Liver Disease 1

ALCOHOL-RELATED LIVER DISEASE

Student’s Name

Course Name

Professor’s Name

Institutional Affiliation

City

Date
 Liver Disease 2

ALCOHOL-RELATED LIVER DISEASE

Abuse of alcohol has led to a number of difficulties during the past couple of years,

including stroke, heart illnesses, digestive disorders, and cancers of the mouth, throat, and

esophagus; nevertheless, liver diseases are the most serious of all of these complications. This

essay will discuss the liver damage caused by alcohol in one of the patients, Miss Karen Green,

who is a fictional case. The school of health and life sciences policy on confidentiality and

consent will be followed carefully throughout this project (Reference). A medical expert inquired

about the patient's permission to proceed. Miss Karen Green, age 50, is admitted to the ward with

a suspected alcohol-related liver injury. She lives alone in a rented terraced house in a socially

impoverished area in the town center of a town in the Northeastern region of England. She

consumes two bottles of wine daily, which is consistent with her history of alcoholism. Also, she

is a smoker who consumes 15 cigarettes every day. She is no longer married and cannot find

work because she was fired from her job as a bakery assistant six months ago for being

intoxicated while on the job. In addition to having an allergy to penicillin, her body mass index is

15, which indicates that she is undernourished. Her son, who is 38 years old and lives far from

work, is estranged from her. Although she has two young grandkids, she only gets to spend time

with them during the holidays. She likes hanging out with her buddies at the neighborhood bar

and watching T.V. while playing bingo or darts.

Local, National, and Global Factors that Contribute to Miss Karen’s Alcoholic Liver Disease

It is particularly alarming how common liver disease brought on by alcohol is in the

North East of England. According to the 2017 Annual Population Survey, more than one in five

adults and more than one in three individuals in the North East of England consume alcohol at

risky levels (Office of National Statistics, 2017). Regionally, the North East of England
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continues to have the highest rates of hospital admissions for liver illness, with 166.8 per

100,000 inhabitants during the fiscal year ending in 2021, according to GOV. U.K. (2022). It

further claims that, in the fiscal year ending in 2021 (the first full year of the COVID-19

pandemic), hospital admission rates with liver disease as the primary diagnosis dropped sharply

from 143.6 per 100,000 people in the fiscal year ending in 2020 to 124.3 per 100,000 people

(GOV.UK, 2022). The rate of hospital admissions for alcoholic liver disease grew dramatically

from the fiscal year ending in 2020 to the fiscal year ending in 2021, reaching its highest level

since the fiscal year ending 2011 (45.5 per 100,000 people, or 24,544 admissions). There was a

factor of 14.6 separating the counties and unitary authorities (U.A.) with the highest and lowest

admission rates for alcoholic liver disease (143.5 per 100,000 people in Hartlepool and 9.8 per

100,000 people in Reading in the fiscal year ending in 2021). (GOV.UK, 2022). For every

100,000 persons in England in 2020, chronic liver disease (including cirrhosis) claimed the lives

of 17.61 males and 9.75 women, according to Stewart's report from the year 2202. The highest

mortality rate from liver illness was found in the North East of England, where there were 26.55

deaths per 100,000 males and 17.01 deaths per 100,000 women. Men account for 7.7% of all

alcohol-related deaths worldwide, according to the WHO (2022), whereas women account for

2.6% of all fatalities. In 2016, the average amount of pure alcohol drunk by men and women

worldwide was 19.4 liters for men and 7.0 liters for women. Each year, 3 million deaths

worldwide are caused by the harmful use of alcohol. This represents 5.3% of all fatalities.

