MEDIAL SURGICAL NURSING

Case Scenario 3
Care of Client with GI, PUD, Cancer, Liver Failure

Mr. MJ , 56 years old was brought to the Emergency Room because of weakness, loss of
apetite and decreasing level of consciousness. During the interview by the nurse, the wife
revealed that he was a smoker, alcoholic drinker , since he was 17 and fond of eating fatty, less
fiber food. He leads a stressful life because of his work in a multinational company. He had
undergone many diagnostic exams and procedures like colonoscopy with biopsy , esophago
gastrocopy, sclerotherapy, paracentesis for ascites , chemotherapy and radiotherapy. He had
been fatigued and anemic for the past year and had taken vitamin and iron supplements. The
wife narrated that he had undergone major abdominal surgery with colostomy, after which he
was placed on PCA morphine, post op monitors and were taught to take care of his colostomy
site.

Past medical history of MJ also revealed the following

2017 – Hepatitis A

2018 – PUD ,managed by medications. BPH with dysuria. DRE revealed soft enlarged
prostate

2019 – Rectosigmoid cancer stage 3, underwent Abdominoperineal resection (APR) with

colostomy, underwent radiotherapy and chemotherapy

January 2020- Cirrhosis with portal hypertension.

A. What are the other possible risk factors that can contribute to his
present condition?

B. When you assess Mr MJ having undergone APR, what kind of colostomy

do you expect?

C. What would you expect to drain from the colostomy? What are the
different kinds of colostomies?

D. How will he monitor his colostomy? Discuss colostomy care and

colostomy irrigation.

E. Having undergone this surgery, discuss your nursing care for MJ after
this abdominal surgery.

F. Having undergone chemo/radiotherapy, the nurse knows that side

effects can occur with these therapy since these affect both abnormal
and normal cells. What are these side effects that the nurse should
focus on her health teachings whenever the nurse is taking care of
patient with cancer ?

G. What possible diagnostic exams and management were given to him

when he was suffering PUD?
 PART II

During your interview with the wife of MJ, he is also taking Aldactone, Lactulose. At times
he has been disoriented and had memory problems. You noticed ascites, some edema on his
lower extremities. Additional tests were done like serum enzyme tests, serum Bilirubin ., total
protein A/G ratio, PT.

H. What can cause MJ’s liver cirrhosis?

I. Cite the complications of Liver cirrhosis that already exist with his
presenting signs and symptoms?

J. Give the rationale of the above management and diagnostic

assesements for his cirrhosis..

During the 4th week of MJ’s confinement, the nurse observed the patient to be restless and
suddenly he vomited fresh blood.

K. What would be your immediate management at this time?

L. What could have caused the vomiting of fresh blood? What are your
other parameters of assessment with these advancing liver condition?

For the succeeding days, MJ became comatose, ascites and edema worsening and was
hooked to dopamine for his dropping blood pressure and was confined in ICU with decreasing
GCS everyday.. The physician explained the irreversible effects of his advanced liver disease
and later on the family and relatives signed for DNR .

M. What ethical concepts are related to issues at end of life happening to

MJ.

N. With what members of the interdisciplinary team does the nurse

collaborate when caring for the dying patient and providing support for
the family.?

O. Give signs and symptoms related to the end of life.

P. Discuss the ethical and legal obligations of the nurse with regard to
end of life care.

MN/2020