NURSING CARE PREPARATION

Student Name:

Jason Villavicencio, SN

Unit/Room Number: IMCU/234

Age: 58
Gender: MALE
Eriksons Developmental Level: Generativity vs.
Stagnation

Date of Care:

05/06/14

Date of Admission:4/24/14
Ethnic/Cultural Preferences: WHITE/MARRIED/SELF
EMPLOYED/LUTHERAN
Allergies: OXYCODONE
Code Status: FULL CODE

Primary Diagnosis:
UPPER GI BLEED
Co-morbidities:
ETOH, HTN, CIRRHOSIS

Discharge Plan (add day of clinical):

Social services indicate that wife is unable to care for patient in home due to overwhelming circumstances
related to legal and financial issues. Estimated stay is undetermined related to complexity of treatment,
rehabilitation, and coherency. Placement in a skilled nursing facility is necessary for recovery but due to
coherency local placement is not an option. The Portland area is being pursued for placement. The patient
has opted for minimal medical insurance limiting resources for treatment. State medical insurance is another
option but financial issues with the wife increases complexity of discharge and planning.

Preliminary Integrated Pathophysiology primary diagnosis (what is going on with your client at the cellular
level for the health condition, due before clinical shift; (typed 1-3 pages with APA formatting). Explain how
your clients primary diagnosis, co-morbidities, medications and labs interrelate.

Data Collection (Record exactly what is written on the personal information sheet [aka Kardex]. Any
assessment/elaboration should be made on the assessment sheet):
Diet (Type): 2GM SODIUM, MECH SOFT MED. WHOLE IV (Fluid type, rate, access type): PERIPHERAL/UPPER
PUREE. ORAL CARE S/P INTAKE, ROUTINE.
LT ARM/saline lock; PERIPHERAL/LT FOREARM/saline
lock
I&O (MD order/Nursing Order/Frequency): Routine
CBG (Yes/No, frequency): NO
Fall Risk/Safety Precautions (Yes/No): YES/ YELLOW
Activity (Patients activity level ): UP AD LIB/ACTIVITY
WRISTBAND, GOWN, BED ALARM, LOWEST POSITION AS TOLERATED
Wound Care (Yes/No): IV SITE
Oxygen (Yes/No, Delivery method, how much): 1-4
lpm NC spO2 </= 92%
Drains (Yes/No, Type): no
Last BM: 5/6/14
Other Tubes: no

ASSESSMENTS
(Include Subjective & Objective Data)
Integumentary:
Skin: Bilat LE edema pitting +1 , warm, venous stars
bilat, jaundice; nails thick; Lt hand face ecchymosis,
UE bilateral warm, nails thick, longitudinal ridges, no
clubbing, capillary refill <3sec upper/lower. Abdomen
smooth, shiny, warm, scattered veins, herniated
umbilicus. Thorax hair appropriate for age/race, portwine scattered, macule scattered; Hair on scalp
evenly distributed dyed, mobile, non-tender. Bruising
bilateral upper extremities multiple injections, blood
draw, and IV (LUE).
Eyes/Ear/Nose/Throat:
Color vision intact, Diminished visual field, eyes
parallel, light reflex sluggish, jaundice sclera
extraocular motion hesitant OU, some wandering, +
corneal reflex, pupils 2mm, Hx trauma OD; Ears
hearing limited bilaterally, external ear non-tender,
no lesions; Nose: symmetrical dry, pink septum intact,
hair appropriate for age.

Head and Neck:

Head: Normocephalic, erect, midline; Facial
expression appropriate; Hair distribution appropriate
age, sex, and ethnicity; No lesions, abnormal
movement of mouth verbal communication;
periorbital edema OD; Sinuses no pain or swelling
Lips moist no visible lesions; missing teeth
top/bottom; gingiva pink, moist, lesions scattered;
Neck midline AROM + swallow and gag reflex, skin
intact; Larynx and trachea rise with swallowing

Cardiac:
Visible cardiac pulsation; JVP <3cm; Precordium
+pulse at apex; Neck vessels pulse equal, +2, no thrills
or irregular rhythm, no bruit, pedal pulse bilaterally.

