DIAGNOSTIC EXAM IMAGING

ACTUAL RESULT Liver Cirrhosis with R hepatic lobe mass, splenomegaly, massive ascites, prostatic concretions Bile sludge with tiny cholelithiases gall bladder wall thickening

NORMAL VALUE No mass No ascites No thickening No stone No enlargement

ANALYSIS

REFERENCE

Ultrasound CT Scan

Image demonstrates the Caroline R morphologic evidence of Taylor, MD, cirrhosis within the liver and in Chief Editor: showing mesenteric and GI John Karani tract abnormalities, as well as the development of collateral vessels in portal hypertension.

Secondary manifestations of cirrhosis include thickening and edema of the small and large bowel, as well as of the gallbladder wall, which is more common in the setting of ascites and hypoproteinemia.

DIAGNOSTIC EXAM HEMATOLOGY

ACTUAL RESULT

NORMAL VALUE

ANALYSIS

REFERENCE Chris Sherwood, ehow contributor

WBC

11,000/ cu.mm

5,000-10,000

RBC Hemoglobin

10 gms/dl

13.5-18

As the body senses an infection, it initiates an increased production of white blood cells to fight the infection. Once the problem has been alleviated, the white blood cell count returns to normal.

DIAGNOSTIC EXAM GLUCOSE PROTEIN DETERMINATION Peritoneal Fluid

ACTUAL RESULT

NORMAL VALUE

ANALYSIS

REFERENCE

Protein: 542 mg/dl

Glucose: 137 mg/dl

Protein and glucose cannot be Labtestonline. absorbed by the liver causing org No peritoneal fluid them to accumulate at the peritoneal cavity as ascites.

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

ADVERSE EFFECT/ SIDE EFFECT ADVERSE EFFECT: CNS: dizziness, vertigo, paresthesia, xanthopsia, weakness CV: orthostatic hypotension, thrombophlebitis DERMA: photosensitivity, rash, urticaria, purpura GI: n/v, anorexia, GI irritation GU: polyuria, urinary bladder spasm HEMA: leukopenia, anemia, thrombocytopoenia SIDE EFFECT: Increased volume and frequency of urination, dizziness, faint when arising, sensitivity to sunlight, increased thirst, loss of body potassium

NURSING CONSIDERATION *Record therapy. *Weigh patient on a regular basis. *Blood glucose level may be temporarily elevated in patients with DM. *Report loss/gain of more than pounds in day, swelling of ankles, unusual bleeding/bruising.

GN: Furosimide BN: Lasix CLASS: Loop Diuretic DOSE 40mg/IV

Inhibits reabsorption of sodium and chloride from the proximal and distal tubules and ascending limb of the Loop of Henle, leading to a sodiumrich diuresis.

IV: edema associated with heart failure, cirrhosis, renal disease

Contraindicated with allergy to Furosimide, Sulfonamides; allergy to Tartazine, anuria, severe renal failure, hepatic come, pregnancy and lactation. Use cautiously with SLE, Gout, DM

DRUG NAME

ACTION

INDICATION

CONTRAINDICATION

ADVERSE EFFECT/ SIDE EFFECT ADVERSE EFFECT: CNS: dizziness, head ache, drowsiness DERMA: rash GI: cramping diarrhea GU: impotence, irregular mens HEMA: hyperkalemia, hyponatremia, agranulocytosis SIDE EFFECT: Increased volume and frequency of urination, confusion, feeling faint when arising. Drowsiness, increased thirst, deepening voice

NURSING CONSIDERATION *Record alternate day therapy. *.Weigh yourself on a regular basis *Avoid foods rich in potassium *You may experience possible side-effects. *Report weigh change of morethat 3pounds in 1 day.

GN: Spironolactone BN: Aldactone Novospirotone CLASS: Aldosterone Antagonist Potassium sparring diuretic

Competitively blocks the effect of aldosterone , in the renal tubule causing loss of sodium and water and retention of potassium.

Adjunctive therapy in edema associated with HF, hepatic cirrhosis when other therapies are inadequate and inappropriate

Contraindicated with allergy to Spironolactone, hyperkalemia, renal disease, anuria, amiloride/ triamterene use. Use cautiously with pregnancy, lactation

ASSESSMENT
Subjective: Nagmamanas ang paa ko. as verbalized by the patient. Objective: (+) bilateral feet edema (+) abdominal globular distention (+) fatigue (+) weight gain

INFERENCE
Increase alcohol consumption lead to hepatocyte damage causing liver infklammation. Alteraion in blood and lymph flow occurred resulting to liver necrosis. Decreased metabolism of CHO and CHON occurred with decrease production of ADH that lead to accumulation of fluid causing edema.

DIAGNOSIS
Excess fluid volume related to compensated regulatory mecahnism as manifested by abdominal edema and weight gain.

PLANNING
GOAL: After 1/2 shift /s of nursing intervenion, patients fluid volume accumulated is expected to lessen from the body. OBJECTIVE: The patient will be able to: 1.Stablize fluid volume as evidenced by lesser weight and lesser sign of edema. 2.Verbalize understanding of individual dietary and fluid restriction. 3.Demonstrate behavior to monitor fluid status and reduce recurrence of fluid excess.

