SCRIPT

Mikole: Today we are going to present our case study entitled Nursing Care and
Management of a 70-year-old Client with Decompensated Alcohol Liver
Cirrhosis. I am Mikole Tatel, the leader of this group. Together with me are the
following:

● Aizel S. Agustin
● Fathyma J. Ismael
● Merhoneza A. Kahal
● Reiji G. Kikkawa
● Charisma E. Pastor
● John Paolo G. Patino
● Ezekiel Kim E. Quimson
● Clouise Junice B. Renolla
● Richelle Mae F. Reyes
● Jorgee S. Sahali
● Indira P. Salih
● Nur-hathi M. Sanaani
● James Ryan K. Usman
● Yusrhina S. Usman

(next slide)

Introduction - Aizel
this is aizel s. Agustin for introduction
● As of June 17, 2021, the Philippine Statistic Authority reported that diseases of
the liver ranked twelve in the leading causes of death in the Philippines, and a
total of 9,810 deaths were recorded in the last five years.
● PSA (2017) reported that excessive alcohol use is prevalent among people aged
15 to 49 residing in Zamboanga Peninsula. This is as a result of numerous
gatherings and celebrations that are influenced by drinking habits.
● With the increased prevalence of this disease, medical professionals and
students should be knowledgeable regarding liver cirrhosis
● As a result, the researchers decided to study this case in order to obtain a
thorough understanding of the disease process and management of liver
cirrhosis, specifically alcoholic liver cirrhosis.(next slide)
Patient and the problem
Patient Z is a 70 year old male.He has a family history of diabetes mellitus, bile
acids, and hypertension. On August 6, 2021, four days prior to admission, the client
complained of abdominal pain and distention. The pain became unbearable on the
fourth day, August 10, 2021. He was rushed to the hospital with a chief complaint of
severe abdominal pain with distension for four days, weakness and decreased appetite
for 15 days, and significant weight loss - 20 kg in 6 months.

During the first day of admission (August 10), the client was scheduled for an
abdominal ultrasound. Significant findings revealed that the client has liver cirrhosis with
splenomegaly with possible portal hypertension and massive ascites. The following day
(August 11), important laboratory tests were performed, and results indicated liver
function abnormalities. An abdominal CT scan was also performed during the second
day of admission. (next slide)

During the third day (August 12), the client was scheduled for abdominal
paracentesis to reduce intra-abdominal pressure and relieve ascites. The succeeding
days were focused on interventions to aid the client in recovery. The client was
discharged last August 15, 2021, with improved status. The client’s final admitting
diagnosis was decompensated liver cirrhosis

(next slide)

Significance - Aizel

For our significance of the study and General & Specific Objectives please refer to our
paper
with that we will now proceed to anatomy and physiology

Anatomy and Physiology - Ira

The liver is the largest gland of the human body

It is responsible for the regulation of the chemical levels in the blood and the excretion
of bile

The liver comprises four lobes, the right lobe, left lobe, smaller caudate lobe, and
quadrate lobe.

One of the most important elements of the liver is the circulation of blood in and out of it.
It receives approximately 80% of the blood supply which carries nutrient-rich but
oxygen-insufficient blood from the portal vein, and the rest from the hepatic artery with
oxygen-rich blood. Compared to the other organs in the body, the liver is unique as it
receives both oxygenated and deoxygenated blood. This is made possible by the Portal
Venous System (PVS) present in the liver.

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While the liver plays a vital role in the storage and clearance of exogenous drugs, it is
also a key site where nutrients and minerals pass through for lipid synthesis and
metabolism.

Bile is an important fluid of the body produced by the main cellular unit of the liver called
hepatocytes.
Once secreted from the liver, they are stored in gallbladder and emptied into the
duodenum.

Other functions of the liver include bilirubin metabolism, fat and protein metabolism,
drug metabolism and storage of vitamins and minerals.