Musculoskeletal:
Upper extremities Limited ROM strength + 3
Lower extremities limited ROM strength +2
Reposition self in bed
Neck AROM limited strength +3
Gait unstead
Stance erect
Greater 2 person assist stand pivot
Gastrointestinal:
Hyperactive all quads
Protuberant
Ascites
Tender with percussion
Acute pain with meal Rt upper/lower quad

Genitourinary:
Moist; hair, color appropriate for age, race.
No bulges skin intact. Urinary retention 164ml
bladder scan; urine: dark yellow, slight odor. Bowel
movement loose, liquid, caramel color, strong odor.

Neurological / Psychosocial
Lethargic, oriented self/place; slurred speech,
dysarthria, cooperative, sleeping, inappropriate
comments.

Thorax/Lungs:
Respirations labored symmetrical.
No barrel chest or spinal deformities
Chest non-tender, no masses
E to A consolidation bilat LL
Course sounds

Other (Include vital signs, weight):

T: 97.9 BP: 100/64 R: 20 P:83 spO2: 95% Room air
Pain (chronic or acute): Chronic/acute
Pain management: Rx IV push

CURRENT MEDICATIONS
List ALL regularly scheduled and prn medications scheduled on your client.
(Due morning of clinical)
Generic &
Trade Name

Classification

Dose/Route/
Rate if IV

Onset/
Peak

Lactulose
(Kristalose)

Osmotic laxative

30 GM= 3
Pack PO TID

Potassium
Chloride (KLORCON M20 SA)

Electrolytic
replacement
solution

20 MEQ = 1
tab PO daily
WITH MEAL

Magnesium
Oxide (Mag-OX
400)

Salines
Mineral
electrolyte
replacements
supplements
Laxaties

400 MG= 1
Tab PO DAILY

Senna/Docusat
e 8.6/50
(Senokot-s)

Stimulant
Laxatives
Stool softeners

2 Tab= 2 tab
PO BID

O: 2448 hr
P:
Unkno
wn
D:
Unkno
wn
O:
unkno
wn
P: 12 hr
D:
unkno
wn
O: 3-6
hour
P:
Unkno
wn
D:
Unkno
wn
O: 612 hr
P:
Unkno
wn

Intended
Action/Therapeutic
use. Why is this
client taking med?
Decreases blood
ammonia in patient
with hepatic
encephalopathy

Adverse reactions
(1 major side
effect)

Nursing Implications for this client. (No

more than one)

Distention

Asses for abdominal distention, presence

of bowel sounds, abnormal pattern of
bowel function, assess color, consistency,
and amount of stool. Assess mental
status, may cause decrease ammonia
concentrations, may increase blood
glucose.

Supplement

Avoid laying 10
min after

Monitor I&O ratio and pattern in patients

receiving the parenteral drug.

Laxative

Sweating

Assess for heartburn and indigestion as

well as location, duration, character, and
precipitating factors, assess for
constipation.

Softening of stool

Cramps

Assess for abdominal distention, presence

of bowel sounds, and unusual pattern of
bowel function. Asses color, consistency,
and amount of stool produced.

Lidocaine 5%
patch
(lidoderm)

Class 1B
antiarrhythmic;
local anesthetic
(amide type)

Enoxaparin

Anticoagulant

(Lovenox)

Nystatin oral
susp
(Mycostatin
Oral Susp)
Multivitamin
(THERAGRAN)
Pantoprazole
(Protonix)

Antifungal

1 PATCH = 1
PATCH
TOPICAL
DAILY; 12H
ON/12H OFF

D:
Unkno
wn
Onset
4590sec
Half life
1.5-2h

Suppress
automaticity in HISPurkinje system of
the heart and
elevates electrical
stimulation threshold
of ventricle during
diastole . Prompt,
intense, and longer
lasting local
anesthetic than
procaine.
30mg =
Peak
An effective
0.3mL SC
3h
anticoagulant agent,
daily
Half life
it is used for
4.6h
prophylactic
treatment as an
antithrombotic agent
following certain
types of surgery.
500,000 unit
None
Fungistatic and
= 5mL PO QID listed
fungicidal activity
against a variety of
yeasts and fungi.

