LIVER CIRRHOSIS

A Case Study Presented by Group 4 (ThFS) of Level III of

College of Nursing and Midwifery

BATAAN PENINSULA STATE UNIVERSITY

Group 4 (ThFS Group)

Bugay, Clarisse

Malimban , Krissle Jade

Margallo, Carole

Miguel, Monaliza

Pareńa, Alyssa Kent

Santos, Ajim Elizar

Santos, Adria Darlene

Sulangi, Alyssa

Tutol, Faye Margarett

Yere, Carizza May

 Table of Contents

I. Introduction
II. Patient’s Profile/Personal Data
III. Personal-Social History
IV. Past Medical History
V. Present Medical History
VI. Family Medical History
VII. Theoretical Framework
VIII. Patterns of Daily Living
IX. Physical Assessment
X. Laboratories/Diagnostic Procedure
XI. Anatomy and Physiology
XII. Pathophysiology
XIII. Nursing Care plan
XIV. Drug Study
 I. Introduction

Cirrhosis is scarring of the liver that involves the formation of fibrous (scar) tissue
associated with the destruction of the normal architecture of the organ. It is the result of long-
standing injury most commonly due to alcohol in excess but there are a number of other
important causes.

The destruction of the normal architecture and the loss of liver cells prevent the
liver from functioning normally. It plays an important part in digestion of food but it also has a
major role in metabolising drugs and making proteins, including those that help the blood to clot.

Cirrhosis is a serious condition. Only 30 per cent of patients with this problem will
survive five years after diagnosis and the outlook is worse if the cause is alcohol and the patient
continues to drink.

The portion of the liver chiefly involved in cirrhosis consists of the portal and the
bile canaliculi of each lobule communicate to form the liver bile ducts. These areas become the
sign of inflammation ,and the bile ducts become occluded with inspissated (thickened bile and
pus).The liver attempts to form new bile channels; hence, there is an overgrowth of tissue made
up of largely of disconnected, newly formed bile ducts and surrounded by bile tissue.

The causes the inflammation that leads to cirrhosis of the liver. First is Alcohol
excess: the rate of cirrhosis in a country is directly related to the average alcohol consumption in
that country. Half of all cases of cirrhosis are due to alcohol excess.

Chronic viral hepatitis: the two important viruses are hepatitis B and hepatitis C.
Cirrhosis due to hepatitis B is common in Africa and Asia. Hepatitis C is increasing in
importance both in Europe and the US. Hepatitis A (infectious hepatitis) does not cause cirrhosis.

Primary biliary cirrhosis: this is an uncommon disease mainly affecting women. It

is not due to alcohol. For some reason the body mounts an attack on the liver in patients with
primary biliary cirrhosis.

Autoimmune chronic active hepatitis: another uncommon condition that results in

the body's immune system attacking and destroying liver cells.

Drugs and chemicals: a number of drugs and chemicals can cause liver damage but
few cause cirrhosis. Certain specialised drugs need monitoring for their effect on the liver.

Metabolic and inherited disorders: These are a number of uncommon conditions that
allow the accumulation of toxins in the liver. The commonest is haemochromatosis, which
causes excess deposits of iron in the liver.

The person who are at risk of Liver Cirrhosis are the more alcohol a person drinks,
the more likely they are to develop cirrhosis. Women seem to be more susceptible than men. It is
therefore advisable to restrict alcohol consumption to 28 units a week for men and 21 units a
week for women (a unit of alcohol is a single measure of spirits, a half pint of ordinary beer or
lager or a standard size glass of wine).Patients who have ongoing infection with hepatitis B or
hepatitis C virus. Patients with primary biliary cirrhosis or autoimmune chronic active hepatitis.
Patients with metabolic or inherited disorders.
 Liver Cirrhosis can be prevented by limiting the intake of alcohol and precautions
should be taken to avoid getting hepatitis and if it is contracted it is important that it is
treated.Avoid contact with toxic chemicals at work.
 II. Patient’s Profile

Name: Mark Menor Manalo

Age: 30

Gender: Male

Room Number: 304

Address: Orion, Bataan

Birth date: May 22, 1980

Civil Status: Single

Occupation: Construction Worker

Religion: Roman Catholic

Admission Date: June 21,2010

Admission Time: 1:35 pm

Attending Physician: Dr. Alfonso

Chief Complaint: Abdominal Pain

Clinical Finding: Massive ascites decompensated liver cirrhosis of Hepa B and Hepa C

infection
 III. Personal / Social History

Mark Menor Manalo, is a 30 year old male, he had worked for more than two
years, working as construction worker.

