QUESTIONS.1. What nursing assessment findings support the diagnosis of Liver Cirrhosis?2. Correlate the patient’s presenting clinical manifestations of esophageal varices in livercirrhosis?3. In what order should the nurse institute the physician orders that are listed above? Perform dosage calculations and state how to administer the medications.4. The nurse observes the nasogastric secretions and, upon admission to the ICU, there was200 mL of dark red-colored drainage. The nurse continues to monitor the drainage and, asthe nurse hangs the first unit of PRBCs, 200 mL of bright red bloody drainage is dumpedinto the collection canister. What should the nurse do?5. The gastroenterologist orders for the nurse to increase the octreotide to 50 mcg/hr and the endoscopy nurse and the physician will be up shortly to perform a vertical band ligation (VBL). What does the nurse need to do in preparation for this procedure?6. What nursing diagnoses should the nurse formulate for the patient?7. Create a Nursing Care Plan for patient Jose.8. Create FDAR chart. (F-ocus, D-ata, A-ction, R-esponse)Thank you! Mr. Jose, 35 years of age, presented in Emergency Department due to nausea and vomiting. Uponinterview by the nurse, client noticed with progressive abdominal distension, bearable on and offabdominal pain for two months duration and loss of weight over three weeks despite a goodappetite. The patient has quit drinking alcohol for the past 2 months. His systemic inquiry wasunremarkable. There was no significant past medical, surgical or allergic history. The admissionvital signs include: BP, 88/50; P, 110; R, 26; and T, 37.3. Patient then, was transferred at intensivecare unit.He is a tailor by profession and never married; He has two siblings who are healthy. Onexamination, he was dark in complexion and appeared well. He was not pale, or icteric. There wasno clubbing or peripheral stigmata of chronic liver cell disease. There were no hepatic flaps ordependent edema. The abdomen was distended and firm, upon percussion there was no hepaticbruit or splenomegaly. His cardiovascular, respiratory, and neurological examinations were normal.The supplemental oxygen is on room air and the patient is placed on 2 L/min of oxygen per nasalcannula with supplemental oxygen. IV Fluid Started with PLRS 1 Lat 100 cc/hr.Routine laboratory investigations were done and revealed a hemoglobin of 14.9 g/dL with a MCVof 83 fL. The total leucocyte count was 10.06 X 109 /L with normal differentials and platelet countof313,000/mm3. Blood film showed acanthocytes and target cells which was suggestive of a liverpathology. Liver function tests showed an elevated alkaline phosphatase level of 319 U/L withnormal alanine and the aspartate aminotransferases (AST= 21 IU/L, ALT-=26 IU/L) and a normalserum bilirubin concentration. The total serum protein was 6.5g/dL, with albumin levels of 3.3g/dL.The Gamma GT level was mildly elevated (58.5 U/L)Prothrombin time was 16.3 seconds with an INR of 1.43. Serum electrolytes and renal functiontests were within normal limits. The inflammatory markers were normal. Peritoneal fluid examination showed 40 cells/mm3 and a very high protein level of 8g/dL withnegative acid-fast bacilli (AFB). Peritoneal fluid cytology was negativeHe had negative hepatitis B and C serology. Retroviral screening, Mantoux test and sputum AFBwere negative.Ultrasonography of the abdomen revealed a hepatomegaly of 18.2cm with an enlarged caudatelobe and an architecture characteristic of chronic parenchymal liver disease.There was moderate ascites and bilateral pleural effusions. There was evidence of early portalhypertension. The initial colour doppler studies failed to show any abnormalities.Liver biopsy revealed effaced architecture with the liver parenchyma was separated into nodulesby thick fibrous septae. Hepatocytes showed ballooning and degeneration.There was no steatosis, bile stasis, necro-inflammation or interphase hepatitis. These findingswere compatible with established liver cirrhosis.The health provider places orders for the following:Kеep Spo2 92%Keep HOB 30 degreesInsert 2 large bore Parenteral IV lines (PIV's)500 mL NS IV bolus STAT100 mL/hr NS IV continuous infusionHydrocodone/Acetaminophen 5-500 mg 1-2 tabs q4h PRN moderate to severe painDiphenhydramine 25 mg PO q8h PRN itchingOndansetron 4 mg IV q6h PRN nauseaLactulose 20 mg PO qồhAfter 24 hours upon admission patient experienced vomiting 2 times of fresh blood moderate inamount.Repeat laboratory done, result patient's hemoglobin is 7 g/dL, the hematocrit is 12%, and theplatelets are 75,000. The patient has a prolonged PT and PTT.EGD was requested, which later revealed esophageal varices.The physician placed a right subclavian triple lumen catheter and there is NS infusing at 100 mL/hr.The iCú nurse administered vitamin K.Additional orders on the chart from the gastroenterologist include the following:Octreotide (Sandostatin) 5-mcg bolus followed with continuous infusion 500 mcg in 250 mL D5NSat 25 mcg/hr.Type and cross of 6 units of PRBCS STAT and transfuse 2 units of PRBCS over 2 hours each andadminister furosemide (Lasix) 20 mg IVP in between each unit.Repeat CBC 1 hour after the transfusion is completed.

