CASE STUDY 3

CASE STUDY 3

Please read the case scenario and answers the question (the point value for each individual question is indicated). The assignment is worth 8 points. Be very thorough in your responses. Cite and reference per APA (this is a requirement). Submit by Thursday March 12, 2015. Be sure to add your text in as your reference!!!

Gastrointestinal Disorders
Case Study
Mr. Escobar is a 47-year-old male with a history of cirrhosis. He lives with his wife and teenage sons. His wife brought him to the emergency department today because she noticed that Mr. Escobar had increasing confusion and lethargy and was having difficulty walking. His wife states, “He is probably acting a little funny because he is sleep deprived. He hasn’t slept very much in the past few days.”
On admission to the ED, Mr. Escobar is afebrile. His BP is 136/68, pulse 88, and respiratory rate is 18. His oxygen saturation is 98% on room air. He is awake, alert, and oriented to person only. His speech is slow and he appears tired. The nurse notices a foul odor to his breath. Upon physical examination, Mr. Escobar has a slightly distended abdomen. The physician does not note any asterixis. An ultrasound of the abdomen is ordered, and it reveals fatty infiltration of the liver, an enlarged spleen, a polyp in his gallbladder, and a moderate amount of ascites. A CBC, comprehensive metabolic panel (CMP), liver function tests (LFTs), prothrombin time, an ammonia level, and a urinalysis are ordered for Mr. Escobar.
Results of a CBC indicate: WBC 4.8 cells/mm3, RBC 2.94 million/mm3, Hgb 9.8 g/dL, Hct 28.2%, and platelet count 89,000.
Results of a comprehensive metabolic panel (CMP) are: Sodium 145 mEq/L, potassium 3.6 mEq/L, chloride 112 mEq/L, and carbon dioxide 25 mEq/L. Mr. Escobar’s glucose is 185. His BUN is 42 mg/dL and creatinine is 1.6 mg/dL.
Liver function test (LFTs) reveal total protein 5.7 g/dL, albumin 3.1 g/dL, total bilirubin 1.8 mg/dL, aspartate aminotransferase (AST) 17 U/L, alanine aminotransferase (ALT) 14 U/L and lactate dehydrogenase (LDH, LD) of 266 U/L.
His prothrombin time is 13.1 seconds. His ammonia level is 124 ?mol/L. Urinalysis results are within normal limits.
The physician schedules Mr. Escobar for a gastroscopy to rule out any gastrointestinal (GI) bleeding. The gastroscopy indicates Mr. Escobar has esophageal varices. IV fluids of D 5 ½ NS are started at 100 ml/hour.
Mr. Escobar is admitted for hepatic encephalopathy, ascites, and esophageal varices. On admission, Mr. Escobar has been ordered daily weights, strict I & O, monitoring the stools for occult blood, neurological assessment every 4 hours, and a low-protein, low-sodium diet.
Mr. Escobar is prescribed lactulose 30 ml every 6 hours and neomycin sulfate 500 mg qid.

1. Discuss the pathophysiology of cirrhosis. How is hepatic encephalopathy related to cirrhosis?

2. Identify 3 priority nursing diagnoses for Mr. Escobar.

3. Identify which of Mr. Escobar’s laboratory results are abnormal and provide a rationale for why the result is abnormal.

4. Why has Mr. Escobar been prescribed lactulose and neomycin? What are the potential adverse effects of each of these medications?

5. Discuss esophageal varices. What are the treatment options for esophageal varices?

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