According to the client, he is single and then raised by her parents.

Mark Menor Manalo claimed that he usually sleeps at 7:00 pm and wakes up at
6:00 in the morning for his work.
 IV. Past Medical History

According to the mother of Mr. Mark Menor Manalo, he has received complete
immunization.She also stated that she had not know any allergies experienced by her son from any
food nor drugs.

The patient stated that he hasn’t experienced any major kind of illnesses aside from
cough and colds that he treated with over the counter medications.Mr. Manalo also stated that he
hasn’t previous hospitalization.
V. Present Medical History

On 21st day of June 2010 at exactly 1:35 pm, a 30 year old male client was admitted
through ER with chief complaint of abdominal pain.

The client has initial vital signs of T= 37°C, PR =93, RR= 22 and BP= 90/60. He has
undergone in ultrasound on June 2010 that lasted 5-10 minutes. The results are: The liver is
written normal size with coarsed and increase in echopattern. The intra and extra hepatic ducts
are not dilated. No fecal mass seen. Spleen is enlarged in size with homogenous echopattern.
Massive petvoabdominal ascitis seen. Gallbladder is undistended and within normal size with
free echo lumen. The wall is not thicken. The common duct is not dilated. Pancreas is obscured
by overlying gas. Right kidney measures 11.2 x 5.4 cm CT 1.9 cm, left kidney measures 10.9
x 6.2 cm CT 1.5 cm. Both kidneys are within normal in size with homogenous echopattern,
configuration, and cortical differentiation. The calyces are not dilated. There are no echogenic
structures nor shadowing seen. He also undergone XRay procedure on June 18, 2010. The
findings are negative for pneumoperitoneum. Distended bowel loops of the mix type. Bulging
of the . Bones intact. Impression: Ileus related on intraperitoneal fluid. Examination such as
HBSAG (screening) which results as reactive, RPR, VDRL, and HIV which is negative. The
pathologist concerned is Gabriel J. Cruz.

After the procedure, the client was transferred to the medical ward by means of wheel
chair accompanied by his mother. His attending Physician, Dr. Alfonso ordered PNSS 1L
KVO, ranitidine 1 am IV q8 PNSS 1L plus 40 mEqs KCL and a DAT diet.

The orders made by Dr. Alfonso were carried out by means of gauge 22 IV cannula
and an IVF of PNSS 1L hooked on client infusing well at right arm regulated 10 gtts. The nurse
provided appropriate health care management for Mr. Mark M. Manalo’s condition.

On June 21,2010 at 6:00 am, we started to handle the client, and observed the following
data: weak and pale in appearance, enlarged abdomen and bipedal edema.
VI. Family Medical History

The client started that in his Father’s side of the family, there were
histories of diabetes, while in his Mother’s side of the family, there’s none. His
Father and Mother are alive.
 VII. Theoretical Framework

Self-Care Deficit Theory of Nursing

By: Dorothea Orem

Self-care is an activity that promotes a person’s well-being. It is performed by persons

who are aware of the time frames on behalf of maintaining life, continuing personal development
and a healthy functional living.

Self-Care Requisites
Self-care requisites are insights of actions or requirements that a person must be able to
meet and perform in order to achieve well-being. These are reasons for any actions of self-care
that must be undertaken. The two elements of self-care requisites are:
a) The factor to be controlled or managed to keep as aspect(s) of human functioning and
development within the norms compatible with life, health, and personal well-being
and,
b) The nature of the required action.

These are universally set goals that must be undertaken in order for an individual to
function In scope of a healthy living. The eight self-care requisites common in men, women, and
children are as follows: Maintenance of a sufficient intake of air, maintenance of a sufficient
intake of food, maintenance of a sufficient intake of water, provision of care associated with
elimination, maintenance of balance between activity and rest, maintenance of balance between
solitude and social interaction, prevention of hazards to human life, human functioning and
human well-being, and promotion of human functioning and development.

