Mr. S is a 50-year old male presenting to the emergency departmentwith reports of fatigue, dyspnea,

Mr. S is a 50-year old male presenting to the emergency departmentwith reports of fatigue, dyspnea, poor concentration and abdominal distension. He is accompanied by his wife who reports that he is coughing up blood.  Mr. S is the CEO of a large real estate company. He reports that his job is very stressful and that he deals with this by drinking 2-3 cans of beer, and several glasses of wine, every evening. He also reports having 2-3 alcoholic drinks per day.  He has been hospitalized four times in the past 2 years for an upper gastrointestinal bleed. He reports he was referred to a specialist for a liver biopsy 3 months ago, and was found to have cirrhosis of the liver. He missed his follow-up appointment with the specialist. Past medical history: Alcohol intake 5-7 drinks/day x 24 years Smoking history: 30 pack years Hypertension Gastrointestinal bleeding x 4 episodes over past 2 years Physical exam findings:Neurological: awake, alert, orientated to time, but not to place, initially irritable and confused. HEENT: Epistaxis noted; Yellow scleraRespiratory: lung lobes clear bilaterally, breath sounds diminished to bases, complaining of shortness of breathCardiac: normal S1 S2, no S3 or S4. Heart rhythm regular, HR 122. BP 88/50 mmHg, feels fatigued & lethargicAbdomen: abdomen firm and distended, bowel sounds hyperactive to 4 quadrants, vomiting small amounts of bright red bloodGU: normal urinary outputMSK: mild tremors in both handsSkin: pale, jaundiced, multiple ecchymotic areas on his body Lab values:• Hemoglobin 72 g/L (normal for males: 140 – 180 g/L)• Hematocrit 0.24  AST 260 µ/L (normal: 0 – 35 µ/L) • Ammonia level of 117 µmol/L, (normal: 6 – 47 µmol/L)• INR 3 (INR 0.81- 1.2) Mr. S was admitted to a medical unit with ascites, portal hypertension and hepatic encephalopathy secondary to cirrhosis of the liver. Immediate treatments include packed RBCs, two units infused over 2 hours each, oxygen 3 litres/min via nasal prongs, and IV NS at 25 mL/hr.  He is also started onLactulose (Cephulac) 30 mL po BIDFurosemide (Lasix) 80 mg IV BID  Diet: sodium restricted. Questions:  What risk factor(s) in Mr. S’s history predisposes him to develop cirrhosis of the liver? What additional history is needed? 2. What type of cirrhosis does Mr. S have? Explain how this type of cirrhosis develops. 3. What are the reasons for his physical exam findings? Choose at least three (3) physical exam findings. 4.  Explain the rationale for his treatment, focusing on the blood transfusion and the orders for lactulose and furosemide. 5. Why is Mr. S ordered a special diet? Provide a rationale for this order. Health Science Science Nursing NURS 3517 Share QuestionEmailCopy link Comments (0)

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