Question

QUESTIONS.1. What nursing assessment findings support the diagnosis of Liver Cirrhosis?2. Correlate the patient’s presenting clinical manifestations of esophageal varices in livercirrhosis?3. In what order should the nurse institute the physician orders that are listed above? Perform dosage calculations and state how to administer the medications.4. The nurse observes the nasogastric secretions and, upon admission to the ICU, there was200 mL of dark red-colored drainage. The nurse continues to monitor the drainage and, asthe nurse hangs the first unit of PRBCs, 200 mL of bright red bloody drainage is dumpedinto the collection canister. What should the nurse do?5. The gastroenterologist orders for the nurse to increase the octreotide to 50 mcg/hr and the endoscopy nurse and the physician will be up shortly to perform a vertical band ligation (VBL). What does the nurse need to do in preparation for this procedure?6. What nursing diagnoses should the nurse formulate for the patient?7. Create a Nursing Care Plan for patient Jose.8. Create FDAR chart. (F-ocus, D-ata, A-ction, R-esponse)Thank you! Mr. Jose, 35 years of age, presented in Emergency Department due to nausea and vomiting. Uponinterview by the nurse, client noticed with progressive abdominal distension, bearable on and offabdominal pain for two months duration and loss of weight over three weeks despite a goodappetite. The patient has quit drinking alcohol for the past 2 months. His systemic inquiry wasunremarkable. There was no significant past medical, surgical or allergic history. The admissionvital signs include: BP, 88/50; P, 110; R, 26; and T, 37.3. Patient then, was transferred at intensivecare unit.He is a tailor by profession and never married; He has two siblings who are healthy. Onexamination, he was dark in complexion and appeared well. He was not pale, or icteric. There wasno clubbing or peripheral stigmata of chronic liver cell disease. There were no hepatic flaps ordependent edema. The abdomen was distended and firm, upon percussion there was no hepaticbruit or splenomegaly. His cardiovascular, respiratory, and neurological examinations were normal.The supplemental oxygen is on room air and the patient is placed on 2 L/min of oxygen per nasalcannula with supplemental oxygen. IV Fluid Started with PLRS 1 Lat 100 cc/hr.Routine laboratory investigations were done and revealed a hemoglobin of 14.9 g/dL with a MCVof 83 fL. The total leucocyte count was 10.06 X 109 /L with normal differentials and platelet countof313,000/mm3. Blood film showed acanthocytes and target cells which was suggestive of a liverpathology. Liver function tests showed an elevated alkaline phosphatase level of 319 U/L withnormal alanine and the aspartate aminotransferases (AST= 21 IU/L, ALT-=26 IU/L) and a normalserum bilirubin concentration. The total serum protein was 6.5g/dL, with albumin levels of 3.3g/dL.The Gamma GT level was mildly elevated (58.5 U/L)Prothrombin time was 16.3 seconds with an INR of 1.43. Serum electrolytes and renal functiontests were within normal limits. The inflammatory markers were normal. Peritoneal fluid examination showed 40 cells/mm3 and a very high protein level of 8g/dL withnegative acid-fast bacilli (AFB). Peritoneal fluid cytology was negativeHe had negative hepatitis B and C serology. Retroviral screening, Mantoux test and sputum AFBwere negative.Ultrasonography of the abdomen revealed a hepatomegaly of 18.2cm with an enlarged caudatelobe and an architecture characteristic of chronic parenchymal liver disease.There was moderate ascites and bilateral pleural effusions. There was evidence of early portalhypertension. The initial colour doppler studies failed to show any abnormalities.Liver biopsy revealed effaced architecture with the liver parenchyma was separated into nodulesby thick fibrous septae. Hepatocytes showed ballooning and degeneration.There was no steatosis, bile stasis, necro-inflammation or interphase hepatitis. These findingswere compatible with established liver cirrhosis.The health provider places orders for the following:Kеep Spo2> 92%Keep HOB > 30 degreesInsert 2 large bore Parenteral IV lines (PIV's)500 mL NS IV bolus STAT100 mL/hr NS IV continuous infusionHydrocodone/Acetaminophen 5-500 mg 1-2 tabs q4h PRN moderate to severe painDiphenhydramine 25 mg PO q8h PRN itchingOndansetron 4 mg IV q6h PRN nauseaLactulose 20 mg PO qồhAfter 24 hours upon admission patient experienced vomiting 2 times of fresh blood moderate inamount.Repeat laboratory done, result patient's hemoglobin is 7 g/dL, the hematocrit is 12%, and theplatelets are 75,000. The patient has a prolonged PT and PTT.EGD was requested, which later revealed esophageal varices.The physician placed a right subclavian triple lumen catheter and there is NS infusing at 100 mL/hr.The iCú nurse administered vitamin K.Additional orders on the chart from the gastroenterologist include the following:Octreotide (Sandostatin) 5-mcg bolus followed with continuous infusion 500 mcg in 250 mL D5NSat 25 mcg/hr.Type and cross of 6 units of PRBCS STAT and transfuse 2 units of PRBCS over 2 hours each andadminister furosemide (Lasix) 20 mg IVP in between each unit.Repeat CBC 1 hour after the transfusion is completed.

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