Liver disease
Bob was a 79 year old father of three adult children who was dying of end stage liver disease. He had been a lifelong alcoholic even though he stopped drinking for a period of 7 years following an acute episode of his alcoholic cirrhosis. Bob and his wife have retired in Florida. Bob was hospitalized with acute onset of GI bleeding no doubt from esophageal varices. Bob’s wife was very attentive visiting him daily. His three children lived in Northern states but came to visit during this hospitalization. Bob was not an outwardly religious guy but had an underlying spirituality that was fairly strong. You are the advance practice palliative care nurse covering for the weekend. When you receive the consult for advance care planning in this case, you wondered what directions his care might have to take. Upon entry to his room you see his youngest daughter who is a nurse and his wife sitting at the bedside. Bob is agitated and argumentative with his family.

What concerns have you identified?

Upon physical exam you detect asterixis. What are the implications of this symptom?

What are four common emergencies in end stage liver failure?

What are some of the ways to assess for alcohol related cirrhosis?

How will you manage Bob’s agitation?