Supplement

1 Tab = 1 TAB
PO Daily

O:unk
P:unk

Supplement

Proton pump
inhibitor

40 MG = 1
Tab PO BID

O: 2.5
hr
P:
unkno
wn
D: 1

Diminished
accumulation of acid
in the gastric lumen,
with lessened acid
reflux.

Respiratory
depression

Auscultate lungs for basilar rales,

especially in patients who tend to
metabolize the drug slowly (e.g., CHF,
cardiogenic shock, hepatic dysfunction).

Hemorrhage
(bleeding gums
may be indicator)

Inspect subcutaneous site for S&S of site

reaction (itching, swelling, redness, pain,
tenderness, or hardened skin)that usually
last for less than 7 days post injection.

Nausea &
vomiting

Monitor oral cavity, especially the tongue,

for signs of improvement.

May be taken with food to avoid GI upset.

Diarrhea

Assess for epigastric or abdominal pain

and for frank or occult blood in stool,
emesis, or gastric aspirate. May cause
abnormal liver function tests. May cause
hypomagnesemia.

folic acid

Vitamin B9

1 mg = 1 tab
PO daily

Losartan
(Cozaar)

Antihypertensiv
es

25 MG=1 tab
PO daily

Metoprolol
(Lopressor)

Beta blocker

50 MG=1 TAB
PO BID

Alpradolam
(Xanax)

Benzodiazepine

Morphine
VARIABLE HIGH
RANGE

MENTHO/CAM
PHOR ANTIITCH LOTION
(SARNA, MEN-

Opioid Agonists

Antipruritic

0.5 MG=1
Tab PO TID
PRN

2-8 MG IV
Q1H PRN
BREAKTHROU
GH PX

Topical PRN

week
Peak
3060min

O: 6 hr
P: 3-6
wks
D: 24
hr
O: 15
min
P:
Unkno
wn
D: 6-12
hr
O: 1-2
hr
P: 1-2
hr
D: Up
to 24
hr
O:
Rapid
P: 20
Min
D: 4-5
hr
O: 35m
D: up
to 5h

Stimulates
production of RBCs,
WBCs, and platelets
in pt with
megaloblastic
anemias.
Management of HTN

Slight flushing
feeling

Obtain a carful history of dietary intake

and drug and alcohol usage prior to start
of therapy.

Hypotension

Assess BP and pulse, assess patient for

signs of angioedema (dyspnea, facial
swelling). Hold if systolic <90. May cause
angioedema. Monitor renal function.

Decreased BP and HR

Hypotension

Monitor BP, ECG, and pulse. Monitor

intake and output ratios and daily
weights. Assess for S/S of HF. DO NOT
GIVE IF HR <50, and/or SYSTOLIC BP <90

Anxiety

Dizziness

Assess degree and manifestations of

anxiety and mental status. Monitor CBC
and renal function. May cause decreased
hematocrit and neutropenia.
Flumazenil is antidote

Moderate Pain

Respiratory
Depression

*VARIABLE DOSE 2-8

MG, supplied AS
2MG, 4 MG, OR
10MG syringes
Temporary relief of
itching

Burning, stinging,
sensitization

Assess type, location, intensity of pain

prior and after, high alert medication.
Assess LOC, BP, pulse, respirations. If
respirations <10/min assess level of
sedation.
Narcan antidote
Monitor for and report promptly
significant tissue irritation or sloughing

PHOR)
Naproxen
(NAPROSYN)

NSAID

500mg = 2
TAB
PO Q24H PRN
FEVER
GREATER
THAN 100.4F

2h
peak

Ondanesterone
INJ
(Zofran INJ)

