Decompensated Liver Cirrhosis

Order Description
Decompensated Liver Cirrhosis
Mr Ronald Stone is a 47 year old man who was brought in by ambulance to emergency department with haematemesis. According to his partner he vomited a total of 300mL of fresh blood this morning. He reported that he has been spitting blood stained sputum for the last few weeks with no associated cough or shortness of breath. For the past 3 days he has complained of increasing abdominal pain but with no diarrhea or black stools. Mr Stone tested positive for Hepatitis C virus (HCV) genotype 1A in June 2010. He has cirrhosis and a history of heavy alcohol use, although he no longer drinks. He ceased intravenous drug use 10 years ago, and still smokes tobacco and marijuana on a daily basis. He used to work with City Rail but has been made redundant 13 months ago and has been unemployed since. He lives with his partner and 2 young children from a previous marriage.

On assessment, Mr Stone’s vital signs are: HR 112 bpm; RR 24; BP 105/64mmHg; Temp 37.4; SpO2 94& on room air. He has a body mass index (BMI) of 31.5kg/m2. He is lethargic but orientated to time, place and person. He has a swollen and tight abdomen typical of ascites and bilateral leg oedema. Blood test results show Hb 85 g/L, decreased WBC, platelets and albumin, and a marked increase in both serum ammonia and total bilirubin levels. 6 months ago he underwent an eosophagogastroduodenostomy (EGD) which showed grade 2 oesophageal varices. He is ordered the following medications: Vitamin K 1mg IV stat, aldactone 25mh PO TDS, lactulose 15mls PO TDS, and vitamin B12 100mg IV TDS. He is awaiting a CT abdomen scheduled for this afternoon.
1. Outline the causes, incidence and risk factors of the identified condition and how it can impact on the patient and family (400 words).
2. List five common signs and symptoms of the identified condition; for each provide a link to the underlying pathophysiology (350 words).
a. This can be done in the form of a table – each point needs to be appropriately referenced
3. Describe two common classes of drugs used for patients with the identified condition including physiological effect of each class on the body (350 words).
a. This does not mean specific drugs, but rather the class that these drugs belong to.
4. Identify and explain, in order of priority the nursing care strategies you, as the registered nurse, should use within the first 24 hours post admission for this patient (500 words).