Case Study

Patient Profile
Mr John, aged 55 years, admitted with a diagnosis of cirrhosis of the liver.
He has been vomiting for 2 days and noticed blood in the toilet when he
vomits.

Subjective data:
Has had cirrhosis for 12 years.
Acknowledges that he had been drinking heavily for 2oyears but has been sober
for the past 2 years.
Complains of anorexia, nausea and abdominal discomfort.

Objective data:
• Physical examination
o Thin and malnourished
o Has moderate ascites
o Has jaundice of sclera and skin
o Has 4+ pitting edema of the lower extremities
o Liver and spleen are palpable.

• Laboratory Values
o Total Bilirubin:15mg/dL
o Serum ammonia: 220 mcg/Dl
o AST: 190 U/L
o ALT: 210 U/L

Discussion Questions
1. What are the possible cause of cirrhosis? What type of cirrhosis does MR
John have?

2. Describe the pathophysiologic changes that occur in the liver as cirrhosis

develops.
3. List Mr John’s clinical manifestations of liver failure. Fro each clinical
manifestation, explain the pathophysiologic basis.

4. Explain the significance of the results of the laboratory results.

5. If Mr John starts to manifest signs and symptoms of hepatic

encephalopathy, what will you monitor? What measures should be
instituted to control or decrease the encephalopathy?

6. What are the possible causes of his gastrointestinal bleeding?

7. Priority decision: Based on the assessment data, what are the priority
nursing diagnosis? Are there any collaborative problems?

8. Priority decision: what are the priority nursing interventions for the
patient at this stage of illness?