Care Study on Alcoholic Liver Cirrhosis
ALCOHOLIC LIVER CIRRHOSIS
Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrous scar tissue as well as regenerative nodules (lumps that occur as a result of a process in which damaged tissue is regenerated), leading to progressive loss of liver function. Cirrhosis is most commonly caused by alcoholism, hepatitis B and C and fatty liver disease but has many other possible causes. Some cases are cryptogenic, i.e, of unknown cause, but most of these are probably due to previously unrecognized fatty liver disease.
Alcoholic cirrhosis is the most serious type of alcohol-induced liver disease. Cirrhosis refers to the replacement of normal liver tissue with scar tissue. Between 10 and 20 percent of heavy drinkers develop cirrhosis, usually after 10 or more years of drinking. Symptoms of cirrhosis are similar to those of alcoholic hepatitis. The damage from cirrhosis is not reversible, and it is a life-threatening disease. Your condition may stabilize if you stop drinking.
Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis and is associated with a poor quality of life, increased risk of infection, and a poor long-term outcome. Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma) and bleeding from esophageal varices. Cirrhosis is generally irreversible once it occurs, and treatment generally focuses on preventing progression and complications. In advanced stages of cirrhosis the only option is a liver transplant.
Many heavy drinkers will progress from fatty liver to alcoholic hepatitis and finally to alcoholic cirrhosis, though the progression may vary from patient to patient. The risk of developing cirrhosis is particularly high for people who drink heavily and have another chronic liver disease such as viral hepatitis C.
HISTORY OF PRESENT ILLNESS
One month prior to admission, the patient experience gradual abdominal distention with tolerable abdominal pain. Three weeks after prior to admission, he noted an increase of abdominal distention associated with grade IV bipedal edema, positive for anorexia, has a good bowel output, with mild weight loss for two to three times per day, negative distention associated with grade IV bipedal edema negative for dyspnea, positive sleep disturbances.
One week prior to admission, increased abdominal distention associated with grade IV bipedal edema, negative dyspnea, and positive sleep disturbances.
Four days prior to admission, increased abdominal with unbearable abdominal discomfort, sought consult with “herbal doctor” prescribe with lots of herbal medicines which worsened the condition. The patient is coherent, weak, afebrile, and not in pain.
Few hours prior to admission patient was unable to void thus sought consultation at a District Hospital where Foley Bag Catheter was inserted.
PAST HEALTH HISTORY
Patient was known to be alcoholic drinker since 20 years old. He drinks mixed hard and alcohol beverages liked Kulafu, tuba, tanduay 65 two to three times a day. He also smoke “lumboy” estimated 20 to 25 stick per day. He claimed to have no allergies in medication, no previous hospitalization and negative exposure to blood products. The spouse of the client was a strong believer of “herbal medicines”, sought consulted a “herbal doctor” “albularyo” in their near town.
According to the patient every time he feels a certain condition he manages to consult a doctor and was prescribed with medications but then the result was unnoticeable by the client so they rather consult a “albularyo” and yet he claimed he was relieved.
- Vital Signs monitored every 2 hours.
- Intake and Output monitored every hour.
- Monitored and documented Nasogastric tubing output every hour .
- Medication given as prescribed by the physician.
- Facilitate completion of NPO diet required.
- NGT patency checking prior to medication done
- Assessment for any alterations in body comfort and report immediately to the physician.
- NGT feeding done and medication.
- Assessment for any profuse gum bleeding and note for the colour discharge, include odor.
- Education for the significance of medication given
- Encouraging the client to do exercise at a minimal level to promote circulation.
- Lifestyle modification: weight reduction (body mass index [BMI] goal <25), reduction of dietary sodium to less than 2.4 g/day, DASH diet (i.e., diet high in fruits and vegetables, reduced saturated and total fat), aerobic physical activity >30 minutes most days of the week, tobacco avoidance, increased dietary potassium and calcium, moderation of alcohol consumption.
- Use of self BP monitoring. Home measurement device should be checked regularly for accuracy. Mean self measured BP >135/85 is generally considered to be hypertensive
B. ACTUAL CARE GIVEN
- Assess for any significant findings on the abdominal size -to provide a basis of proper and comfortable positioning
- Assess for any discomfort related to pain at the right side of the body- to provide a basis of proper and comfortable positioning.
- Monitor intake and output closely(hourly)- to monitor any improvement or worsening of patient’s condition
- Regulate IVF to ordered flow rate- to prevent overload and under load of fluid intake.
- Provide side rails. - to promote patient’s safety
- Encourage the client to urinate if feeling of voiding is present.- to alleviate urinary distention
- Educated the client and the SO about the significance of urination.- to provide information about the significance of voiding in relation to its underlying condition
- Bedside care done-to promote comfort and safety of the client’s condition.
- Position the patient in a Fowler’s or Semi Fowler’s position with pillows - Relieves pressure on diaphragm. -Observe for manifestations like crackles or increased respiration.- Identifies fluid in the lungs
- Monitor vital signs every 2 hours- to identify any changes in patient’s health status.
- Encourage the client to inhale and exhale exercise. - To alleviate breathing difficulty.
- Use light, cool clothing which promotes evaporation. Keep clothing and bed dry. - Minimizes irritation and itching
- Keeping the environment cool.- Minimizes itching
- Avoid activities that promote sweating. Minimizes itching
- Keep nails short and smooth.- Prevents breaking skin integrity when scratching
- Reposition patient every 2 hour.- Relieves pressure over bony prominences
- Medications were given as prescribed, lactulose 30 ml, metronidazole 500mg 1 tab TID via NGT. To alleviate client’s condition as prescribed by the physician.- to promote wellness and alleviate the existing problem.