The spleen also works hand in hand with the liver to carry out functions such as blood
filtration, iron metabolism and erythrocyte homeostasis]

next reporter please

Pathophysiology - Nur
● This is Nur-hathi Sanaani For the pathophysiology
● Liver cirrhosis starts when various substances (alcohol, acetaminophen, and
viruses.) cause inflammation to the liver.
● As a result the liver got fibrosed and scarred, which led to the obstruction of
arteries and veins that supply the liver and causes portal hypertension

Next slide please

● For portal hypertension, various organs linked to the liver such as stomach,
anus, spleen etc can experience PORTAL VEIN BYPASS which can lead to the
manifestation of various signs and symptoms associated liver cirrhosis.
● Portal hypertension can lead to formation of varices in the stomach and
esophagus and can predispose clients to hemorrhage.
● For the spleen, since various cells cannot be exerted to the system due to the
portal hypertension, it can lead to SPLENOMEGALY. This causes this
insufficient excretion of vital cells such as RBC, WBC, and platelets which can
cause anemia, thrombocytopenia, and leukopenia.
 ● In addition, Hepatic Encephalopathy can also occur when the liver is unable to
excrete ammonia; this can cause great accumulation of Ammonia in the brain
which can lead to decreased level of consciousness, coma, and eventually
death.
● For the integumentary system, since the liver cannot facilitate the bilirubin out of
the body it stays in tissues and can cause yellow discoloration in the eyes and
skin or jaundice.
● In addition, since the liver can't produce sufficient albumin and proteins that
necessary to maintain oncotic pressure it causes ascites as a result of third fluid
shifting

And with that we will now proceed to the introduction of the case

This is Yusrhina Usman for Nursing process and Bates

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Nursing Process

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Biographic data
Chief Complaint: severe abdominal pain with distension for 4 days, weakness and

decreased appetite for 15 days, and significant weight loss (20 kg in 6 months)

Final Diagnosis: Decompensated liver cirrhosis

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Comprehensive Nursing History

History of Present Illness
● Fifteen days ago, no appetite and started feeling weak.

Past Illness
● Cannot recall any history of childhood illness and immunizations.
● No allergies were noted

Family History
● Family history of diabetes mellitus and hypertension.
(NEXT SLIDE)

Gordon’s - Patch & Paolo

I-V - Patch

I am Fathyma Ismael and next we have the MARJORIE GORDONS 11

FUNCTIONAL HEALTH PROBLEM

I. - Health Perception/Health Management

Whenever Patient feels any pain or discomfort, he relies on herbal medicines and
manghihilot.He consumes not less than 20 sticks of cigarettes every day

(NEXT SLIDE)

II. - Nutritional/Metabolic Pattern

Patient loves salty foods & drinks at least 3 to 5 bottles of alcohol everyday. He
then started losing weight and appetite, from 70 kg to 50kg.

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III. - Elimination Pattern

Patient was able to urinate five (5) times a day and defecate twice a day. The color of
his stool is gray, and urine has a dark color too. During admission, he excreted urine
through a catheter. Urine output is approximately 50-100 mL/hr. Defecates 1-2 times a
day using diapers.

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IV. - Activity/Exercise Pattern

The only exercise the patient does was walking to the Church every Sunday. As his
condition got worse, he already needed someone to assist him. During admission, the
functional level for his ADL is rated as follows:

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V.- Sleep-Rest Pattern

Patient sleeps at least 8-10 hours a day and encounters interruptions due to abdominal
pain.

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 VI-XI - Pao
VI: The patient perceives pain as he rates it an 8 out of 10 on the pain scale. Patient is
with prescription glasses; due to advanced age, patient has mild hearing loss.

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VII: The patient got anxious regarding his weight loss and body changes; He verbalized
feeling weak and relying on his wife on daily activities.

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VIII: Patient has 5 children, 2 of which are already working while the other 3 are
university students.

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IX: Patient and his wife have not gone through any family planning method. He stated
that he has been sexually inactive starting 60 years old.

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X(Coping and stress tolerance pattern): Patient regularly drinks alcohol as a way to
destress; along with drinking, he also started smoking at the age of 18.

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XI: The patient prays for his well-being and recovery; he and his family follow the roman
catholic faith.

