John Richards, 45 years old Cirrhosis Case Study with complete solutions

John Richards, 45 years old Cirrhosis Case Study with complete solutions of Present Problem: John Richards is a 45-year-old male who presents to the emergency department (ED) with abdominal pain and worsening nausea and vomiting the past three days that have not resolved. He is feeling more fatigued and has had a poor appetite the past month. He denies any ETOH (alcohol) intake the past week, but admits to episodic binge drinking on most weekends. John weighs 150 pounds (68.2 kg) and is 6'0" (BMI 17.6). You are the nurse responsible for his care. Personal/Social History: John is single, has never married, and lives alone in his own apartment. He has struggled with heroin use/abuse in the past, but has not used in the past two years. John is currently unemployed and has no health insurance. He was diagnosed with hepatitis C ten years ago but has had minimal follow-up medical care since. What data from the histories are RELEVANT and have clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: Abdominal pain Worsening N&V for 3 days Fatigue & poor appetite for the past month Binge drinking on most weekends Underweight at 150 lbs, 6’0” (BMI 17.6) Nausea and upset stomach are common early symptoms of liver disease. Fatigue associated with liver disease likely occurs as a result of changes in neurotransmission within the brain. Patient is underweight due to liver damage and not absorbing nutrients (malnutrition). Binge drinking produced fatty liver tissue and triggered early stages of inflammation, both indicators of alcoholinduced liver disease. Binging also increased the levels of alcoholmetabolizing enzymes, whose activity can produce oxidative damage and other forms of harm to the liver RELEVANT Data from Social History: Clinical Significance: Single and lives alone Past heroin abuse Unemployed, uninsured Ten-year history of Hepatitis C with minimal medical care. Illness and lifestyle may be the reason for relationship status, patient may be depressed and reason for binge drinking. Low income and uninsured leads to improper health care or none at all. IV drug use increases the risk of contracting HIV, AIDS and Hep C. Patient is not getting the needed medical care for his condition. What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds? (Which medication treats which condition? Draw lines to connect.) PMH: Home Meds: Pharm. Classification: Expected Outcome: *ETOH abuse x 25 years IV drug abuse *Hepatitis C–past history of Ibuprofen 600 mg PO prn for headache NSAID Increased risk of further liver damage One disease process often influences the development of other illnesses. Based on your knowledge of pathophysiology, (if applicable), which disease likely developed FIRST that created a “domino effect” in his/her life? • Circle the PMH problem that likely started FIRST. • Underline the PMH problem(s) FOLLOWED as domino(s).