Mr. Escobar is a 47-year-old male with a history of cirrhosis. He lives with his wife and teenage sons. His wife brought him to the emergency department today because she noticed that Mr. Escobar ha increasing confusion and lethargy and was having difficulty walking. His wife states, “He is probably acting a little funny because he is sleep deprived. He hasn’t slept very much in the past few days.”
Mr. Escobar is afebrile. His blood pressure is 136/68, pulse 88, and respiration rate 18. His oxygen saturation is 98% on room air. He is awake, alert and orientated to person only. His speech is slow and he appears tired. The nurse notices a foul odor to his breath. Upon physical examination Mr. Escobar has a slightly distended abdomen. The health care provider (HCP) does not note any asterixis. The HCP requests an abdominal ultrasound, which reveals fatty infiltrates of the liver, an enlarged spleen, a polyp in his gallbladder, and a moderate amount of ascites.
Results of a CBC reveal white blood cell count of 4.8 cells/mm³, RBC 2.94 million/mm³, Hgb 9.8 g/dl, Hct 28.2%. Results of a CMP are sodium 145mEq/L, potassium 3.6 mEq/L, chloride 112 mEq/L and carbon dioxide 25mEq/L. Mr. Escobar glucose is 185. His BUN is 42 mg/dL and creatinine is 1.6 mg/dL. LFT’s reveal total protein 5.7 g/dL, albumin 3.1 g/dL, total bilirubin 1.8 mg/dL, AST 17u/L, ALT 14u/L, LDH of 266 u/L. His prothrombin time is 13.1 seconds. His ammonia level is 124 umol/L. Urinalysis results are within normal limits.
The HCP schedules Mr. Escobar for a gastroscopy to rule out GI bleeding. Intravenous fluids of D5 ½ NS are started at 100 ml/hr. Mediations prescribed include lactulose, neomycin sulfate. The HCP admitting Mr. Escobar also prescribes daily weights, strict intake and output documentation, monitoring for stools for occult blood, neurological assessment every four hours and a low protein, low sodium diet.
6) Identify which of the client’s admitting laboratory results are abnormal and provide a rationale for why each is above or below the normal range.
7) Define ascites. Explain what causes ascites and how the nurse will assess for this condition.
8) Mr. Escobar has been prescribed 30 mL of lactulose every 6 hours and neomycin sulfate 500 mg four times a day. Explain why each of these medications has been included in the client’s medical management plan and what assessment prior and post administration is needed.
9) Provide an explanation for the low protein, low sodium diet the HCP prescribed for Mr. Escobar.
10) A gastroscopy reveals that Mr. Escobar has esophageal varices, which are treated with banding. Discuss what esophageal varices are and the banding procedure used to treat them.
Q. 6 Which of the clients admitting labortary results are abnormal and providing rationale for why each is above or below the normal range
Answer: The clients following laboratory results shows abnormal
1) RBC shows 2.94 which is below normal range of 4.7 to 6.1
Rationale: Suggestive of an upper gastrointestinal bleeding due to oesophageal varieces
2)Hgb 9.8 which is below normal range of 13.5 to 17.5
Rationale: Suggestive of iron deficiency anemia due to bleeding from esophageal varices.
3) Hct shows 28.2% which is below normal range of 41% to 50%
Rationale: Due to bleeding of esophageal varices.
4)Glucose shows 185 which is above normal of 100 to125
Rationale: Due to hepatogeneous diabetes.
5) BUN is 42 mg/dL which is above normal range of 7 to 20
Rationale: Due to renal dysfunction
6)creatinine is 1.6 mg/dLwhich is above normal range of 0.7 to1.3
Rationale: Due to acute or chronic renal failure
7)LFT’s reveal total protein 5.7 g/dL below normal of 6.6 to8.3
total bilirubin 1.8 mg/dL above normal 0.2 to 1.3 due to Cirrhosis of liver
8)Ammonia level is 124 umol/L above normal of 15 to 45
Rationale: Due to impaired liver function.
Q. 7 Define ascites. Explain what causes ascites and how the nurse will assess for this condition.
Answer:Ascites is an abdominal swelling caused by accumulation of fluid,most often related to liver disease.
Causes are Cirrhosis of liver due to drinking too much alchahol and different types of cancer' Nurse will assess for shifting dullness by percuss from the upper side of his abdomen down ward,so will hear tympany at first,then dullness over the area with fluid.
8) Mr. Escobar has been prescribed 30 mL of lactulose every 6 hours and neomycin sulfate 500 mg four times a day. Explain why each of these medications has been included in the client’s medical management plan and what assessment prior and post administration is needed.
Answer:30 mL of lactulose every 6 hourly tob reduce high Amonia leval
Neomycin sulfate 500 mg fourth hourly is an antibiotic used to reduce the infection.
Q 9) Provide an explanation for the low protein, low sodium diet the HCP prescribed for Mr. Escobar.
Answer:Low protein and low sodium diet to reduce the work load of kidney as his BUN and creatinine are high
Q10) A gastroscopy reveals that Mr. Escobar has esophageal varices, which are treated with banding. Discuss what esophageal varices are and the banding procedure used to treat them.
Answer:Esophageal varices are enlarged veins in the esophagus
esophageal variceal banding the doctor uses an endoscope to place an elastic ring that looks like a rubber band around an enlarged vein. Banding the vein in this manner will cut off blood flow through the vein to arrest bleeding.
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