Antiemetic

8MG=4ML IV
Q4H PRN N/V
IVP OVER 3-5
MIN

O:
rapid
P: 1530 min
D: 4-8
hr

Magnesium
Hydroxide
(MOM)

Osmotic Laxative

30 ML = 30
ML PO daily
PRN

Albuterol
NEB Soln 0.083
% 3 ML
(Ventolin,
Proventil)

Bronchodilator

2.5 = 3 ML
Q2H PRN SOB

Saline Flush

Mineral
Electrolyte

2 ML IV PRN
every shift

O:
Delaye
d
P: 30
min
D: 30
min1 hr
O: 1530 min
P: 23 hr
D: 46 hr
O:
Unkno

Mechanism of action
is related to
inhibition of
prostaglandin
synthesis by
inhibiting COX-1 and
COX-2 isoenzymes.
FEVER GREATER
THAN 100.4F
Nausea/vomiting

Palpitations,
dyspnea

Take detailed drug Hx prior to initiation of

therapy. Observe for signs of allergic
response in those with aspirin or other
NSAID.

Drowsiness

Constipation

Diarrhea

Assess effectiveness. Assess patient for

nausea, vomiting, abdominal distention,
and bowel sounds prior to and following
administration. Assess patient for
extrapyramidal effects. Monitor ECG in
patients with hypokalemia or
hypomagnesemia. May cause transient
increase in serum bilirubin, AST, and ALT
levels.
If needed monitor for effectiveness.

SOB

Palpations

Assess lung sounds, pulse, and BP before

administration and during peak of
medication.

Used to flush IV

Edema

Assess fluid balance (intake and output,

daily weight, edema, lung sounds). Assess

Replacement
Isotonic

wn
P:
Unkno
wn
D:
Unkno
wn

patient for symptoms of hyponatremia

(headache, tachycardia, dry mucous
membranes, nausea, voming, muscle
cramps) or hypernaturemia. Monitor
serum sodium, potassium, bicarbonate,
and chloride concentrations.

DIAGNOSTIC TESTING
Include pertinent labs [ABGs, INRs, cultures, etc] & other diagnostic reports [X-rays, CT, MRI, U/S, etc.]
NOTE: Adult values indicated. If client is newborn or elder, normal value range may be different.
Date
Lab Test
Patient Values/
Interpretation as related to Pathophysiology
Normal Values
Date of care
cite reference & pg #
5/6 Sodium
135 145 mEq/L
Potassium
3.5 5.0 mEq/L
Chloride
97-107 mEq/L
Co2
23-29 mEq/L
Glucose
75 110 mg/dL
BUN
8-21 mg/dL
Creatinine
0.5 1.2 mg/dL
Uric Acid Plasma
4.4-7.6 mg/dL
Calcium
8.2-10.2 mg/dL
Phosphorus
2.5-4.5 mg/dL
Total Bilirubin
0.3-1.2 mg/dL

<0.30L

Because serum calcium is bound to albumin,

calcium levels are low due to low albumin levels
(Corbett & Banks, 2013, p. 163)

14.9H

Breakdown of red blood cells can increase

causing an increase in free bilirubin in the
bloodstream (Corbett & Banks, 2013, p. 261))
Total serum protein levels are decreased with
severe or chronic liver disease as a result of
decreased synthesis (Ignatavicius & Workman,
2013, p. 1298)
Severe malnutrition or chronic liver dysfunction
caused by cirrhosis. (Corbett & Banks, 2013, p.
233)

4.7L

Albumin
3.4-4.8gm/dL

1.8L

SGOT or AST
10 48 IU/L
LDH
70-185 IU/L
CPK
38-174 IU/L
WBC
4.5 11.0

Severe liver failure causes a reduction of urea in

serum since urea is synthesized in the liver
(Corbett & Banks, 2013, p. 87)
Decreased creatinine level may indicate atrophy
of muscle tissue. (Corbett & Banks, 2013, p. 90)

7.9L

Total Protein
6.0-8.0 gm/dL

Cholesterol
<200-240 mg/dL
Alk Phos
25-142 IU/L

05/05

7L

355H

157H

18.4H

Liver dysfunction elevates levels by actual liver

tissue damage which could be associated with
necrosis of the liver caused by cirrhosis (Corbett
& Banks, 2013, p. 276).
Trauma or cirrhosis can cause lesser elevation
levels of AST (Corbett & Banks, 2013, p. 282).