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Bate’s - Yus

HE was awake, alert and responsive but a bit anxious. He is also well-oriented to his
surroundings

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The patient was seen with Spider Angiomas, visible veins on the palmar erythema
abdomen, palmar erythema.
He had dull/coarse skin, normal temp, dec skin turgor. He also had a bilateral ankle
edema
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There's no problem with his head, however he had slightly jaundiced eyes with 20/30 &
20/40 for the R l VF respectively.

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the mouth, face, ears, and neck are normal upon inspection.

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For the lungs, rr is 20 its normal, diaphragmatic excursion with 5cm on both fields, no
other problems noted.

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CArdio, for the pulses, the grade is normal, easily palpable except for the pedal pulse
since the patient is presented with edema.

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Musculo no deformities, normal gradings of pulses except for dorsalis pedis. Weakness
on hand and leg muscles.

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The abdomen of the patient looks round with bulging flanks. It’s tender with an
abdominal girth of 110cm, with mass and again the ascites.

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the patient has no problem with the neurological system

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As well as genitourinary. urine is dark yellow, output is 50 ml, with indwelling urinary
catheter.

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patient is also suffering from a financial problem

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He is underweight with a bmi of 18.4 and needs assistance in feeding due to severe
fatigue which also led to his decreased appetite. no NGT attached

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he's been infused with 1L Lactated Ringer 10drops/min

Abdominal pain was reported with a pain scale of 8 duration and had a guarding
behavior. Alleviating factors, if he works himself too much, the pain increases,
precipitating factors is his lifestyle.

(NEXT SLIDE)

he was also given an appropriate patient education

That’s all for BATES

Diagnostic Test -
● Whole abdomen ultrasound was done on august 10.
● This test is necessary for evaluating the liver and the volume of ascitic fluid
present.
● The result showed massive ascites and anechoic fluid collection was noted. Liver
cirrhosis with splenomegaly was also seen.

● Next we have the abdominal ct scan which was done a day after the ultrasound.
● Ct scans of the liver can provide more detailed information about the liver thus
providing more information related to injuries and or diseases of the liver
● Vascular collaterals within the omentum and the lower esophagus indicative of
portal hypertension were seen. Massive amount of ascites was also seen.

● The next day paracentesis was performed.

● This can help identify infection, causes of liver disease or portal hypertension and
also relieve symptoms by removing a massive volume of fluid.
● At least 4000 cc of serous fluid was drained from the peritoneal cavity.
● There were no post paracentesis complications noted.
● There were no signs of active bleeding, hematoma formation or rapid fluid re
accumulation.

● After performing paracentesis, gram staining was done.

 The gram staining shows no presence of organisms

● This repeat test is done post paracentesis to check if there is still a significant
amount of fluid left.
● Results showed that there was a significant decrease in the peritoneal fluid.

(This is Merhoneza Kahal for laboratory results)

Laboratory Results - Mer & Reiji

(NEXT SLIDE)

COMPLETE BLOOD COUNT (CBC) can evaluate a patient’s overall health and detect
a variety of diseases and conditions, such as infections, anemia and leukemia

1. Hemoglobin test (LOW) - due to the occurrence of portal hypertension, an

insufficient blood flow within the kidney causes a release of erythropoietin which
causes the stimulation of the release of immature RBC.

2. Red Blood Cells (LOW) - due to the occurrence of portal hypertension a

development of splenomegaly occurs which predisposes the patient on the
inability to secrete various cells such as Red Blood Cell which can predispose
the client to anemia.

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3. Hematocrit (LOW) - this indicates extracellular fluid excess and anemia, the
most common complication of liver cirrhosis.

4. White blood cell (LOW) - Because of the occurrence of portal hypertension, the
client is predisposed to an inability to produce different cells such as white blood
cells.

5. Erythrocyte Sedimentation Rate (HIGH) - this indicates the presence or

abatement of infection.

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 6. Platelet count (LOW) - Because Thrombocytopenia, which is often observed in
patients having liver cirrhosis, can manifest decreased thrombopoietin production
and accelerated platelet destruction caused by hypersplenism.

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Prothrombin Time - is a blood test that determines how long it takes for blood to clot
and also used to determine whether blood clot prevention medication is effective.

