Assessment
Convert Mr. W's weight in lbs (192) to kg.
87 kg
What is Cirrhosis?
Late-stage scarring (fibrosis) of the liver, caused by liver diseases and conditions such as hepatitis and chronic alcoholism.
Why would Spironolactone be prescribed?
As a potassium-sparing diuretic, it will help get rid of excess fluid and will also help retain potassium since it was low on admission.
Which of Mr. W's vital signs are abnormal?
BP (150/86), RR (24),HR (116)
Situation
The patient is Mr. W, a 65-year-old male, admitted for problems associated with alcoholic cirrhosis.
Which of Mr. W's vital signs are abnormal?
RR- 22
HR- 102
Pain- 6/10
Why is Mr. W receiving a paracentesis?
Decreased liver function due to his cirrhosis has caused a build-up of fluid in the abdomen because of portal vein hypertension.
You look at the ordered meds and there is one you don't recognize. What information should you gather before safely being able to administer and educate the patient on this medication?
Reason for taking; Therapeutic effects; Side effects; Contraindications/Drug interactions; safe dosage; proper administration technique; labs to monitor
Given Mr. W's abnormal vitals, visible anxiety, and long history of alcohol abuse, what do you think may be causing his new symptoms? (hint: he is sober)
Alcohol withdrawal
Background
Two days ago Mr. W received a paracentesis that removed 1.2 L of fluid from his abdomen. He was placed on medications including Spironolactone, Lactulose, and Thiamine to help with his cirrhosis symptoms.
What details from the hand-off report are worrying?
- 33-year history of alcohol abuse
- Hypertension
- GERD
- Has smoked 2 packs a day for the last 40 years
- Ascites shown on ultrasound
The patient asks about the paracentesis- what do you tell him to expect?
You will be numbed with a local anesthetic so you won't feel any pain. A needle will be inserted into your abdomen, and a catheter will drain the extra fluid to relieve the pressure and pain you've been feeling.
Why were folic acid, a multivitamin, and thiamine prescribed?
To help with the anemia Mr. W was experiencing upon admission
What would you score Mr. W on the CIWA scale?
10
Assessment
Today he presented with symptoms of alcohol withdrawal including elevated vitals (116, 24, 150/86), signs of anxiety (disorientation, tremors, diaphoresis), and a CIWA scale score of 10.
What lab values are abnormal?
K+, Magnesium, Hemoglobin, Platelets, AST, ALT, Ammonia
Mr. W is a 65 y/o male. He was admitted for problems associated with alcoholic cirrhosis. He’s had abdominal pain rated at 6/10 and has been confused and lethargic, but will follow commands. He’s getting a paracentesis to help with the ascites present.
Why was lactulose prescribed?
a) It helps treat constipation
b) It can be used to prevent CNS symptoms caused by liver failure by binding up ammonia.
What is the rationale behind administering lorazepam?
Lorazepam will help decrease Mr. W's anxiety symptoms by increasing GABA in his brain.
Recommendation
We would recommend maintaining a calm environment, continuing to administer the lorazepam as needed, and considering discussing referral to detoxification centers or psychological help.
Based on these abnormal vitals, labs, physical assessment findings, and his history, what would you think is the underlying cause?
Cirrhosis r/t alcoholism
What should you plan to monitor after Mr. W returns from the procedure?
- Incision site & dressing
- Vital signs (signs of infection?)
- Pain
- Drainage fluid (color, volume, consistency)
What lab values would be impacted by lactulose? What assessment data would prove it is working?
a) AST, ALT
b) Mr. W would be less lethargic and confused and more alert and oriented
What additional complications can arise for Mr. W, related to his alcohol abuse and liver cirrhosis?
- Increased risk for liver cancer
- Weight loss & weakness
- Hepatic encephalopathy
- Heart disease (alcoholism)
Based on your past two days spent with Mr. W, what is a nursing diagnosis you would assign to him?
- Anxiety
- Excess fluid volume
- Risk for acute confusion
- Acute pain