The socioeconomic disadvantage of Miss Karen Green's neighborhood is a local element

that affects her health and disease. In a northeastern English town center's socially disadvantaged

region, Miss Green rents a terraced house. These areas frequently have greater unemployment,

poverty, and crime rates, which can reduce access to healthcare, impair health literacy and
 Liver Disease 4

knowledge, and foster an overall sense of hopelessness. According to the Office for National

Statistics, unemployment was a significant problem in the North East in 2013, as many kids

grow up in homes where neither parent works (2013). In 2010, Easington had the greatest

percentage of houses without working adults in the country (40.3%), followed by Sedgefield

(34%) (Office for National Statistics, 2013). Such issues directly affect one's physical and mental

well-being and raise the likelihood of drug dependence, particularly alcohol consumption. Ms.

Green's past history of alcoholism is probably a result of her surroundings, which offer her few

opportunities to enhance her standard of living. Low-income areas frequently lack options for

stress management, such as leisure time and social networks. Ms. Green may have used alcohol

as a coping mechanism due to her limited financial resources and access to healthcare. The main

cause of Miss Green's health issues and disease is her alcohol dependence. Misuse of alcohol can

have a seriously detrimental effect on a person's physical and mental health. Alcohol abuse can

result in illnesses such as liver and kidney damage, Hypertension, stroke, depression, anxiety,

and alcohol poisoning. Also, her community may lack access to educational opportunities like

health-related lectures and seminars, which might have helped her avoid becoming an alcoholic

in the first place.

Several elements at the federal level affect Miss Green's health and disease. Alcohol

consumption has long been a problem in the U.K.; alcohol-related health issues are becoming

more prevalent. This is particularly true in less affluent places where alcohol is more readily

available and reasonably priced. Collis, Grayson, and Johal (2020) report that the number of

fatalities per 100,000 persons peaked in 2008 at 11.3 and in 2012 at 10.0. The mortality rate

associated with alcohol use in England was steady between 2006 and 2019. However, in 2020,

alcohol-related deaths rose to 13.0 per 100,000 persons, a 19% increase from the year before and
 Liver Disease 5

the highest rate ever noted since the data was made accessible. This increase in alcohol-related

mortality was seen in both the most and least advantaged deciles of the population and across

genders, though varying degrees. The lack of knowledge and awareness about the harmful

effects of alcohol may also influenced Miss Green's condition. However, the number of people

living in poverty in the U.K. has increased recently, with an estimated 14 million people doing so

(Collis, Grayson, and Johal, 2020). Increased health difficulties, such as mental health

conditions, substance misuse, and declining access to medical care, have been connected to this

rise in poverty. This poverty, which is probably felt in Miss Green's area, may have contributed

to her alcoholism.

There are a great number of things at play on a worldwide scale that contributes in some

way to Miss Green's health or disease. The unequal distribution of wealth and resources is one of

the most important and major aspects contributing to the problem. This inequality has been

related to increased poverty, which can lead to increased health difficulties such as substance

misuse and mental health problems (Rehm and Shield, 2019). In addition, the state of the global

economy has been connected to rising stress levels, which might result in an elevated probability

of engaging in substance misuse. In addition, the proliferation of false information regarding the

dangers posed by alcohol to one's health can play a role in developing an increased need for

alcohol. Misinformation can lead to underestimating the health dangers connected with alcohol,

which can raise the likelihood of developing an alcohol issue. This is because misinformation

can lead to an increased risk of developing an alcohol problem.

Impact of the Illness

The effects of Karen's alcohol-related liver impairment on her biopsychosocial well-being

are extensive. The biopsychosocial model, created by George Engel in 1977, is a method for
 Liver Disease 6

comprehending health and illness that considers a person's social environment and the biological

and psychological aspects of their health and illness. This model highlights the significance of

considering the entire individual when assessing health and illness instead of just a single

symptom or diagnosis (George and Engel, 1980). Alcohol-related liver impairment can have a

substantial psychological and social impact on a person, according to Rodrigues et al. (2021). It

may result in despair, social isolation, and a decline in everyday functional activities. Due to

their illness, the person might be unable to work or struggle to get a job. The effects of Karen's

alcohol-related liver impairment on her biopsychosocial well-being are extensive. In the case of