In relation to our client’s case, our client needs a lot of care, since we know that the cause
of his disease is the intake of contaminated foods, foods which are not properly prepared and
because of encountering some chemicals in his work. Being a care provider to our client we must
help and teach him in order to achieve well-being. We help our client to establish or identify the
ways to perform self-care activities. He needs to maintain sufficient intake of clean foods, and
sufficient intake of water. He also need to have good elimination and urination. Maintenance of
balance between activities and rest and avoid hazards to human life, human functioning, and
human well-being.
 VIII. Patterns of Daily Living

ADL Before Hospitalization During Hospitalization

NUTRITION
a. Time ( meals)
b. Frequency (feeding)
c. How much food
>According to Mr. Manalo,
he eats 3 meals everyday. He
takes his breakfast between 7-
8 am, lunch at 12 pm, and
dinner at 6 pm.
>During his confinement in
the hospital, he eats 3 meals a
day. The client was under
DAT diet.

ELIMINATION (Bowel)
a. Color
b. Odor
c. Shape
d. Frequency

(Urine)
a. Color
b. Odor
c. Frequency

HYGIENE
a. Skin Care >The client bathes onces a >Client’s mother assists him
b. Eye Care day in taking bathes everyday.
c. Nose Care
d. Oral Care >Brushes his teeth after meals
e. Nail Care

REST AND SLEEP

a. Routine >Mr. MMM usually sleeps >The client sleeps and rests.
around 7 pm and wakes up
early around 6:00 am because
of his works.
>The client often lies on bed,
but is ambulatory with
assistance.
 IX. Physical Assessment

GENERAL SURVEY

Vital Signs:

 Temperature >37 °C >Normal

 Cardiac Rate >92 beats per minute >Normal
 Respiratory Rate >22 breaths per minute >Normal
 Blood Pressure >90/60 mmHg >Abnormal

>With abdominal pain >Due to inflammation of the

left spleen.

>Weak and pale in appearance >Due to ongoing and

progressive presence of
disease.

>With enlarged abdomen >Due to inflammation of the

spleen.

>With bipedal edema >

 BODY PARTS TECHNIQUE FINDINGS INTERPRETATION

Head Inspection >symmetrical >Normal

(face and neck) >smooth

Scalp Inspection >round >Normal

>symmetrical

Skin Inspection >pale >Abnormal

>without lesions >Normal
>without pain and
sensitivity

Eyes Inspection >symmetrical >normal

Sclera Inspection >white in color >normal

Pupils Inspection >round and equal >normal

Eyebrows Inspection >equally distributed >normal

Eyelashes Inspection >evenly distributed >normal

and turned outward

Eyelids Inspection >eyelids cover the >normal

sclera and iris when
closed

Ears Inspection >symmetrical >normal

without deformitic

Nose Inspection >symmetrical >normal

Palpation without nasal flaring
>no tenderness or >normal
masses

Mouth Inspection >moisted oral >normal

mucosa

Lips Inspection >pale in color >abnormal

>symmetrical >normal
>dry >abnormal

Gums Inspection >pale >abnormal

>without swelling >normal
nor abnormal
discharge

Teeth Inspection >light yellow in color >normal

 >without dental >normal
carries
Tongue Inspection >moist >normal
>positioned medially >normal
>pale >abnormal

Abdomen Inspection >enlarged abdomen >abnormal

>collateral veins >abnormal
visible on abdominal
wall >abnormal
>pale in color >abnormal
>pain sensation
 XI. Anatomy and Physiology

The liver is a large, meaty organ that sits on the right side of the belly. Weighing
about 3 pounds, the liver is reddish-brown in color and feels rubbery to the touch. Normally you
can't feel the liver, because it's protected by the rib cage.

The liver has two large sections, called the right and the left lobes. The gallbladder
sits under the liver, along with parts of the pancreas and intestines. The liver and these organs
work together to digest, absorb, and process food.

The liver's main job is to filter the blood coming from the digestive tract, before
passing it to the rest of the body. The liver also detoxifies chemicals and metabolizes drugs. As it
does so, the liver secretes bile that ends up back in the intestines. The liver also makes proteins
important for blood clotting and other functions.
 XII. Pathophysiology

NON- MODIFIABLE MODIFIABLE

Age Occupation

Gender Lifestyle

Nutrition

Infection of the liver

Inflammation of the liver

Injury of the liver cells

Necrosis of the liver

Scarring of liver tissue

Regeneration of liver cells

Proliferation of inflammatory cells

Abdominal Ascites
pain
Edema Weight Loss
Weakness

Hypotension
Spleenomegaly
Firm, Enlarged Liver