1. INR (HIGH) - This means that the liver could not make the blood clot normally.

2. PT (HIGH) - a prolonged pt means that the blood is taking too long to form a clot.
A High PT means that there is serious liver damage or cirrhosis. And may
indicate that there is a higher risk for internal bleeding from the upper part of the
GI tract.

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Hepatitis B Surface Antigen Test - is used to find out whether the patient has had a
recent or long-standing infection from the hepatitis B virus (HBV).

1. Hbsag (NON-REACTIVE) - A Negative or nonreactive, meaning that no hepatitis

B surface antigen was found.

A serum electrolyte test is a blood test that assesses the levels of the body's major
electrolytes: Electrolytes are minerals found in the blood and bodily tissues.

1. Na (sodium) (LOW) - This is due to impaired renal capacity to eliminate solute-

free water, resulting in water retention

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Liver functions test (LFT) are a set of tests for checking the amount of proteins,
enzymes and bilirubin present in the blood. Can help diagnose liver infection, liver
disease or damage.

1. SGOT (HIGH) - This indicates that the liver is damaged

(This is REIJI KIKKAWA for the continuation of the laboratory results)

2. SGPT levels are (HIGH) - this can be an indication of damage or problems

related to the liver.
 3. ALP levels are (HIGH) - this can be a sign of blockage of bile ducts or liver
inflammation.

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4. Albumin levels are (LOW) - this may indicate that the liver is not functioning
properly.
5. Globulin levels are (HIGH) - this can be from autoimmune diseases such as
lupus, kidney disease, or liver disease.
6. Total Bilirubin is (HIGH) - Direct bilirubin levels in the blood that are higher than
normal may this suggests that the liver is not eliminating bilirubin effectively.

(NEXT SLIDE)

next is Renal function test (RFT), this is a group of tests used to assess the functions
of the kidney.

1. Ammonia levels are (HIGH) - An elevated blood ammonia level may indicate
kidney or liver damage or an underlying metabolic disease.

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Lipid profile test can help identify the risk of plaque formation in the arteries, which can
lead to atherosclerosis

1. Cholesterol levels and triglycerides are high this may indicate that the patient has
fatty liver disease
2. DHDL level is (HIGH) - this indicates a reduced risk of heart and blood vessel
disease.

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3. Direct LDL level is (HIGH) - this indicates that there is too much LDL cholesterol
in the blood which can lead to atherosclerosis.

(THATS ALL FOR THE LABORATORY RESULTS)

Drug Study - Nur & Richelle

In this portion of the presentation Reyes and Sanaani will be discussing the different
drugs given to the client.
1. Nur - TRAMADOL
a. With the 1st drug the client receives tramadol IV 500mg every 8 hours for
the client’s severe pain, tramadol is a potent drug that can potentially
cause respiratory depression. A medicating nurse one must put in mind
the twelve rights of medication administration when administering all
medications. Furthermore, RR should be assessed before, during, and
after the administration to monitor for respiratory depression.

(This is Richelle Reyes for continuation of the drug study)

2. Richelle - UDILIV
● The next drug is 600mg of Ursodeoxycholic acid, administered PO.
Ursodeoxycholic acid is a bile acid indicated for patients with biliary
cirrhosis.
● It works by reducing elevated liver enzyme levels by facilitating bile flow
through the liver. Nursing responsibility includes assessing the patient’s
allergy to bile salts.
(next slide)

3. Richelle - HEPAMERZ
● Our patient was also administered 10mg of Hepamerz PO. This drug was
administered to lower the patient’s blood ammonia levels.
● Nursing responsibility includes monitoring the patient’s serum and urinary
levels of urea.
(next slide)

