Mr. James Alvarez’s Priority Diagnosis
Based on the symptoms Mr. James Alvarez presents in the clinic, the priority diagnosis is liver cirrhosis which occurs in non-alcoholics. The condition is caused by fibrosis that involves diffusion, forming abnormal nodules, and interfering with the normal functioning of the liver. Though the condition is most common among alcoholics, the risk factor in this category includes hepatitis C history and obesity (Gines et al., 2021). However, in this case, it is impossible to tell if the patient had the same predisposing factors. However, according to research, liver cirrhosis primarily affects men aged forty to sixty years compared to women of the same age.
The Affected Organ and Its Pathophysiological Processes
The patient presented organomegaly in the right upper quadrant during the examination, indicating his liver was enlarged. Some of the causes of liver enlargement involve hepatotoxic substances, including inhalants, injectable drugs, anesthetic agents, medications, exposure to chemicals containing phosphorus, and infectious schistosomiasis. Hepatotoxic substances, including alcohol, can trigger diffuse fibrosis. The excess disposition of glycoproteins and collagens in the hepatocytes and sinusoids occurs in response to liver injury (Yoshiji et al., 2021). During the physical examination, abdominal palpation can elicit liver inflammation and a sharp nodular edge. Abdominal pain is probably because of rapid liver enlargement. Fat deposits accumulate in liver cells, causing organ enlargement and triggering tension in the fibrous cover. The damaged liver cells are gradually replaced by scar tissue. Inflamed liver causes blood flow resistance during circulation, leading to portal hypertension. In addition, coagulopathy, GI bleeding, hepatic encephalopathy, ascites, and impaired detoxification of the liver are other complications. Liver failure is caused by obstructed portal circulation. The flowing back of the blood also impairs liver function in the spleen and GI tract. Consumption of excess protein foods piles up in the peritoneal cavity resulting in ascites, and fluid produced can be detected through fluid wave precision and dullness. Moreover, excess loss of proteins through ascites results in malnutrition and weight loss.
Care Plan and Patient’s Population-Based Component Based on Care Plan
In order to manage this patient, the doctor will depend on the symptoms presented by the condition (Tarao et al., 2019). The care plan for Mr. James is the provision of vitamins and nutritional supplements to improve nutritional status and to promote healing of damaged liver tissues, blood pressure control by using beta blockers, administration of antacids to reduce gastric distress and GI bleeding, administration of oral antibiotics such as metronidazole and vancomycin to aid in reducing bacteria in the large intestines. Other care plan strategies include using potassium-sparing agents and surgical intervention through paracentesis to reduce ascites and electrolyte correlation for restoring fluid balance and nervous system functioning.
Despite the prescribed treatment modalities and lifestyle modification, the patient needs tertiary and health promotion services of prevention. To promote the general population’s health, some additional public health efforts and prevention of cirrhosis and its associated burden are essential. Some health promotion interventions for the general population include creating awareness of the importance of limiting alcohol intake, screening for early detection of diseases, and immunizations.
Recommendations for Care Continuity and Follow-Up
Some of the crucial recommendations involve counseling on diet modification. The nurse should conduct follow-up and assessment of the patient at home, vaccinations against pneumonia and influenza, involve a hematologist in the care process of the patient, monitor signs for any complication, and assess the prescribed medications to ensure they do not predispose the patient to more liver damage.
References
Ginès, P., Krag, A., Abraldes, J. G., Solà, E., Fabrellas, N., & Kamath, P. S. (2021). Liver cirrhosis. The Lancet, 398(10308), 1359-1376.
Tarao, K., Nozaki, A., Ikeda, T., Sato, A., Komatsu, H., Komatsu, T., … & Tanaka, K. (2019). The real impact of liver cirrhosis on developing hepatocellular carcinoma in various liver diseases—meta‐analytic assessment. Cancer medicine, 8(3), 1054-1065.
Yoshiji, H., Nagoshi, S., Akahane, T., Asaoka, Y., Ueno, Y., Ogawa, K., … & Koike, K. (2021). Evidence-based clinical practice guidelines for liver cirrhosis 2020. Journal of Gastroenterology, 56(7), 593-619.
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