- Instructed the So to maintain Nothing Per Orem Diet (NPO) as recommended given since Gastrointestinal function are impaired due to abdominal distention.- to reduce gastric irritation.
- Administer Oxygen as ordered.- to alleviate breathing difficulty and assist the need of air by the client.
PROBLEMS ENCOUNTERED DURING THE IMPLEMENTATION OF NURSING CARE
There was no huge problem encountered upon assessment and interviewing the client. He welcomes me warmly as her student nurse and actively participates and response to every question asked. But there were times that my client does not want to be interrupted since she was busy with something computing about her business flow while she was in the hospital. The significant others of my client was also responsive and has a sense of humour that made the whole interviewing session a successful one. Generally, I described my client as a participative type of person and cooperative and really understand my responsibilities and part as her student nurse.
RESTORATIVE MEASURES USED
To maintain the therapeutic communication to my client, I address every question ask to the client in a polite manner, and explain every procedure prior to doing it to the client. Through doing these things will reduced the anxiety of my client and irritability during the implementation of care. I also ask the consent of my client every time I want to ask some questions that is about her family data and lifestyle in order to take the approval of my client for my care study.
The Patient tolerated every procedure performed onto her and was cooperative and responsive to every care given. Vital signs of the patient were stabilized upon monitoring it every four hours, and Intake and Output was within the normal range.
M: Encourage the client to urinate if feeling of voiding is present and to take the medication as prescribed. To attain the desired effect of the drug and for the completion of the medication therapy.
E: Encourage patient to have a clean and safe environment for faster recovery.
¨ Clean and safe environment promotes comfort and relaxation for faster recovery of the patient.
¨ Encourage the patient to be calm and maintain a comfort position.
¨ Counsel patient about diet and exercise because losing weight and exercising can decrease the risk of developing hypertension.
¨ Encourage also the patient the importance of blood pressure monitoring.
¨ Educate the patient the importance of proper medication administration and timing.
T: Emphasize to the patient the importance of right timing and right dosing during insulin administration.
¨ To avoid the undesired effect of medications.
H: Encourage the client to inhale and exhale exercise.
¨ To improve air gas exchange in the body.
O: Encourage the patient to visit the physician for condition monitoring.
D: Encourage the patient to have a low cholesterol, low sodium and low carbohydrate diet.
¨ For the blood volume not to increase resulting to hypertension.
S: Encourage the patient to continue praying and seek guidance from God.
¨ Strong faith to God helps the patient spiritually to alleviate the condition with God's will.
CONCLUSION AND RECOMMENDATION
Is always, there are many important things you can do to help minimize the likelihood of potential damage associated with serious complications as a result of decompensated liver disease. Stay informed about your condition and about new and developing therapies. Get support form family, friends, counselors and other patients to maintain the very best quality of life.
Talk with your physician about your particular situation and what to look for. Work closely with your healthcare providers, and do what is necessary to safeguard your health. Once you have cirrhosis, you should contact a liver transplantation program for evaluation and consultation, particularly if you have evidence of decompensation. With both your primary care physician and your liver specialists (hepatologist), you can develop a plan for what can be done to prevent complications or to treat complications if they occur. Both patients and physicians have every reason to believe that the understanding of liver disease and the ability to manage liver disease and its complications will continue to improve. This offers a very real promise that the outcomes also will continue to improve.
IMPLICATION OF THE STUDY
The significance of this study promulgates a comprehensive learning, skills and responsibilities on the said case. It includes a thorough collaborative discussion and interaction between me, as a student nurse and my client at the Medical Ward at VCMC. Different nursing assessment and interventions, both ideal and actual was presented in order to show a comparison and variability of each procedure done. Not only on the nursing part was presented, a comprehensive medical and diagnostic procedures was also compared, both actual and ideal to show the essence of every care given. During the discussion of anatomy and physiology, and its pathophysiology related to the condition, the case will thoroughly deviate from the normal flow of the story and yet further analysis is required since no actual Pathophysiology was thoroughly discussed to explain the theory presented. All the essential data required are presented and tabularized in order to ease up the readers upon reading.
The whole discussion will truly give innovations to the related education and field studies and will somewhat aid the readers to enlighten their minds about Liver Cirrhosis.
As a student nurse exposed in the clinical area, knowing the significance of each nursing practice will promote a great alteration in our future profession. Every case encountered whether complicated or not deals a lot for us because we deal with life here and yet simple problem can lead onto huge complication if no intervention will be done immediately. I really appreciate the significance of this case in relation to my chosen field of studies for it made my mind twist for awhile leaving my head open-ended question of how a simple liver cirrhosis can cause a serious experience if not intervene. But later on, I develop and find the answer to my question upon further studying.
Handling and giving care to a client under this condition truly challenge my knowledge, skills and attitude as a student nurse vital signs, especially the blood pressure was the most significant responsibility to be done. At the clinical area, shift to shift monitoring of intake and output was also done to provide and monitor the metabolism of my client. Regular monitoring of IV fluid was also done to maintain fluid balance and replenish the client’s body in a desired manner and as prescribed. Health teaching and demonstrating the proper breathing exercise, including the rationale of each procedure done was also shared to my client to show competitiveness in my task and chosen course.
The study will provide data that can be potentially used up in during a future research related to alcoholic liver cirrhosis with Urinary Tract Infection. Through the comprehensive discussion and comparison of every actual and ideal care given, it will be helpful in doing client education on patient under the same manner. Although a new innovation of the said topic is presented, I also recommend a further research for a better data and enhancements of the topic. The said topic can also be used as a basis for studies and maybe helpful enough in the upcoming more studies