4. Nur - ALDACTONE
a. For the 4TH drug we have Aldactone given PO 100 mg Once a day to
address the client's ascites, edema, and portal hypertension associated
with liver cirrhosis to prevent exacerbation of the condition.
b. With this medication it is important to Place clients on a BP precaution to
prevent hypotension, and to Assess associated signs and symptoms of
hyperkalemia such as EKG disturbances, lethargy etc.
(next slide)
5. Nur - NEOMYCIN
a. FOR THE 5th DURG WE HAVE NEOMYCIN PO 500 mg given every 8
hours
b. This drug is given to prevent the progression of Hepatic encephalopathy
by preventing the ammonia converting bacteria from converting ammonia
within the intestine.
c. With this drug we must also assess for ototoxicity associated with the
administration of aminoglycoside drugs.
 6. Nur - OMEPRAZOLE
a. Next is omeprazole given PO 20 mg two times a day to prevent the
occurence of curling ulcers since the client is undergoing an invasive
procedure which is the paracentesis.
(next slide)
7. Richelle - TRANEXAMIC ACID
● The next drug is 1.5g of Tranexamic acid administered PO. The drug was
administered to prevent bleeding following paracentesis.
● The nursing responsibilities are to monitor VS, platelet count and clotting
factors and assess for thromboembolic complications.
(next slide)

8. Richelle - ALBUMIN
● 25mg/100mL of Albumin was administered through IV as a temporary
replacement of albumin after aspiration of ascites fluid during
paracentesis.
● The nursing responsibilities are to monitor VS, CVP and I&O before and
during therapy to determine fluid overload. We assess for signs of
vascular overload during and after administration, monitor serum sodium
levels, hemoglobin and hematocrit levels

(next slide)

9. Richelle - METRONIDAZOLE
● Lastly, 160mg Metronidazole was administered through IV to help
decrease the risk of hepatic encephalopathy by disrupting the conversion
of protein to ammonia.
● The nursing responsibilities are to monitor neurological status, avoid
intake of alcoholic beverages, and inform the patient that medication may
cause urine to turn dark.

(And that concludes our drug study)

NCP -
This is Renolla and Pastor for NCP. (NEXT SLIDE)

1. Clong- Pain
 We have made six significant nursing care plans pertinent to the client’s condition
in this case. Our first priority is Acute pain related to the inflammatory process of
enlarged liver and spleen as evidenced by facial grimace and protecting body
part. Assessment reveals client verbalizing he is in pain with pain level of 8 at
right upper quadrant of his abdomen. Heart rate and respiratory rate are high.
Ultrasound also reveals an enlarged liver and spleen. For the nursing
interventions done to the patient ,
● Monitored vital signs and pain characteristics.
● Identified sources of stressors.
● Provided a quiet environment and encouraged to rest. NEXT SLIDE
● Demonstrated different non-pharmacological methods to the patient.
● Administered Tramadol 500 mg/amp via IV as needed every eight hours.
back
After 8 hours of nursing care, our evaluation shows that out of 5 goals, there
were only two goals that were partially achieved. Patient reports reduced pain but
with pain level of 5 which is within moderate scale as well as complaint due to
discomfort during mobility. Also, heart rate and respiratory rate are also still high.
(NEXT SLIDE)
2. Cha- FVE
The next priority is Excess fluid volume related to decreased plasma proteins as
evidenced by decreased albumin, ascites and ankle edema. Other assessment
findings include hypertension, greater intake than output. Lab findings include
low sodium and Hgb and Hct.
For the nursing interventions done:
● Measured I&O, weigh daily, BP and Respiratory status hourly,
Auscultated lung sounds and heart sounds

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● Assessed degree of peripheral edema and compare to previous findings.
● Abdominal girth 7am daily.
● Monitored serum albumin and electrolytes

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● Restricted sodium intake and limited fluids
● Administered albumin and diuretics
● Prepared patient for paracentesis,

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● then post-procedure examined and reinforced the dressing of the
punctures, inspected amount and color of drainage.
 After 5 days, Patient’s fluid volume was stabilized, and was compliant to
dietary/fluid restriction.

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3. Cha- Imbalance nutrition
The next priority identified was Imbalanced Nutrition: Less Than Body
Requirements related to decreased appetite, abdominal distention, and
weakness as evidenced by weight loss and low serum albumin level. Health
history reveals the patient lost 20kg in the past 6 months and now has an
underweight BMI of 18.4. Lab findings also include a high ammonia.
Interventions are the following:
● Weighed the pt daily and monitored I/O
● Encouraged the patient to eat and explained the ordered diet rich in carbs,
protein, vit A and E. Avoiding salt substitutes, foods with ammonium, GI
irritant foods.
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● 5 small meals were given a day, after each, mouth care was performed.
● Educated on smoking and alcohol cessation
● Monitored albumin and ammonia

(NEXT SLIDE)
● Referred to a dietitian for the diet plan
After 5 days, Patient participated actively in meal planning and was
compliant. Albumin increased to 3.7g/L. With no further signs of
malnutrition.

