case study on cirrhosis of liver

7/28/2019 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.


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.


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.


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.

case study on cirrhosis of liver

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