Download - Case Study on Cirrhosis of Liver
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BIODATA OF PATIENT
Name of Patient - Mr. Rameshwar S/o. Mr. Nathu Lal
Age/ Sex - 29 Yrs/M
Education - 8th
Occupation - Auto Riksha Driver
Income - 5000/- month
Marital Status - Married
Religious - Hindu
Address - Subhash Nagar, Indore
Date of Admission - 11th Feb. 2009
Diagnosis - Cirrhosis of Liver
Consultant - Dr. R.K. Jha
Ward - Medicine ICU
Present Complaints :
Patient having complaint of Pain in abdomen, Discomfort, Anorexia, Fatigue,
Nausea, Vomiting.
History of Present Illness :
Patient admitted in SAIMS hospital with complain of pain in abdomen &
vomiting.
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Past Medical History:
He was previously admitted in government hospital before 3 months with
same problem.
Past Surgical History:
Patients have no any past surgical history.
Socio Economic History:
Mr. Rameshwar lives in his own concrete house. There was adequateelectricity & water supply is present. He has 3 rooms in his house they are
proper ventilated.
His income is 5000/- month. His relation with other member of family & with
other relatives is good & healthy.
Family History:S. No. Name of Family
Member
Age/ Sex Relation with
Patient
Health Status
1 Mrs. Ganga Bai 52 yr./F Mother Normal
2 Mrs. Durga Devi 27 yr./F Wife Normal
3 Mr. Gangaram 23 yr./M Brother Normal
4 Sona 6 yr./M Son Normal
5 Gaytri 3 yr./F Daughter Normal
Functional Health Pattern -
Hygiene : He is doing brush in morning. He takes bath daily in morning.
He changed clothing per days. He is going for hair cutting 2 times in a month.
He is washing hands after toileting.
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Dietetic History : He is non-vegetarian. He takes meal 2 times in a day.
He eats non-veg once in a month. He likes to eat chapatti, green vegetables,
milk & egg. Some time he consumes fruits. He doesnt take any fast.
Activity and Exercise : His activity is normal in daily life. He was not
doing any exercise in his daily life.
Sleep and Rest : He was sleeping at 6-7 hrs. in night & he take rest 1-2
hrs. in day time after taking meal.
Elimination Pattern : He goes for defecation for once or twice a day
and 5-6 for urination. He has no complaint of constipation.
Values & believes : He belongs to Hindu religion. He believes on god.
He participates in every holly festivals. He doesn't take any fast.
PHYSICAL EXAMINATION -
Height - 5 ft 7"
Weight - 60 kg.
Temperature - 98.8*F
Pulse - 72 / min.Respiration - 22/ min.
Blood Pressure - 130/70 mm Hg
Head:
Hair - Black in Color
Scalp - No itching, no dandruff, no scar marks
Face - Slight pigmentation
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Sinus - Normal
Cranium - symmetrical
Eyes :Visual activity - Normal
Ocular movement - Normal
Lids - Clear
Lacrimal gland - Proper functioning
Conjunctiva - Pale
Sclera - White
Ears:
External Structure - Normal
Mucus membrane - No discharge
Tympanic membrane - Normal
Hearing - Normal
Nose:
Eternal Structure - Short & round
Septum - symmetrical
Mucous Membrane - pink colour
Olfactory sense - Normal
Oral Cavity:
Lips - pink colour
Gums - no swelling
Oral cavity - clean, pink colour
Teeth - Symmetrical & white
Tongue - pink in colour, center line is present.
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Taste - normal
Voice - soft
Neck:General Structure - Normal
Trachea - centered
Thyroid - Normal
Node - no enlargement
Muscle - Flexible
Chest and respiratory systems
Chest Shape - symmetrical
Type of respiration - normal
General palpation - normal
Percussion - normal
Breathe sound - slow
Abdomen
Scar marks - absent
Hernias - absent
Masses - absent
Liver - tender ness is presentSpleen - normal
Kidney - normal
Bladder - normal
Palpation - not normal
Back
Scar mark - absent
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Deformities - absent
Infection - absent
Upper & Lower extremities-Movement - Range of motion (ROM) is normal in
upper & lower extremities.
Scare marks - Not present in both extremities.
Deformities - Not present in both extremities.
Genitalia & rectal examination No pus inflammation.
No scars present.
Any infection is not present.
DESCRIPTION OF DISEASE
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Introduction:
Cirrhosis of liver is mainly characterized by the scarring. It is a chronic
disease in which irreversible destruction & fibrotic regeneration of the liver
cells occur. Cirrhosis of the liver is 12th leading cause of death all over the
world. In adult age, after 25 years, however it is 8th leading cause of death.
Cirrhosis of liver also may result from chronic hepatitis, prolonged obstruction
of the bilory duct, long term sever health problems.
Definitions:
Cirrhosis of liver is progressive disease of the liver characterized by the
extensive degeneration & degeneration & destruction of liver parenchyma
cells.
Or
Cirrhosis of liver is end stage of liver disease. It is progressive, irreversible
disorder leads to liver failure.