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4. Clong- Activity Intolerance
The next nursing care plan is focused on Activity Intolerance related to general
malaise and fatigue. Assessment includes patient complaining of weakness and
fatigue. Heart rate and respiratory rate are high and with 7 rating of perceived
exertion during ADLs.
For the interventions done to the patient,
● Collaborated with the patient about his perceived realistic goals
● Allowed the patient to express his feelings
● Instructed the patient to rest.
● Assessed the need for assistive devices.
● Assisted the patient in planning activities.
● Assessed the patient's capabilities consistent with his energy.
● Assisted the patient during gradual progression of physical activity. NEXT
SLIDE
 ● Lastly, monitored and documented response to activities and note
abnormal responses
Back. For our evaluation, all goals are met after 2 days of implementation.
Patient exhibits tolerance to physical activity with vitals within normal limits during
rest and exertion. With a perceived rate of exertion of 3, able to perform ADLs
independently as well as getting adequate rest.

(NEXT SLIDE)
5. Cha- Risk for bleeding
The patient was at Risk for bleeding related to abnormal blood profile. Risk
factors noted were low platelet count, high INR and PT.
Interventions done were:
● Monitored s/s of bleeding, such as GI bleeding, or superficial bleeding.
● Monitored PR and BP, tachypnea and hypotension may indicate
hemorrhage.
● Observed for changes in mental status.

(NEXT SLIDE)
● Conducted health teachings to avoid bleeding.
● Monitored Hgb, Hct, and PLT, INR, and PT.
● Administered tranexamic acid prior to paracentesis to prevent massive
bleeding.
After 5 days, patient manifest no signs of massive bleeding, and compliant
to preventive practices.

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6. Clong- Risk for disturbed sensory perception

The last problem is Risk for Disturbed Sensory Perception related to
neurosensory changes occurring with cerebral accumulation of ammonia. This
risk is observed from the day the patient was admitted until discharged.
Assessment reveals high ammonia levels.
For the nursing intervention, it is mainly monitoring and continuous assessment.
● Monitored patient’s GCS.
● Interviewed the wife regarding the patient’s usual behavior.
● Monitored blood ammonia levels, signs and symptoms of hepatic
encephalopathy, and signs and symptoms of bleeding.
(NEXT SLIDE)
● Evaluated sleep and rest schedule.
● Encouraged bedrest.
 ● Padded the side rails. Maintained the bed in a low position. Oriented the
patient to time, place and person. Provided emotional support.
● Monitored signs of infection
● Instructed to decrease diet that contains high in protein and ammonia
● Advised to drink glucose supplements and increased fluid intake.
● Anticipated the need for medications intended for prophylaxis against
ammonia accumulation such as
○ Neomycin 500mg tablet per orem every eight hours, 160 mg
○ Metronidazole via IV once daily and
○ Hepamerz ten mg tablet once a day.
Back. Our evaluation after 5 days of implementation is a success. All goals were
met. Patient’s GCS is constantly 15 during the 5 day admission and he exhibits
changes in lifestyle by alcohol cessation and decreased protein intake.

Discharge/Instructions Plan - Jorgee & Kim

Initially, here are the following discharge medications. The following drugs will be
instructed to the patient with its purpose and health considerations while taking it:
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A. SPIRONOLACTONE - (Aldactone) 100mg/tab
Cautions:
- Educated the patient with the signs and symptoms of hyperkalemia, and to call
his HCP if symptoms worsen.
- To avoid driving or performing activities requiring physical & mental alertness
since this drug may cause dizziness, headache, or vision disturbances.
- To avoid potassium-rich diets, and to move slowly when assuming an upright
position to minimize orthostatic hypotension.
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B. OMEPRAZOLE - (Omepron) 20 mg/capsule
Cautions:
- Instructed the patient to observe for the drug’s effects; if symptoms persist or
adverse reactions (such as headache, diarrhea and nausea or vomiting) occur,
notify the prescriber.
- Informed the client to never crush or chew the drug, because these formulations
are delayed-release and long-acting.
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C. TRAMADOL - (ConZip) 50 mg/tab
Cautions:
- Informed the patient that nausea, vomiting, constipation, dizziness, drowsiness,
or headache may occur.
- To avoid alcohol and to encourage the patient to follow the prescribed drug
 regimen because misuse of this drug can cause addiction, overdose or death.