Miss Karen Green, this biopsychosocial model would consider both her psychological and

emotional condition, such as agitation and anguish, as well as her physical symptoms related to

her alcohol dependence, such as weariness, weight loss, and stomach problems. It would also

consider the social and environmental aspects of her disease, such as the fact that she lives in a

low-income neighborhood and has a history of alcoholism. Because Miss Green occasionally lost

her job due to intoxication, her alcoholism impacted her ability to do her job. She also likes to

watch T.V. and play darts and bingo with pals at the neighborhood bar, both of which she can no

longer do due to her illness. The Dahlgren-Whitehead rainbow, a paradigm for discovering

health disparities, is said to map out the relationship between an individual, their environment,

and their health, according to Patient-Safety-Learning (2021). It was developed in 1991 by

Göran Dahlgren and Margaret Whitehead. It puts the individual at the center of a complex web

of variables that can affect their health, including their lifestyle, community-level decisions, the

surroundings in which they live and work, and broader social conditions. Depending on the

person and the degree of the ailment, Miss Green's health issue will have a variety of

repercussions. In general, those who have liver impairment caused by alcohol may experience
 Liver Disease 7

physical discomfort, exhaustion, and weight loss, which can make it harder for them to work and

do daily duties. Also, individuals could experience despair and a decline in their social life

because their disease may make it challenging for them to engage in activities that they once

found enjoyable. It is crucial to remember that Miss Green's health will impact her family, her

caregivers, and other members of her social network, in addition to herself. For instance, her

family and caregivers can be concerned for her well-being and find it difficult to manage her

condition. With the stigma surrounding alcoholism and her physical limitations, Karen may find

it difficult to maintain relationships with her family and friends. They might also be impacted by

Miss Green's decision to seek medical attention for her health because it might prevent her from

going about her regular activities and routines.

Assessment, Planning, and Implementation of Nursing Care

An assessment component of the nursing process entails gathering data consistently and

effectively to enhance the patient-specific nursing process (Khatiban, Tohidi, and Shahdoust,

2019). Ms. Green was not coerced into accepting the national early warning scores (NEWS);

instead, I explained what they were to her and asked for her agreement before implementing

them. In order to improve the patient's prognosis, the NEWS evaluation was performed on Miss

Green (National Institute for Health and Care Excellence (NICE), 2011). It enhances the

detection and response to clinical deterioration in patients. Some of the parameters that Miss

Green scored fell within the acceptable range. Her body temperature was 38.5 degrees, she had a

fever, and she had an elevated respiration rate of 23 breaths per minute. Her blood pressure was

150/90, which showed Hypertension. Her pulse rate was 110 beats per minute, which is

considerably above normal and indicates anxiety and stress. Her BMI of 15 indicated that she

was underweight. She was aware, and her blood sugar level was 14, which is slightly high. Miss
 Liver Disease 8

Karen was given the CAGE and AUDIT tests. She received a three on the CAGE screening

exam. O'Brien (2008) claims that the CAGE test uses the CAGE questions, a group of four

clinical interview questions that have been successfully used to diagnose alcoholism. The major

subjects of the questions include cutting back, being angered by the criticism, feeling guilty, and

eye-openers. She admitted to considering reducing her alcohol intake, feeling irritated when

people criticized her drinking and feeling guilty about her alcohol dependence. She did not,

however, use the alcohol as a morning wake-up call. According to the AUDIT test, she has a

substance use disorder since she lives alone, consumes three bottles of wine each day, and was

fired six months ago for being intoxicated at work (Bradley et al., 1998). Interventions will be

offered to Karen to assist her in stopping consuming alcohol and to stop a relapse so that her

liver can heal. She will stay in the hospital for 5 to 7 days as she begins counseling, receives

nutritional support, and begins taking naltrexone, which will be upped to 50 mg per day after the

first day.

