Known Liver Cirrhosis with portal hypertensionDepressionFamily history is unremarkable Carvedilol 6.25mg PO dailyFolic Acid 5 mg PO daily 4.5mcg / m * i * n5.6mcg / m * i * n4.8mcg / m * i * n8.4mcg / m * i * n

Question Answered step-by-step AUD (alcohol use disorder)Non- smokerMultivitamins 1 Tab PO daily Paroxetine 40 mg PO daily Known Liver Cirrhosis with portal hypertensionDepressionFamily history is unremarkable Carvedilol 6.25mg PO dailyFolic Acid 5 mg PO daily 4.5mcg / m * i * n5.6mcg / m * i * n4.8mcg / m * i * n8.4mcg / m * i * nSpironolactone 25 mg PO daily Thiamine 100 mg PO daily clear air entry to all lung fields, no SOB, no cyanosis, respirations unlabouredCardiovascular: S1 S2 heard, no murmur, pulses moderate, regular and palpable, skin warm, dry. Cap refill <3 seconds, +2 edema to lower legs bilaterallyGastrointestinal: Abdomen large, softly distended, mild diffuse tenderness, BS x4, loose BM x2 today looseGenitourinary:  Voiding without difficulty, urine clear yellow. No bladder distention notedPsychosocial:  Lives alone, no kids, divorced. Retired factory worker. Poor management of cirrhosis and portal hypertension. Currently has ETOH consumption ~8beers/day. Vital Signs:  T.  37.8, HR 96 regular, RR 18, 96% RA, BP 94/60DiagnosticsCT scan demonstrates worsening liver cirrhosis Abdominal U/S demonstrates significant Ascites Ascites fluid diagnostics demonstrate spontaneous bacterial peritonitisEndoscopy demonstrates increased portal hypertension  CBC:  Hemoglobin 130 g/L (120-160), Platelets 90 (130-380), WBC 13.2  (3.5-10.5)Electrolytes:  Sodium 136 mEq/L (135-145), Potassium 3.8 mEq/L (3.5-5.0), Chloride 100 mEq/L (98-107), magnesium 0.82mmol/L (0.74-1.07) Renal panel:  Creatine 187 (53-106mcmol/L) , eGFR 26  ml/min (>60 ml/min)Liver panel:  AST 68 U/L (0-35), ALT 55  (4-36), ALP 225 (35-120 U/L),   Total Bilirubin 32  mcmol/L(5.1-17)  ammonia 77 mcmol/L (6-47 mcmol/L), albumin 22 g/L (35-50 g/L),  INR 1.9 (0.9-1.1)Hepatic encephalopathySpontaneous bacterial peritonitis (SPB)Query onset of Hepatorenal syndrome Significant progression of liver cirrhosis and portal hypertensionAlcohol withdraw  Paracentesis drained 3L fluid CIWA protocolDelirium and CAM (confused assessment method) monitoringMonitoring and replacement of electrolytes Monitoring of refeeding syndromeAlbumin IV 25% x3 doses Baclofen 5mg TID (*new)Ceftriaxone 2g daily x5 days for SPB Carvedilol 6.25 mg PO daily   (discontinued)Diazepam 10mg IV/PO Q1H PRN  for CIWA scores 10-19 until scores less than 10.Folic Acid 5 mg PO dailyKCL 10mmol IVPB x3 dosesLactulose 30ml QID- titrate to 3-4 BM’s /day (*New)Multivitamins 1 Tab PO daily Paroxetine 40 mg PO daily Rifaximin 55mg PO BID (*new) Spironolactone 50 mg PO daily (*New dose) Thiamine 100 mg PO dailyT.  36.8, HR 92 regular, RR 18, 96% RA, BP 102/74Mr. Scottaline is having a complicated and likely an extended hospital stay for end-stage liver cirrhosis. His complications have included moderate alcohol withdrawal, electrolyte imbalances, refeeding syndrome, delirium, skin breakdown from edema and frequent diarrhea, hypotension, and deconditioned mobility.For assignment 2 concept map and case analysis you are the RN in charge of Mr. Scottaline’s care and you want to develop a nursing care plan to provide direction for his acute priority needs. Use the assessment data and information in the case scenario to guide your development of the one-page only concept map visual diagram. Identify and outline 6-10 nursing care priorities related to this case scenario and number the care priorities in level of importance.  Include lines and arrows to visually display relationships and connections among concepts. Include linking words with the lines to indicate the nature of the connection or relationship (for example: leads to, influences, contributes to, results in, etc.) Part B. MethodsInclude a full nursing care plan (nursing diagnosis, SMART goals, nursing interventions supported with credible and current sources of evidence, and evaluation statements) with the first nursing care priority you have identified. This can be completed as an appendix attached to the paper portion of the assignment. Refer to the Assignment 1 and 2 marking guide in the Assessment Overview for further direction of the requirements of the concept map as well as case analysis. You may also find it useful to go back to Unit 1 and review the content related to Concept Mapping. Keep in mind the concept map in Unit 1 is not as fully detailed as we expect your concept map to be. The concept map is worth 65% of your entire mark for this assignment, so spend your time constructing this.Can you write 10 nursing diagnosis and number it which one first, second, third priortya.. what did you do?b. who did you do it for?c. What was the outcome?  Health Science Science Nursing Share QuestionEmailCopy link Comments (0)