together to digest, absorb, and process food. The liver's main job is to filter the blood coming from the digestive tract, before passing it to the rest of the body. The liver also detoxifies chemicals and metabolizes drugs. As it does so, the liver secretes bile that ends up back in the intestines. The liver also makes proteins important for blood clotting and other functions.

XII.

Pathophysiology

NON- MODIFIABLE
Age Gender

MODIFIABLE
Occupation Lifestyle Nutrition

Infection of the liver

Inflammation of the liver

Injury of the liver cells

Necrosis of the liver

Scarring of liver tissue

Regeneration of liver cells

Proliferation of inflammatory cells

Abdominal pain Weakness Spleenomegaly

Ascites Edema Hypotension Firm, Enlarged Liver Weight Loss