Safe Use of Medication

The Food and Drug Administration of the United States has given its blessing to the use

of three medications for the treatment of alcohol use disorders (AUD). These medicines are

designed to help regulate disease, and there is no evidence that they cause addiction. Medication

may not be effective or necessary for everyone with AUD; nevertheless, when incorporated into

a tailored treatment plan, it can be quite beneficial in assisting a person in accomplishing their

goals (Patel and Balasanova, 2020). Naltrexone, acamprosate, and disulfiram are the names of

these medications. It has been demonstrated that acamprosate can reduce drinking excessively

and assist individuals already sober. It also has the potential to help some people better regulate

their cravings. When alcohol is consumed while taking, disulfiram hinders the body from
 Liver Disease 9

breaking down the alcohol, which can lead to uncomfortable side effects, including nausea.

These symptoms may make some people desire to give up drinking, while studies have shown

that naltrexone can reduce the number of days spent binge drinking and help people remain

sober. Also, it may assist certain individuals in regulating the desires they have to drink. It may

be administered in the form of an injection or a tablet to be taken once per day. According to a

paper that the National Library of Medicine published in 2008, the typical starting dose of

naltrexone is 25 milligrams for a few days, followed by an increase to 50 mg per day over

approximately one week (Anton, 2008). Although Miss Karen's current dose of naltrexone is 25

milligrams per day, increasing it to 50 milligrams per day is a viable option. In order for Karen to

make safe use of her medications, she needs to ensure that she is taking them exactly as her

physician has instructed her to, be aware of any potential drug interactions, avoids taking more

of the medication than is recommended, and let her healthcare provider know about any adverse

reactions or side effects she experiences.

Nine Rights of Medical Administration

The term "Nine Rights of Medication Administration" refers to the nine requirements that

must be met to guarantee the secure and appropriate administration of medication. This includes

the appropriate patient, drug, dosage, timing, location, justification, documentation, response,

and even the right to reject. These rights are necessary to guarantee that the patient gets the right

drug correctly (Elliot and Liu, 2010). The right patient refers to ensuring that the right patient

receives the drug. The patient's name, birthdate, and other identifying details are checked to

accomplish this. Examining the medication's name, strength, and dosage makes it possible to

ensure that the patient receives the right drug. This is known as the right drug. The right dose

refers to ensuring the patient receives the appropriate medication dosage. Assuring that the drug
 Liver Disease 10

is administered at the proper time and interval is referred to as giving it at the right time. Also, it

is critical to confirm that the medication is being administered through the recommended route of

administration, such as an oral dose that should not be injected. The term "appropriate reason"

refers to making sure that the medication is administered for the proper reason. This is achieved

by verifying the medication's diagnosis and indication to make sure it is administered for a good

purpose.

The right paperwork refers to ensuring that the appropriate records are preserved for

administering the drug. It is important to ensure that the patient responds to the drug as it should

for the proper reaction. This is done by keeping a close eye on the patient for any unfavorable

effects or modifications in their condition that the medicine might bring. The nine rights of

medication administration must be fulfilled in Miss Karen Green's case to protect her safety

when giving her medication. She is to take naltrexone, starting at 25 milligrams per day, and then

increase it to 50 milligrams per day, as directed. As well as ensuring that the correct drug, dose,

route, time, frequency, and reason for administration are checked and recorded, it is crucial to

ensure the right patient receives the medication. It is also necessary to let Miss Green know that

she can decline the medication.

In conclusion, this assignment has examined Miss Karen Green, a 57-year-old woman

admitted to the ward with suspected alcohol-related liver impairment, from a medical,

psychological, and social standpoint. Her physical and mental health issues and her social life

result from her alcoholism. Her sickness significantly affects both her and her family/caregivers.

Her care should be on lowering her alcohol intake, assisting her in ceasing drinking, offering her

nutritional support, and assisting with quitting smoking. To guarantee that the appropriate

medication is administered to the appropriate patient, the nine rights of medication must be
 Liver Disease 11

followed. Karen can recover and live healthier and happier lives with the correct care and

support.
 Liver Disease 12

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