Increase in WBCs could be associated with bacterial

infection, inflammation, physical stress, or tissue
necrosis, such as cirrhosis (Corbett & Banks, 2013, p.
49)

RBC
male: 4.7-5.14 x 10
female: 4.2-4.87 x 10

HGB
male: 12.6-17.4 g/dL
female: 11.7-16.1 g/dL

HCT
male: 43-49%
female: 38-44%
MCV
85-95 fL

MCH
28 32 Pg
RDW
11.6-14.8%
Platelet
150-450
Ammonia
35-65
NEUTS,ABSOLUTE
(1.5-7.5)X10 3
MONOS,ABSOLUTE
(0.2-1.0)X10 3

3.41L
12.9L

112H

37.8H

84H

Indicator of abnormal loss or destruction of

erythrocytes (Corbett & Banks, 2013, p. 28)
Levels directly correlate with RBC (Corbett &
Banks, 2013, p. 27)

Macrocytic erythrocytes are larger RBCs

associated with pernicious anemia and folic acid
deficiency, common in liver disease r/t cirrhosis
(Corbett & Banks, 2013, p. 34).
Hyperchromia, indicating RBCs have excessive
amounts of Hgb (Corbett & Banks, 2013, p. 35).

Elevated serum ammonia results from either

decreased blood flow through liver or actual
liver failure (Corbett & Banks, 2013, p. 244)

13.4H
2H
DIAGNOSTIC TESTING

Date

4/30

Date

UA

Normal
Range

Results

Color/Appearance
pH
Spec Gravity
Protein
Glucose
Ketones
Blood
UR WBCS

AMBER

RBCS

10-20H

Other
(PT, aPTT, PTT, INR,
ABGs, Cultures,
etc)

4+H
10-20H

Normal
Range

Results

Interpretation as related to
Pathophysiology cite reference &
pg #

Infection or inflammation
anywhere in the urinary tract
cause increase (Corbett & Banks,
2013, p. 75)
Increase indicative of bleeding in
the urinary system, renal disease,
trauma, or bleeding disorder
(Corbett & Banks, 2013, p. 75)
Interpretation as related to
Pathophysiology cite reference &
pg #

Date
Radiology

5/5

4/30

X-Rays: 1 Chest
View
Scans: CT
Head/Brain
EKG-12 lead
Telemetry
Other Abd
ultrasound, limited,
rt side.

Ultrasound, renal
bilateral

Results

Mild enlg. Liver with fatty

infiltration. No focal mass in liver.
Gallbladder wall mild thickened,
but this is of doubtful clinical
significance, since there is no
cholelithiasis, neg murhys sign,
no pericholecystic fluid. Common
bile duct not visualized.
Intrahepatic ducts not dilated
Rt kidney unremarkable. Inferior
pole left kidney is lobulated with
evidence of mass of
hydronephrosis, splenomegaly,
ascites.

Interpretation as related to
Pathophysiology cite reference &
pg #

DAR NURSING PROGRESS NOTE

Include the same note that was written in the client record for the priority nursing diagnostic
statement.
Include the date/time/signature.

05/06/14 1930 Verbalized need to defecate, bedside commode, 2 person or greater stand pivot assist, stance
erect, unsteady gait, gait belt utilized. Cooperative with transfer. Stool, loose, liquid, medium, Carmel in color,
strong odor. Brief change incontinent void yellow sm. Pericare preformed, clean dry intact. 2015 left in bed,
snoring HOB semi fowlers, 1:1 observation, bed lowest position, uncovered per patient request.------------------------------------------------------------------------------------------------------------------------------------------J.Villavicencio, SN

PATIENT CARE PLAN

Patient Information: MARRIED, WHITE, MALE, 58 YEARS OLD, SELF-EMPLOYED, PRIMARY DX GI BLEED, HX
ETOH, HTN, CIRRHOSIS, IMCU, ROOM 234.
Nursing Diagnosis should include Nanda Nursing Diagnostic statement, related to (R/T), as evidenced by (AEB).