Anatomy & Physiology
The liver is the largest gland in the body. It weight about 100 gm in an
average adult. The liver is located behind the ribs in upper right portion of the
abdominal cavity. The liver is almost covered by visceral layer.
Liver is divided into four lobes. The lobe of liver are made up of many
functional units called 'lobules', A lobule is six cone structure which is made
up of epithelial tissue. Lobules are formed by cuboidal shaped cells called
'hepatocytes'.
Blood Supply
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The blood supply to the liver is mainly from two source approx 75% blood
come to liver from the portal vein. Rest blood supply is by the abdominal
artery which supply.
G.I. tract. Venous return is alone by the hepatic portal vein.
Function of the liver
There are 3 major function of liver they are given below:
1. Storage - The substance include :
Glycogen
Fat soluble vitamin
Essential fatty acid
Glycerol
Some water soluble vitamin eg - vitamin B 12
Iron & copper
2. Secretion -
The hepatocytes synthesis is the constituent of the bile from the mixed
& venous blood of the liver. It includes bile salt, pigment & cholesterol.
3. Protein metabolism-
Liver plays a vital role in the metabolism of protein. It degenerate the
protein molecule in to the simple form amino acid & excrete the end
product of protein metabolism (N2 waste) through the kidney.
4. Other -
It also helps in
Breakdown of fatty acid
Heat production
Detoxification of the drug
Carbohydrate metabolism
Etiology in General:
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Alcoholism
Smoking
Lacnneis (macronodular) also called alcoholic cirrhosis.
Fibrosis -mainly around central veins & portal area.
Post necrotic cirrhosis - because of previous acute viral hepatitis.
Malnutrition
Billary cirrhosis
Billary duct obstruction.
In patient:
In my patient etiological factory may be:
Alcoholism - Mr. Rameshwar is alcohol user. He used to drink wine
from last 5 yr. because of using alcohol, metabolic changes
occur in liver which has affected the liver cells.
Smoking - It may be another factor of liver cirrhosis in my patient.Malnutrition- Mr. Rameshswar have poor economic condition so the
malnutrition may be cause to liver cirrhosis.
Pathophysiology:
Alcoholic cirrhosis is characterized by episode of necrosis involving the liner
cells. Some time occurring rapidly through out the cells & decreased thefunction of liver cells.
Hyper activity to portal vein develops some cirrhosis. IT received blood from
spleen & this is an increase in pressure resistance & enlargement of
esophageal umbilical & superior rectal veins which may result in bleeding
from various organs.
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Continuation of the process as a result of unknown causes or alcohol,
smoking, substance abuse usually result in death of hepatic cells which result
in destruction & degeneration of liver parenchymal cells.
Clinical Manifestation in General
Anorexia
Dyspepsia
Nausea
Vomiting
Change in bowl habit (constipation)
Dull abdominal pain
Gastritis
Haematomasis
Peripheral oedema
Ascities Jaundice
Anemia
Hepatic encephalopathy
Peripheral neuropahty
In patient Abdominal pain
Change in bowel habit
Anxiety
Depression
Restlessness
Cynosis
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Anorexia
Fatigue
Nausea
Vomiting
Diagnostic Evaluation In General
History :
Nurse should take history for collection of data to confirm the diagnosis.
Physical Examination:
In physical examination nurse should observe the condition of patient, check
the abdomen through inspection, palpation, auscultation & identify the
severity of infection.
Liver biopsy
Liver Function test
a) Pigment studies
- Serum bilurubine
- Urine bilinogen
b) Protein studies
- Total serum protein
- Serum albumine
- Serum globuline
c) Serum alkaline phosphate
- SGOT
- SGPT
USG whole abdomen
X-Ray
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CT-Scan & MRI
Blood Culture
In General
History taking
Physical examination
S. No. Investigation Unit Remark
1 Hb 12.3 gm/100 13-17 gm/100
2 Total R.B.C. 3.92 mill/cum 4.5-6.5 mill/cum
3 Packed cell volume 33.5 40-704 Nuetrophils 71
5 Lymphocytes 25% 40-70%
6 Monocytes 02% 20-45%
7 Eiosinophils 02% 2-10%
8 Platelet Count 0.174 lacks 1.5-4 lacks
Management in General
a) Medical Management :
Rest is significant to reduce the metabolic demand of liver.
Avoiding of alcohol
Diuretic therapy to control oedema.
High carbohydrate, protein, amoino acid rich diet & low fat, low
sodium diet.
Treatment with fluid & electrolyte balance.
Antibiotic
Medical Management In Patient
S.
N.
Name of
Drug
Dose Route Time Action Side effect Nursing
responsibility
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1 Inj. Aciloc 50
mg.
I/V T.D.S. Antacid,
Inhibit
histamine
receptor,
which
inhibit
gastric acid
secretion.
Dizziness
Confusion
Constipation
Diarrhea
Rashes
Check the
doctors order
before
administratio
n
Assess
therapeutic
response.
2 Inj.
Ampicilline
1gm I/V T.D.S. Antibiotic Skin rashes
GI alteration
Nausea
Check the
doctors order
before
administratio
n
Administered
slowly.
