Please read this scenario and make patient profile. patient profile…
Question Please read this scenario and make patient profile. patient profile… Please read this scenario and make patient profile.patient profile should include pathophysiology of the disease, signs and symptoms ,nursing interventions.medications, medications parameters nursing implications. drugs correlation to diagnosis diagnostic and tests ( include dates if mentioned in scenario) test results. nursing intervention correlation to diagnosisat the end include end of the shift nursing notes CirrhosisMr. James is a 53-year-old man on disability from his job as awarehouse forklift driver. He became unable to work after developing idiopathic peripheral neuropathy, which resulted in frequent falls and an inability to run the controls of the forklift. He uses a cane to ambulate. Mr. James is being admitted with severe abdominal pain and coffee-grounds emesis. He reports thathe had been vomiting bright red blood in the 2 days before ad-mission. His abdomen is distended, with a measured abdominalgirth of 52 inches. Mr. James also states that he has recently gained several pounds and has had shortness of breath and fatigue for the past several weeks. He reports that he smokes cigarettes but says that he does not use alcohol.Mr. James is scheduled for an upper gastrointestinal endoscopy and paracentesis followed by a CT scan of the abdomen. Review the preprocedure preparations and client teaching required for these diagnostic tests. Also consider the influence of the preprocedural preparations on the order ofscheduling these procedures.Nursing Admission AssessmentMr. James lives in his own home with his wife of 32 years. Hiswife works Monday through Friday as a cook in a public school.Mr. James’ father died at age 50 years of multiple injuries sus-tained in an alcohol-related motor vehicle accident. His 75-year-old mother is in good health. The Jameses have three daughters,who are married and live within driving distance.Selected Admission Laboratory ValuesRBC: 2.78 million/mm3Hb: 11.0 g/dlHct: 30.6%WBC: 12,300/mm3Sodium: 133 mEq/LPotassium: 3.1 mEq/LChloride: 89 mEq/LCO2: 32 mEq/LTotal protein: 5.0 g/dlAlbumin: 2.1 g/dlTotal bilirubin: 1.5 mg/dlAmmonia: 79 g/dlAST: 47 units/LALP: 178 units/LHepatitis panel: NegativeaPTT: 62 secondsPlatelets: 184,000/mm3ANA: NegativeNursing Physical ExaminationHeight: 5 feet, 10 inchesWeight: 235 lb (106.8 kg)Vital signs: BP 110/75; TPR 100.3, 95, 25LOC: Alert and cooperativeEENT: Moon-faced; sclerae are slightly ictericCardiac: Regular rate and rhythm with a grade I/VI systolic murmurPulmonary: Slight crackles in the bases bilaterallyAbdominal: Distended and taut; abdominal girth is 52 inches;fluid wave noted; bowel sounds high-pitched and hypoactive .Genitourinary: Voiding infrequently in small amounts; urine is dark amberPeripheral pulses: 3/3 with pitting pretibial and pedal edemaSkin: Bruising noted on extremities and abdomenInitial Treatment PlanMedicationsFamotidine (Pepcid) 20 mg IV bidBuprenorphine (Buprenex) 0.3 mg IV q 4-6 hr prn for painPhytonadione (AquaMEPHYTON) 2 mg IM every other dayMultivitamin preparation with folate and biotin (M.V.I.-12) 1 am-pule IV dailyIV: D5 and 1⁄2NS with 40 mEq KCl at 100 ml/hrDiet: NPOActivity: Bed rest with BRP; elevate HOBAdditional assessments: Measure abdominal girth and I&O dailyweightsA CT scan of Mr. James’ abdomen revealed a shrunken andcirrhotic liver, an enlarged spleen, and ascites (white arrows).There is also a large regenerating nodule (curved darkarrows).Cirrhosis—cont’dALP, Alkaline phosphatase; ANA, antinuclear antibodies; aPTT, activated partial thromboplastin time; AST, aspartate aminotransferase; BP, blood pres-sure; BRP, bathroom privileges; CO2, carbon dioxide; CT, computed tomography; D5 and 1⁄2NS, 5% dextrose in one-half normal saline; EENT, eyes, ears,nose, throat; Hb, hemoglobin; Hct, hematocrit; HOB, head of bed; IM, intramuscularly; I&O, intake and output; IV, intravenously; KCl, potassium chloride;LOC, level of consciousness; NPO, nil per os (nothing by mouth); O2, oxygen; PO, orally; prn, as needed; RBC, red blood cell (count); TPR, temperature,pulse, respirations; WBC, white blood cell (count).Elsevier items and derived items © 2005 by Elsevier Inc.Respiratory treatments: O2 2 L per nasal cannula, albuterol (Ven-tolin) 2.5 mg in 3 ml NS aerosol qid, spot O2 oximetry dailyDiagnostic tests: Hb and Hct q 4 hr; call if Hb 10 g/dl; aPTTdailyOozing esophageal varices (see figure) were discovered duringMr. James’ endoscopy. The physician notes, as a probable cause, cirrhosis and portal hypertension. During the visit for the CT scan, the nurse tells Mr. James’ daughter that liver disease is suspected. The daughter replies, “I’m not surprised. He’s been drinking like a fish for years.” On further inquiry, the daughterstates that her father drinks both beer and hard liquor frommorning until night while frequently skipping meals.Mr. James’ CT scan reveals a shrunken and cirrhotic liver,splenomegaly, and ascites. During the paracentesis, 60 ml of clear yellow fluid was aspirated. Initial results indicate the absence of abnormal or malignant cells and bacteria. Following di-agnostic examinations, the physician discontinues the buprenorphine and orders acetaminophen (Tylenol) 650 mg q 4 hr prn.Consider the rationale for this change.In addition, the physician orders bumetanide (Bumex) 1 mg IVbid. A one-time dose of salt-poor albumin 25 g IV is also ordered.Consider the rationale of using these medications for treatmentof ascites. Which of these orders should be implemented first?Why?Mr. James’ hemoglobin level remains stable, and no fur-ther bleeding is noted. He is started on an all-cooked, high-carbohydrate, moderate-protein (60-70 g/day) and low-sodium(1-2 g/day) diet. He is to limit his intake of fluids to 1500 ml/day.The IV and IM vitamin K preparations are discontinued. Vitamin K(phytonadione) 5 mg PO twice a week and a daily supplement ofB vitamins are added to his medication orders. The famotidine ischanged from the intravenous route to the oral route of admin-istration. Lansoprazole (Prevacid) 15 mg PO every AM, 30 min-utes before breakfast, is added. The bumetanide IV order is dis-continued and replaced with an order for spironolactone(Aldactone) 25 mg bid and potassium (K-Dur) 20 mEq/day. Do-cusate (Colace) 100 mg/day is also ordered. Discharge isplanned for tomorrow morning.Discharge Criteria and Post-TreatmentConsiderations• Average length of stay: 6.6 days.• Initiate teaching of client and significant others about diet,medications, drug and alcohol incompatibilities, fluid restriction, and the need to report bleeding and changes in mentalstatus. Health Science Science Nursing GIGU NUR Share QuestionEmailCopy link Comments (0)