Problem #1: Breathing pattern ineffective r/t ascites aeb abdominal distension, ultrasound
Desired Outcome: Pt will have respiratory rate and rhythm with in normal limits throughout 1500-2200
Nursing Interventions
Client Response to Intervention
1. Monitor rate, rhythm, depth, effect respiration(chest
1. Rate: 18; Rhythm: abnormal varying with
movement, symmetry, accessory, muscles)
sleep dropping to 10 with 92% sp02, deep,
symmetrical, labored
2. Assess respirations/ circulation for baseline rate rhythm, 2. Baseline: Respirations 18/deep/Labored,
depth, cap refill, cyanosis, skin (color, temp, moister),
Cap refill <3sec. Upper & lower extremities, no
effect ever 4h
cyanosis, skin: jaundice, warm, moist
3. Admin. meds per order or protocol.
3. No respiratory meds scheduled or PRN
needed throughout shift
Evaluation (evaluate goal & interventions, what worked/what didnt, what would you adapt if needed):
Respirations varied with pain medication administration without incident. Encouraged rest with activity, Pt
receptive, cooperative.
Problem #2: Deficient fluid volume r/t active fluid loss aeb melena, diarrhea, confusion, concentrated urine
Desired Outcome: Pt will have normal skin turgor and moist mucous membrane throughout 1500-2200
Nursing Interventions
Client Response to Intervention
1. Assess skin turgor, moister, temp, mucous membrane,
1. Turgor tight, clammy, warm, membrane:
coherency, cap refill, VS, for baseline
moist, coherent, Cap refill <3sec upper and
lower extremities, VS (1600): t 97.9F r: 20
BP:100/64 P:83 sp02: 95%ra
2. Measure I/O every 1-4 hours as needed by output
2. Fluid output sm incontinent void, bladder
volume.
scan 164ml.
3. Encourage fluid intake, admin. IV fluids per MAC.
3. IV fluids d/c prior to 1500, oral fluids
encouraged with rounds and med pass, pt
cooperative.
Evaluation: Pt was cooperative with interventions intake for shift 500ml with little output. Turgor maintained
and membranes remained moist.
Problem #3: Infection r/t tissue destruction aeb high WBC, melena, diarrhea, meds.
Desired Outcome: Pts temperature will stay within normal range 1500-2200
Nursing Interventions
Client Response to Intervention
1. Assess temperature for baseline.
1. Temp oral 97.9F baseline
2. Encourage pt to wash hands and perform mouth
hygiene.
3. Assess IV site s/s of infection (redness, warmth, firm,
perfusion, patency)

2. hand hygiene taught with reinforcement

teaching needed oral hygiene performed prior
to swish and swallow med per MAC.
3. IV site no redness, soft, patent, with no s/s of
perfusion.

Evaluation: Temperature varied between 97.9f and 98.6f throughout shift. Temp was maintained.

Running head: PATHOPHYSIOLOGY AT A CELLULAR LEVEL

Pathophysiology at a Cellular Level

Gastrointestinal Bleed
Jason Villavicencio, SN
Southwestern Oregon Community College
Instructor: Dustin Hawk

Running head: PATHOPHYSIOLOGY AT A CELLULAR LEVEL

Introduction
The patient is a 58 year old, white male, married, self-employed motel owner from
Bandon. On admittance, the patient presented with melena, abdominal pain and distension,
nausea, diarrhea and confusion. Patient has a history of alcoholism, hypertension, obesity,
chronic back pain, and inactive life style. Lab tests indicated hyponatremia, hyperkalemia,
cirrhosis of the liver, and dehydration.

