BACHELOR OF SCIENCE IN NURSING:

NCMB316 RLE
RLE MODULE RLE UNIT WEEK
1 4 3
CASE SCENARIO: LIVER CIRRHOSIS

✓ Read course and laboratory unit objectives

✓ Read study guide prior to class attendance
✓ Read required learning resources; refer to course unit terminologies for jargons
✓ Participate in weekly discussion board (Canvas)
✓ Answer and submit course unit tasks

At the end of this unit, the students are expected to:

1. Apply appropriate principles and concepts of neurological nursing in care of patient with liver
cirrhosis.
2. Properly implement precautions for patient with Liver cirrhosis.
3. Formulate a plan of care to address the needs/problems based on priorities.
4. Implement safe and quality interventions with the client to address the identified
need(s)/problem(s).

Computer device or smartphone with internet access (at least 54 kbps; average data
subscription will suffice)
To facilitate the practice of students’ nursing skills, the following rules must be adhered:
1. Read the materials given (module). You may refer to reference given and other MS books.
2. Attend to the synchronous or asynchronous class facilitated by instructors.
3. Use lecture guide attached in this RLE GUIDE.
2. You must submit the accomplished worksheet through Canvas upload.
3. Take note that the case presented is not definite. This will change/updated during the
4. synchronous session to determine the extent of your knowledge.
5. Below are the concepts that you must review. You may also refer to MS book

LIVER CIRRHOSIS
Is a chronic, progressive disease characterized by diffuse degeneration and destruction of
hepatocytes. that disrupts the structure and function of the liver. Repeated destruction of hepatic
cells causes the formation of scar tissue. There are several types of cirrhosis or scarring of the liver:

1. Laennec’s cirrhosis – the scar tissue characteristically surrounds the portal areas. This is
most frequently due to chronic alcoholism and is the most common type of cirrhosis. Alcohol
induced, nutritional or portal. Cellular necrosis causes eventual widespread scar tissue. With
fibrotic infiltration of the liver.
2. Postnecrotic cirrhosis – in which there are broad bands of scar tissue as a late result of a
previous bout of acute viral hepatitis. Scar tissue causes destruction of the liver lobules and
entire lobes.
3. Biliary cirrhosis – in which scarring occurs in the liver around the bile ducts. This type usually
is the result of chronic biliary obstruction and infection (cholangitis); it is much less common
than the other two types.
4. Cardiac cirrhosis – associated with severe, right-sided congestive heart failure and results
in an enlarged, edematous, congested liver.

Manifestations:
1. Neurologic Findings:
− Asterixis
− Paresthesia of the feet
− Portal-systemic encephalopathy
− Reversal of sleep-wake pattern
2. Gastrointestinal
− Abdominal pain
− Anorexia
− Ascites
− Clay-colored stools
− Diarrhea
− Esophageal varices
− Fetor hepaticus
− Gastrointestinal bleeding
− Hepatomegaly
− Hiatal hernia
 − Vomiting
3. Renal – Increase urine bilirubin
4. Endocrine – Gynecomastia
5. Immune System
− Increased susceptibility to infection
− Leukopenia
6. Cardiovascular
− Cardiac dysrhythmias
− Portal hypertension
7. Pulmonary
− Dyspnea
− Hydrothorax
− Hypoxemia
8. Hematologic
− Anemia
− Thrombocytopenia
− Impaired coagulation
9. Dermatologic
− Caput medusae - dilated abdominal veins
− Ecchymosis
− Jaundice
− Palmar erythema
− Pruritus
− Spider angiomas
10. Fluids and Electrolytes
− Hypocalcemia
− Hypokalemia
− Peripheral edema
− Water retention

Complications
1. Portal Hypertension – a persistent increase in pressure in the portal vein that develops as a result
of obstruction to flow.
2. Ascites – accumulation of fluid in the peritoneal cavity that results from venous congestion of the
hepatic capillaries.
3. Bleeding – esophageal varices: Fragile, thin-walled, distended esophageal veins that become
irritated and rupture.
4. Coagulation deficits – decreased synthesis of bile fats in the liver prevents the absorption of fat-
soluble vitamins. Without vitamin K and clotting factors II, VII, IX, X, the client is prone to bleeding.
5. Jaundice – occurs because the liver is unable to metabolize bilirubin and because the edema,
fibrosis, and scarring of the hepatic bile ducts interfere with normal bile and bilirubin secretion.
6. Portal Systemic Encephalopathy – end-stage hepatic failure characterized by altered level of
consciousness. Impaired thinking, caused by failure of the diseased liver to detoxify neurotoxic
agents such as ammonia.
CASE SCENARIO
Rosa a 50-year-old female, 5’6” with BMI = 32, gradually developed abdominal distention, bilateral
leg edema and her family took her to the Medicine Clinic for check-up. On interview she revealed
that she felt shortness of breath 5 days before, loss of appetite for 10 days, and fatigue. Her family
brought her to the clinic because of these complaints. She was brought to the hospital and was
admitted for further management.

VS: BP - 140-90mmHg, PR – 90bpm, RR – 27cpm, T - 37°C.

On assessment:
(+) abdominal pain (+) pruritus
(+) ascites (+) jaundice
paresthesia of feet

Upon palpation: (+) sharp edge noticeable on upper right quadrant of the abdomen.

Patient has a big dragon tattoo on her back.

After 2 months in Hospital patient displayed flapping tremors, decreasing level of consciousness,
clay colored stool that changed to black tarry stool, with anemia, edema and esophageal varices.

History:
− Drinks alcohol heavily for 10 years
− Multiple sex partners
− Blood transfusion 5 years ago.
− Hepatitis B

Laboratory and Diagnostics

1. Increased ALT (alanine transaminase) 150 U/L
2. Increased AST (aspartate transaminase) 52 U/L
3. Increased ALP (alkaline phosphatase) 190 U/L
4. GGT - increased
5. Serum ammonia - increased
6. Increased bilirubin - 18 mg/dl
7. Decreased albumin - 15 g/dl
8. Decreased serum potassium
9. Decreased serum calcium
10. Ultrasound, CT scan, MRI shows liver damage.

Medical Diagnosis: Liver Cirrhosis

Prescribed medication
1. Silymarin capsule
2. Spironolactone
3. Liver Detox Complex
4. Lactulose

Questions:
1. Identify the etiology and epidemiology of existing medical condition.
2. Recognize the diagnostic test(s) that can be used to support and/or confirm a suspected
diagnosis.
3. Categorize the treatment options for patients with existing medical condition.
4. Trace the pathophysiology of the condition and the course of the disease of the patient.
5. Create a nursing care plan based on the given case scenario.

Date Completed:
Date Submitted:

Hinkle, J. and Cheever, K. (2017). Brunner & Suddharth’s Textbook of Medical-Surgical Nursing,
14th ed. USA: Wolters Kluwer