Scenario liver cirrhosis stage 2

October 13, 2020 @ 9:30 AM, a 56 year old male decided to visit the OPD for checkup
due to itchy skin, yellow discoloration in the skin and eyes (jaundice), loss of appetite, fatigue
and frequent vomiting with blood on it. Patient is known to be alcoholic for 10 years and
consumes alcohol 2-3X a week. Upon initial assessment of the doctor in OPD he suspected a
liver problem. He ordered an x-ray. After an hour, the x-ray confirmed liver scarring. Advised
patient to go to ER for further assessment of his condition.

Vital signs taken: T= 38.9, febrile; PR=112 bpm, irregular; RR=22 cpm, irregular, strong and
bounding; BP= 150/100 mmHg. Patient is seen and examined by Dr. Lu in the Emergency
Department and ordered an ultrasound test called transient elastography to know if there is
portal hypertension. At 11:30 AM the test confirmed portal hypertension and at risk for
possible esophageal varices. Dr.LU made a final diagnosis of liver cirrhosis stage 2. And he
ordered the following:

1. Admit to ward
2. Secure patient consent
3. Start IV line: D5LR 1L @ 30 gtts/min
4. Apply TSB
5. Insert 18 Fr Sengstaken-blakemore NGT tube
6. 200 mL osteorized feeding every 8 hours
7. Medications:
a. Administer Paracetamol 500 mg IVTT PRN