Gastrointestinal Bleed
Gastrointestinal (GI) bleeding is bleeding anywhere in the intestinal tract (Huether &
McCance, 2012). The bleed can present itself in various ways such as, dark, tarry stools, frank
stools (bright red in color), blood in toilet, and vomiting blood (Huether & McCance, 2012).
These are obvious indicators but, GI bleeds can also be less obvious only presenting in lab tests
of excrement (Huether & McCance, 2012). Depending on the severity of the bleed, GI bleeds
can be dangerous or life-threatening (Huether & McCance, 2012). GI bleeds are usually
classified into two categories, lower and upper (Huether & McCance, 2012). With the patients
tarry stools, upper GI bleed is the relevant medical diagnosis as the higher up in the GI tract the
bleed the longer the blood has to digest usually resulting in tarry stool and nausea or possible
blood in vomit (Huether & McCance, 2012).
Co-morbidities
The patient has a history of alcoholism which can result in GI bleeding depending on the
duration. Life style also plays a key role in the patients diagnoses considering, diet, activity,
and hydration. This combined with alcohol can lead to serious liver damage leading to

Running head: PATHOPHYSIOLOGY AT A CELLULAR LEVEL

increased blood pressure (hypertension) by narrowing blood vessels (Huether & McCance,
2012). Hypertension causes resistance to blood flow systemically, which can cause ineffective
perfusion in the bowls for metabolic digestion of nutrients and motility (Huether & McCance,
2012). Both can cause constipation leading to probable inflammation or infection (Ignatavicius
& Workman, 2013).
Medications
The patient is taking a multivitamin and folic acid for possible malnutrition which could
be associated with either the abdomen pain or alcoholism. Intravenous fluids were
administered for hydration and hyponatremia. Stool softeners are indicated to regulate bowel
movement. The patient also has a history of chronic back pain which could have led to
excessive alcoholism and possibly the over use of over-the counter anti-inflammatories or
even illegal drugs. Patient was unwilling or even unable to recall such events but confusion
from medical complications may be an issue.
Lab
Laboratory test indicates an increase in white blood cells and a decrease in both red
blood cells and hemoglobin suggesting immune response and blood lose. Ammonia serum
levels were also increased indicating the livers inability to synthesize, reinforcing possible
cirrhosis induced hypertension (Corbett & Banks, 2013). Stool samples proved positive for
blood upon admittance. Ultrasound was inconclusive indicative to GI bleed.
Treatments
The patient is receiving a proton pump inhibitor per orders to lessen acid secretion of
the stomach to lessen irritation to possible bleed. Lactulose was prescribed for bowel

Running head: PATHOPHYSIOLOGY AT A CELLULAR LEVEL

regulation as well as increased ammonia levels. The dehydration has been addressed with IV
fluids and increased oral fluid intake. The patients nutritional intake has come into question
with reported limited intake. With solid intake, abdominal pain increases in right lower and
upper quadrant resulting in an eight on a zero to ten pain scale. This is reduced with IV push
morphine. Patient is also being given metoprolol and losartan for hypertension, both focusing
on contractibility and pumping force of the heart (Ignatavicius & Workman, 2013).
Conclusion
With the patients current state of increasing coherence and cooperation, neurological
complications seem to be subsiding with continued treatment. Patients list of medical issues,
continued decline of liver function, lack of dietary intake has created a complex situation that
will require continued long term skilled medical care. Personal issues have also proved to
increase the difficulty of placement in such a facility. As of end of shift, patient will continue
treatment in current facility.

Running head: PATHOPHYSIOLOGY AT A CELLULAR LEVEL

References
Corbett, J. V., & Banks, A. D. (2013). Laboratory Tests and Diagnostic Procedures with Nursing
Diagnoses. New Jersey: Pearson Education, Inc.
Huether, S. E., & McCance, K. L. (2012). Understanding Pathophysiology. St. Louis, MO: Mosby
Elsevier.
Ignatavicius, D., & Workman, M. L. (2013). Medical-Surgical Nursing: Patient-Centered
Collaborative Care, 7th Edition. St. Louis: Elsevier Saunders.