Pullen 1

RUNNING HEAD: Cirrhosis of the Liver

Cirrhosis of the Liver; an indepth look at a patient with PBC

Joann Pullen

(Teachers name)

(class number ex NUR 102 LPN program ECPI)

Social and Medical History
1) Health Data Base a. Age: 63 Sex: Male Race: Caucasian b. Marital status: Divorced Children/Family living at home: Daughter and her spouse, 1 grandchild Occupation: Retired construction worker c. Education level: High school diploma Ability to read/write: Yes d. Religion: No religious affiliation Native Language: English Fluency in English: Fluent
e. Cultural influences related to health care: none
2) Medical History
a. Admission diagnosis: Esophageal bleeding
b. Secondary diagnosis: Cirrhosis of the Liver (PBC) Primary Biliary Cirrhosis
c. PPD(date/result): 9/17/2010, results are negative
d. Allergies: No known allergies
e. Advanced Directives: DNR
3) Past Health status:
a. Childhood illnesses: chicken poxs, frequent tonsilitis
b. Hospitalizations/Surgeries: tonsilectomy
4) Health Promotion Efforts a. Immunizations: Pneumonia and flu shot last year, tetanus 6 years ago, Measles mumps rubella (MMR) as a child
b. Smoking (pack/day, #years): 1pack/day for 45years Alcohol(type/frequency): 1-3beers a day until his divorce then binge drinking behavior of beer and whiskey for the past 15years, alcoholic
c. Recreational Drugs: None OTC medications/herbs: asprin
d. Exercise (type/frequency/length): walks for a few minutes around his house, very seldom
Assessment
T 102.0 P 116 R 24 B/P 80/60 Pulse OX 90%
Comfort- Pain: 7 on a 1-10scale N/V: Nauseated, upset stomach
Alert/Oriented/Speech: alert but fatigues easily, confusion and agitation present, speech is fine
Chest- Heart sounds: S1S2 noted Lung sounds: wheezes heard bilateral
Abdomen- Bowel sounds: heard in all four quadrants Abdominal distention: tenderness, abnormal enlargement found in the upper left quadrant
Limbs: jerking of the hands and wrists, edema found in the lower extremities

Pathology Report: Cirrhosis is a chronic disease where normal configuration of the liver is changed resulting in cell death. As new cells form to replace the dead cells, scarring or scar tissue is created causing disruption of the blood and lymph flow which leads to total liver dysfunction. Alcoholic Cirrhosis is caused by the long term abuse of alcohol which leads to irreversible liver damage and accounts for 50% of all cirrhosis cases. Although it is rare, alcoholic cirrhosis can appear in combination with other types/causes of cirrhosis. The cause of Biliary Cirrhosis is associated with the chronic retention of bile and the inflammation of bile ducts. PBC or Primary Biliary Cirrhosis is an inflammatory disease of the intrahepatic bile ducts. Other findings that can appear with PBC are streatorrhea, xanthomatous (yellow tumors) neuropathy, osteoporosis, and portal hypertension. 85% of patients with PBC also commonly have hypercholesterolemia, hyperlipidemia, and hepatomegaly. Up to 40% of patients with cirrhosis have no symptoms; those that do exhibit weakness, fatigue, weight loss, fever, anorexia, nausea, vomiting, abdominal pain, diarrhea, menstural abnormalities, sterility, impotence, loss of libido, hematemesis, dark urine due to the presence of urobilinogen, and stools that are pale or clay like in color due to the lack of bilirubin.

Lab Values (Diagnostic Tests)
Hematologic: RBCs decrease with bleeding, WBCs decrease with hyperslenism but increase with infection, Platelet counts are less than normal (normal values RBC 4.7-6.1X10/L, WBC4.8-10.8X10/L)
Serum Biochemical Tests: Bilirubin levels: elevated due to failure in hepatocyte metabolism and obstruction(normal value0.4-2.0mg/dl) Alkaline Phosphate levels: in PBC elevated 2-3times the normal(normal 38-126IU/L)