B.W., a 60-year-old male client, is admitted to the hospital with hematemesis. He has a history of alcohol abuse. B.W.’s wife and two daughters accompany him. B.W. is 5 10 tall and weighs 140 lbs. His vital signs are temperature (T) 98.2°F (36.8°C), apical pulse (AP) 98 and slightly irregular, respiration (R) 24 breaths/min, and BP 152/88. He is lethargic, confused, and jaundiced. When the nurse assesses his lung sounds, she hears pulmonary crackles in all lobes. His abdominal girth measures 44 inches. His wife states he has not gone to the bathroom all morning. He has 3 edema in his feet and ankles. B.W.’s primary diagnosis is hematemesis with a secondary diagnosis of cirrhosis.
1. Brainstorm other subjective and objective data that are important to include in the assessment of B.W.
2. Relate the pathophysiology of cirrhosis to the assessed symptoms and other symptoms B.W. may have experienced. Develop a patho-flow chart or concept map relating the symptoms to the pathological cause.
3. List diagnostic tests that would be appropriate for the health care provider to order for B.W.
What abnormal laboratory results would be typical of cirrhosis?
4. Relate the possible results of the diagnostic tests to the developed patho-flow chart or concept map.
5. Besides alcohol abuse, what are some other causes of cirrhosis?
6. List complications of cirrhosis caused by chronic alcohol abuse.
7. Explain the pathophysiology of portal hypertension as it relates to cirrhosis. Relate these to the patho-flow chart previously developed.
8. List diuretics that may be ordered for B.W. to decrease the ascites.
9. How does the action of lactulose (Cephulac) lower the level of ammonia in the blood?
10. What other complications result from portal hypertension?
11. Explain the rationale for the complication of pleural effusion.
12. Identify possible nursing diagnoses for B.W.
13. What nursing interventions would be appropriate at this time?
14. Develop a care plan for B.W. using the following chart as a guide.
15. If B.W.’s condition improved and he was scheduled for discharge, what is important to include in the discharge teaching regarding the following?
a. Bleeding tendencies
b. Exercise
c. Nutrition
d. Skin care
16. List local resources/support groups where B.W. and his family could be referred.
B.W.’s daughter says, “I wish Dad would have quit drinking years ago. I was always embarrassed by his behavior when he had too much to drink. His life could have had so much potential.”
17. What would be appropriate therapeutic responses of the nurse?