GG, 59y/o M with
post-paracentesis
hypotension.
Pertinent labs
Psych-Social
Living at home with
his girlfriend. No
children, never married.
Currently working full-time
as an electrician. Has a
high school diploma.
Nursing interventions
Discharge plan
Eats fast food for
lunch while
working. Not adhering
to low salt diet.
Pathophysiology
Pertinent Hx
Has viral hepatitis C
with cirrhosis. Led to
ascites. 2 previous
paracentesis procedures.
Used to drink, but not since
doctors said it was bad for him.
Medications
HTN, hyperlipidemia
Stated that he is
religious but did not
specific what religion
he practices.
Dig more into
religious background
to assist with coping.
Consult chaplain,
ask more questions
Cirrhosis is the end stage of chronic liver disease that is progressive and irreversible. It can be caused by multiple factors, including alcohol abuse, chronic hepatitis B or C infections, prolonged biliary obstruction, or long-term severe right-sided heart failure. The disease cannot be cured but progression can be slowed with the use of diuretics to reduce fluid retention and ascites, meds to reduce nitrogen load, beta-blockers, anemia treatment, nutritional therapy, and possible surgery as the last resort.
Family hx includes strokes, HF, HTN, and
hyperlipidemia. HTN in mother and sister.
Does not exercise, was
prescribed a low salt diet,
but does not adhere to it.
Teach about the importance
of maintaining a low salt diet.
Consult a
dietician
Think of quick lunches
GG can pack for the day
Provide teaching about
why he needs to adhere
to it and how it will help.
Control hypotension.
Administer albumin
as ordered, including
drip and push.
Provide assistance
when GG needs to get
out of bed.
Check VS as ordered.
Take daily weights
and measure I&Os
GG met with the dietician to learn how to manage his diet and the importance of adhering to it. He was discharged but experienced a recurrence of ascites. He ended up having a transjugular intrahepatic portosystemic shunt placed to relieve the portal HTN and was placed on the liver transplant list.
Serum albumin: 2.5
Decreased from
chronic liver disease; transfuse
albumin as ordered, provide
education about diet.
GGT: 90
Elevated from liver
disease and cirrhosis; provide meds
as ordered, provide good skin care,
monitor LFTs, CMP, CBC.
Total bili: 3.0
Elevated from hepatitis, causing
jaundice; provide good skin care,
monitor neuro status, BS, and
serum electrolytes.
Albumin 25%, 25g IV.
Spironolactone, 100mg
PO QD AM
Furosemide 40mg,
PO QD AM
Magnesium oxide,
400mg PO QD AM
Zinc 220mg
PO QD AM
Multivitamin
PO QD AM
Simvastatin 40mg
PO QD HS