3 Syp.
Dulphalac
30
ml
Oral T.D.S. It relive
constipatio
n
CrampsNausea
Check thedoctors order
Explain to
patient about
medication.
4 Tab. Ciplox 10
mg
Oral B.D. Antibiotic Nausea
GI upset Headache
Restlessness
Constipation
Check the
doctors order
Explain to
patient about
medication
c) Surgical Management :
Labectomy : Removal of the affected lobe of the liver is common
procedure.
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Liver transplantation : it is done to relive the life threatening
conditions & end stage of liver disease for which there is not
other treatment is available. The success of liver transplantation
is depending upon the immuno suppression.
Surgical Management :
In this case no surgical management is applied.
Nursing Management AssessmentI assess the patient according there priority needs. The priority needs of my
patient are given below & I assess my patient for.
1. Assess for pain, pain duration, intensity & level of pain.
2. Assess for self care deficit.
3. Assess for complication.
4. Assess for risk of infection.5. Assess for anxiety.
6. Assess for nutritional level.
7. Assess for hygiene
8. Assess for knowledge deficiency.
Nursing Diagnosis
Abdomen pain R/T tissue damage
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Expected Outcome
Patient will have no complaint of abdomen pain.
Intervention Rational
Assess general condition of
patient.
Assess type, severity &
location of pain.
Give comfortable position to
the patient.
Give diversion therapy to
patient.
Keep calm & quite
environment.
To give analgesic as per doctor
order.
To know about the causes of
pain.
To know about the pain.
To give comfort to patient.
To divert the mind.
To provide comfort
To reduce pain.
Evaluation
Pain is reduced and patient feels comfort.
Nursing Diagnosis
Impaired nutrition less than body requirement related to anorexia, vomiting.
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Expected Outcome
Patient will have improved in his nutritional status. He will have adequate
body weight.
Intervention Rational
Check the patient body weight.
Determine dietary intake of
patient.
Encourage to patient for take
proper nutritional diet.
Ask to patient about his like &
dislike related to food.
Give the knowledge about
nutritional diet.
Recommended small, frequent
small to patient.
Restrict intake of caffeine, gas-
producing & spicy food.
To identify variation in patient
body weight.
To get information to input.
To maintain nutritional level.
To make a interesting menu
plan for patient.
To encourage patient for taking
nutritional diet.
To prevent intra-abdominal
pressure.
To reducing Gastric irritation
& abdominal discomfort.
Evaluation
Patient have improved in nutritional status.
Nursing Diagnosis
Risk for injury (hemorrhage) R/T portal hypertension
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Expected Outcome
Patient will have prevent chance of risk for injury.
Intervention Rational
Assess for sign & symptom of
GI bleeding.
Check the conscious level of
patient.
Use small needle for injection,
apply pressure on venipuncture
site.
Avoid to aspirin-containing
products.
Give the medication as by
doctors order.
To know the sign of internal
injury.
To know the cerebral perfusion
to hypovolemia, hypoxemia.
To minimize damage to
tissues, reducing risk of
bleeding.
To prevent risk of hemorrhage.
To prevent hemorrhage.
Evaluation
Now patient is well he have not chance of risk for injury.
Nursing Diagnosis
Knowledge deficiency R/T disease process.
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Expected Outcome
Patient will have adequate knowledge about disease condition.
Intervention Rational
Assess the learning capacity of
the patient.
Encourage to patient for more
verbalize.
Listen patient's talk.
Give knowledge about the
disease including relatives.
Give health education to
patient & his family regarding
diseases processes.
To make effective teaching
program.
To know the standard of
knowledge about disease
condition.
To know the doubt of patient.
It increases knowledge and
remove all doubts.
To give adequate knowledge to
patient & his family.
Evaluation
Patient has adequate knowledge about disease processed.
HEALTH EDUCATION :
I give the health education to my patient & his family. I include several points
in health education, they are given below :
1. I instructed to patient for follow up the medication which is prescribedby doctor.
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2. I instructed to patient for taking high caloric diet which is rich in
protein & vitamin diet for the early recovery.
3. I told to patient for avoid spicy food & fatty diet
4. I advised for proper rest & sleep to patient.
5. I advised to stop heavy work.
6. I instructed to patient to avoid bad habit.
7. I told to patient for maintain proper hygiene.
8. I instructed to patient & his family members if they have seen any
complication then immediate contact with doctor.
9. I gave the health education to patient & his relatives. I explain the all
aspect of disease to patient & his family members.
STUDENT EVALUATION :
After going through the case as well as care of the patient, I came to know
many things regarding cirrhosis of liver like risk factor, clinical manifestation,
basic treatment & care of the patient with cirrhosis of liver.
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Now I can care for a patient with cirrhosis of liver, with my own individual
decision & can follow the doctor's order.
BIBILIOGRAPHY:
Bruner & suddharth's "text book of medical surgical nursing" 10th
edition, 2006, page no. 1387- 1390.
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Mosby's, "text book for medical-surgical nursing" 7th edition, 2003,
page no. 809-812.
Joyce & black, medical surgical nursing, 8th edition, page no. 1347-1350.
Lippincot, medical surgical nursing, 8th edition 2006, page no.1276-
1280.