57yo Male with Cirrhosis of Liver & Pancreatitis

Nutrition

Medication

Psychosocial

lives with recently divorced sister and her four children

uses alcohol and tobacco

constipated unless consistently taking lactulose

reports nausea and vomiting

reports recent decrease in appetite

reports weight loss of 20lbs over past 6months

pancreatitis is exacerbated by food

client states he has dealt with his health problems at home by "having a drink and a smoke"

Risk for Electrolyte Imbalance

client is taking two diuretics: spironolactone 100mg daily & furosemide 40mg daily

Lactulose 30mL daily 3x/day

preexitisng diagnosis of pancreatitis

smokes 1pk/day with no plans of cessation

client states he has lost friends because of his alcohol consumption

client states he feels depressed and hopeless

client states "I haven't eaten in three days because of the pain"

client has difficulty in obtaining his medications

Pain Management

pain is described as "aching"

pain is constant over the past three weeks

pain intensity is rated as a 7 on a 0-10 scale

pain is aggravated by food and alcohol

pain is located in stomach usually, but occasionally radiates around to client's back

Impaired Skin Integrity

client scores 16 on the Braden scale placing him at a high risk for impaired skin integrity

client's diet has been very poor over the past three days

client appears jaundiced with dry skin

spider nevi on chest

broken blood vessels on cheeks and nose

poor skin turgor

nails are dry and brittle - indicative of vitamin deficiency

2x4cm reddened area on client's sacrum

broken arm last year - current diet may be insufficient in calcium and vitamin d

4mg Morphine Sulfate Q2hrs PRN for pain control

NKA

4mg Morphine Sulfate Q2hrs PRN for pain control