INTERVENTION
INDEPENDENT: 1. Measure VS particularly BP. 2. Measure abdominal girth and Grade of Edema. 3. Place patient in semi-fowlers position. 4. Measure patients fluid intake. DEPENDENT: 1. Administer diuretics as prescribed. 2. Weigh patient daily in scheduled time and frequency. COLLABORATIVE: 1.Discuss importance of fluid restriction to patients family.

RATIONALE
To obtain baseline data of patients health status. For changes that may indicate fluid retention /edema. To facilitate movement of diaphragm ; improving respiratory effort. To monitor fluids entering the body.

EVALUATION
After 2 shift/s of nursing intervention, patients grade of edema was lessen to +1 and patient lost .5kg weight. GOAL MET

Measurement: +3 inches on abdominal width Grade 2 bipedal edema +1kg on patient normal weight

To help patient eliminate fluid retained inside the body. To monitor occurrence of weight changes.

To gain their cooperation in maintaining patients condiion.

ASSESSMENT
Subjective: Nanghihina ako. as verbalized by the patient.

INFERENCE
Increase alcohol consumption lead to hepatocyte damage causing liver infklammation. Condition resulted to the incapacity of the liver to absorb nutrients needed by the body.

DIAGNOSIS
Imbalanced nutrition less than body requirements related to inability to absorb nutrients as manifested by anorexia, fatigue, muscle wasting.

PLANNING
GOAL: After 4 hours of nursing intervention the patient is expected to gradually regain the lost nutrients needed by the body. OBJECTIVE: The patient will be able to: 1.Demonstrate progressive health improvement towards goal . 2.Verbalize understanding of causative factors when known and necessary intentions. Demonstrate behaviors, lifestyle changes to regain and maintain appropriate weight.

INTERVENTION
INDEPENDENT: 1. Determine patients ability to chew, swallow and taste food. 2. Ascertain understanding of individual nutritional needs. 3. Discuss importance of proper intake of nutritious food. DEPENDENT: 1. Maintain IV lines as ordered. COLLABORATIVE: 1.Refer patient to a Dietician.

RATIONALE
All factors that can affect ingestion and digestion of nutrients.

EVALUATION
After 4 hours of nursing intervention, patient was able to have a healthier appetite and regain strength. GOAL MET

Objective: (+) anorexia (+) muscle wasting (+) fatigue

Measurement: Peritoneal Fluid Protein: 542 mg/dl Glucose: 137 mg/dl

To determine informational needs of the patient.

To help him understand the necessities and benefits.

To regain the lost nutrients and energy needed by the body.

To have a followed dietary restrictions.

ASSESSMENT
Subjective: Nagmamanas ang paa ko. as verbalized by the patient. Objective: (+) bilateral feet edema (+) abdominal globular distention (+) fatigue (+) weight gain

INFERENCE
Increase alcohol consumption lead to hepatocyte damage causing liver infklammation. Alteraion in blood and lymph flow occurred resulting to liver necrosis. Decreased metabolism of CHON&CHO occurs with decrease production of ADH that leads to accumulation of fluid causing edema. Stretch of skin may be a risk for skin breakage and accumulation of fluid may lead to secretion.

DIAGNOSIS
Risk for impaired skin integrity related to impaired metabolic state as manifested by bipedal edema, abdominal globular distention .

PLANNING
GOAL: After a shift of nursing intervenion, patients risk of impaired skin integrity is expected to totally eradicate. OBJECTIVE: The patient will be able to: 1.Identify individual risk factor 2.Verbalize understanding of treatment and therapy regimen 3.Demonstrate behavior and techniques to prevent skin breakdown.

INTERVENTION
INDEPENDENT: 1. ASSESS skin routinely 2. Handle patient gently 3. Massage bony prominence and use proper hand washing 4. Emphasize importance of adequate nutritional intake. 5. Recommend keeping nails short. COLLABORATIVE: 1.Refer to dietician, certified diet educator as appropriate

RATIONALE
It may indicate particular vulnerability Epidermis of patient at risk is less elastic and prone to injury. Prevent skin impairment. To maintain good health and skin turgor.

EVALUATION
After risk for skin integrity was prevented. GOAL MET

Measurement: +3 inches on abdominal width Grade 2 bipedal edema +1kg on patient normal weight

To reduce risk of dermal injury when severe itching is present. To identify nutritional needs

MEDICATION EXERCISE TREATMENT HEALTH TEACHING

Advise patient to continue taking his medication prescribed by the physician upon discharge. Explain the importance of taking medication, possible side effects and adverse reactions of new drugs and limitation of drug intake. Encourage patient to have simple exercises like breeze walking for health maintenance and explain its importance. Advise not to perform heavy workloads due to the organ problem. Encourage patient and his relative to collaborate with regards to providing and maintaining necessary treatments prescribed for his condition Explain the importance of proper hygiene and hand washing. Explain to the patient and relatives the disease and ways of preventing its occurrence to the family particularly alcoholic drinking and eating fatty foods. Follow-up / visit the physician on the prescribed time to be able to assess the changes/improvement of health condition. Identify appropriate diet necessary for fast recovery. Encourage patient to limit fluid for the mean time, stop alcohol intake and increase intake of nutritious food Encourage patient`s family to continue praying and asking guidance from God in order for the patient to inculcate on his mind that it is important Advise the couple to refrain having sexual intercourse for the mean time.

OUT PATIENT FOLLOW UP

DIET SPIRITUAL/ SEX