Case
NURS 304 Hepatic Disorders Case Study
- Course
- Nurs 304
- Institution
- Maryville University Of St. Louis
This is a comprehensive and detailed case study on; Hepatic Disorders for Nurs 304.
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Case Study, Chapter 49, Assessment and Management of Patients With HepaticDisorders
1. John Adams, 55 years of age, is admitted to the intensive care unit with the diagnosis
of acute esophageal varices bleed. The patient has a long-standing history of alcoholism
and cirrhosis of the liver. Six months ago, the patient received an EGD, which diagnosed
the esophageal varices. The patient has quit drinking alcohol for the past 6 months and
has been active in Alcoholics Anonymous. The patient has a history of coronary artery
disease and angina. The patient has been taking nadolol (Corgard) and isosorbide
(Isordil). The admission vital signs include: BP 88/50, P 110, R 26, and T 99°F. The O2
saturation is 88% on room air and the patient is placed on 2 L/minute of oxygen per nasal
cannula with O2 saturation of 94%. The patient’s hemoglobin is 6 g/dL, the hematocrit is
12%, and the platelets are 75,000. The patient has a prolonged PT and PTT. The liver
profile shows a mild elevation of the aspartate amino-transferase (AST) and the
aminotransferase (ALT). The BUN and serum creatinine are also elevated. The patient
has in place from the emergency department a nasogastric tube to low wall suction. The
emergency department physician placed a right subclavian triple lumen catheter and there
is NS infusing at 100 mL/hr. The emergency department nurse administered vitamin K.
Additional orders on the chart from the gastroenterologist include the following:
octreotide (Sandostatin) 5-mcg bolus followed with continuous infusion 500 mcg in 250
mL D5NS at 25 mcg/hr. Type and cross of 6 units of PRBCs STAT and transfuse 2 units
of PRBCs over 2 hours each and administer furosemide (Lasix) 20 mg IVP in between
each unit. Repeat CBC 1 hour after the transfusion is completed. (Learning Objective 4)
a. In what order should the nurse institute the physician orders that are listed above?
Perform dosage calculations and state how to administer the medications.
Get a type and cross match, transfuse the PRBC as soon as possible (monitor patient
before, during, and after infusion), admisister furosemide IVP, monitor I&O’s,
monitor electrolyte status and do a CBC. Administer 5mcg bolus and then 12.5 ml/hr
of sandostatin, then administer furosemide (Lasix) 20mg IVP.
b. The nurse observes the nasogastric secretions and, upon admission to the ICU,
there was 200 mL of dark red colored drainage. The nurse continues to monitor
the drainage and, as the nurse hangs the first unit of PRBCs, 200 mL of bright red
bloody drainage is dumped into the collection canister. What should the nurse do?
Call Doctor about drainage using COCA (color, odor, consistency, amount) and do a set
of VS to see if there are any changes.
c. The gastroenterologist orders for the nurse to increase the octreotide to 50 mcg/hr
and the endoscopy nurse and the physician will be up shortly to perform a vertical
band ligation (VBL). What does the nurse need to do in preparation for this
procedure?
The nurse should educate the patient on what is about to happen and prepare the room
for the VBL.
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