D. NEOMYCIN - (Neo-Tab) 8 mg/tablet

Cautions:
- Informed the patient that this drug is nephrotoxic and ototoxic, and so several
tests may be performed after 2 to 3 weeks.
- Educated the patient that nausea, vomiting and diarrhea are the common side
effects.
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ECONOMY AND EXERCISE
We signify to the patient the following healthcare management in activity for
patient with Liver Cirrhosis:

A. PROMOTING REST
1. Encourage the patient to perform activities or mild exercises (at least 30 minutes)
daily to prevent loss of muscle mass and muscle strength ++ and that rest must
be planned to promote the liver’s blood supply.

B. REDUCING RISK FOR INJURY

1. To avoid heavy lifting or straining for two to three weeks
2. To change positions slowly because of the risk of hypovolemia related to fluid
removal (abdominal paracentesis).
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3. To ask for assistance from his family member in getting out of bed if he is feeling
fatigue.

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Health
Stop alcohol - Major cause and needs to be stopped to prevent load and further
damage on the liver
Cigar - chemicals present in cigarettes causes damage in blood vessel and lungs and is
associated with increased risk in liver cirrhosis
Liquids - to help flush out toxins and help liver work better
Normal BMI -avoid worsening and prevent fatty liver (18.4 BMI)

Outpatient
Blood in stool and vomitus - indicates that there is bleeding in stomach and esophagus
due to esophageal varices
Confusion - indicates that there toxin build up in the brain due to liver failure which
results to inability to clear toxins properly
Fever - infections are frequent since cirrhosis and alcoholism impairs host defense
mechanism
Difficulty breathing - is a usual symptom in liver diseases and immediate care is needed
Check up - monitor the current health status

Diet
Salt - to prevent ascites or swelling of legs and arms. Less than 2000 mg
Potassium - client is prescribed with potassium sparing as discharge medicine therefore
limit potassium to avoid hyperkalemia
Protein - since patient have weight loss therefore it aids in preserving muscle mass and
prevent weight loss. 1 - 1.5 g per kilogram of body weight per day.
Strict diet - diet plays a large role in progression of liver disease therefore follow to
prevent complications

Sex
Focused on educating the family on how alcoholism generally affects sexual function
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Evaluation - Mikole
● The group was able to relate and apply essential concepts about liver cirrhosis
that were discussed during online class and RLE.
● The group believes they successfully achieved the general and specific
objectives set out at the start of the case study.
● The patient's condition improved after the essential nursing interventions were
implemented:
○ Pain was decreased
○ Abdominal girth was reduced
○ Nutrition improved.
● This study provided the group with a better understanding regarding the condition
of liver cirrhosis.

(NEXT SLIDE)

Recommendation - Mikole
● For the patient, the group recommends the following in order to continue
recovery from the disease:
1. Follow all recommendations, treatments, and medications prescribed.
2. Lifestyle changes should be implemented such as cessation of alcohol
 consumption and cigarette smoking.
3. Limit sodium and potassium intake, increase fluid intake, and follow
prescribed diet plans.
4. Monitor overall condition by reporting any signs and symptoms of disease
exacerbation.

(NEXT SLIDE)

For future researchers and case studies, the group recommends the following:
1. A thorough understanding of medical surgical nursing related concepts.
2. A detailed and comprehensive assessment has to be conducted in order
to ensure the appropriate identification of problems.
3. Mastery of the nursing process is also recommended.
4. Seek for additional information through research.
5. Team work, cooperation, and hard work are essential in accomplishing the
case study.