The nursing process purposely provides an invaluable and systematic problem-solving approach to patient-centric care. It establishes an evidence-based standard of effective care where healthcare professionals assess patients and design relevant action plans to address individualistic patient needs (Panel et al., 2021, pp.659-689). Consequently, the key purpose of this focused clinical activity is to apply the nursing process to the patient encountering liver cirrhosis, as substantiated in the presented case scenario.
Expected Assessment Findings
The expected assessment findings suggestive of the possible liver cirrhosis in the 58-year-old patient are diversified. Particularly, the physical examination findings may encompass the presence of jaundice, palmar erythema, spider angiomata, and general body weakness. The 58-year-old man described in the case scenario may present with jaundice or yellow discoloration of his eyes, mucus membranes, and skin as a result of elevated bilirubin (Abo et al., 2021, pp.223-246). Also, the manifestation of palmar erythema may be caused by the altered metabolism of sex hormones. The presence of spider angiomata may be manifested in the patient due to the risen estradiol levels. General body weakness might also be reported by the 58-year-old man consequent to various constitutional symptoms like muscle atrophy, weight loss, and anorexia.
Similarly, the abdominal assessment findings may include abdominal distension, flank dullness, and caput medusae. Both abdominal distension and flank dullness can be caused by ascites, which usually occur when fluids build up (Panel et al., 2021, pp.659-689). The chest assessment findings might consist of gynecomastia, possibly caused by escalated estradiol levels. Other assessment findings may encompass nail changes and clubbing.
Expected Diagnostic Test Findings
The expected diagnostic test findings suggestive of the possible liver cirrhosis also vary. Notably, the diagnostic laboratory findings that might suggest liver cirrhosis in the 58-year-old man encompass reduced platelet count below 180,000, albumin levels less than 3.8 mg/dL, increased level of liver enzymes, and elevated bilirubin levels above 1.5 mg/dL (Fabrellas et al., 2020, pp.1106-1116). The reduced platelet count (i.e., platelet count <180,000) might be a result of splenomegaly and lessened TPO production within the liver. Low albumin levels (i.e., album below 3.8 mg/dL) can also manifest due to increased sodium retention, which dilutes the albumin content within the extracellular space.
Also, the increased levels of liver enzymes may be attributed to inflamed liver cells that leak liver enzymes and other chemicals into the bloodstream. Elevated bilirubin levels might be caused by splenomegaly, which successively leads to increased bilirubin production. Additionally, the imaging assessment findings that may suggest liver cirrhosis include the presence of ascites, splenomegaly, nodular liver surface, and shrunken liver’s right lobe (Fabrellas et al., 2020, pp.1106-1116). Ascites and splenomegaly might be caused by portal hypertension, while the shrunken liver’s right lobe would possibly result from long-term alcohol consumption.
Expected Outcomes from The Interventions in The Treatment Plan for The Patient Experiencing Liver Cirrhosis
The key recommended interventions incorporated into the treatment of the 58-year-old patient include cognitive behavioral therapy, comprehensive nutritional counseling, and high-quality supportive care. Cognitive behavioral therapy would help address increased risks of worse liver cirrhosis complications by enabling the 58-year-old man to abstain from chronic alcohol use (Panel et al., 2021, pp.659-689). The expected outcomes from cognitive behavioral therapy include improved abstinence from consistent alcohol use and reduced risks of developing liver-cirrhosis-associated complications. In addition, comprehensive nutritional counseling is also another viable intervention for addressing liver cirrhosis in the 58-year-old patient.
The comprehensive nutritional counseling would help the patient to realize improved nutritional status. The expected outcomes from nutritional counseling encompass restoring ordinary fluid volume, positive and sustainable nitrogen balance, reduced fatigue, and improved muscle mass (Fabrellas et al., 2020, pp.1106-1116). Furthermore, high-quality supportive care as a viable intervention would consist of skin care provision, managing and monitoring liver cirrhosis-associated complications, as well as promoting rest. The expected outcomes from this intervention include improved respiratory status, increased comfort level, enhanced skin integrity, and improved mental status.
The Discharge Plan for The Patient
Patient Name: James Calvin Anticipated Discharge Date: April 20, 2023.
Discharge Destination: San Diego, California.
Discharge Diagnoses: Liver Cirrhosis
Types of Care Needed
- Home Care
The patient requires comprehensive and patient-centric home care that primarily focuses on alcohol restriction, proper nutritional diet, as well as appropriate vaccines, medicine, and supplements. Particularly, the patient is strongly advised to abstain from chronic alcohol utilization because it may worsen his liver cirrhosis (Abo et al., 2021, pp.223-246). A proper nutritional diet consisting of low sodium contents, high protein-rich food, and fresh fruits would be necessary for the 58-year-old patient. The patient should also engage the provider before using any over-the-counter drugs and painkillers. NSAIDS like ibuprofen might be detrimental to the patient experiencing liver cirrhosis. Similarly, the patient is encouraged to discuss appropriate vitamin supplements before using them.
- Follow Up Care
This patient will also need to consistently follow up with the involved healthcare provider as appropriately advised (Abo et al., 2021, pp.223-246). Mainly, the 58-year-old patient is encouraged to follow up with the responsible healthcare professional about the MRI or ultrasound of his liver every six months.
Medications Needed
The key medications needed by the patient to manage his medical condition upon successful discharge from the healthcare facility include acamprosate and naltrexone.
Education Needs for The Patient
The key educational needs for the patient experiencing liver cirrhosis include proper training in self-care management (Abo et al., 2021, pp.223-246). Effective patient education and training about self-care management will enhance patient knowledge of how to effectively manage liver cirrhosis while in the community or home setting.
References
Abo El Ata, A. B., Mohammed Ibrahim, N., & Ahmed Mahmoud, A. (2021). Nurses’ Knowledge and Practice Regarding Nursing Care of Patients with Liver Cirrhosis. Port Said Scientific Journal of Nursing, 8(2), 223-246. https://pssjn.journals.ekb.eg/article_186961.html
Fabrellas, N., Carol, M., Palacio, E., Aban, M., Lanzillotti, T., Nicolao, G., … & Ginès, P. (2020). Nursing care of patients with cirrhosis: the LiverHope nursing project. Hepatology, 71(3), 1106-1116. https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.31117
Panel, C. P. G., Berzigotti, A., Tsochatzis, E., Boursier, J., Castera, L., Cazzagon, N., … & European Association for the Study of the Liver. (2021). EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis–2021 update. Journal of Hepatology, 75(3), 659-689. https://www.sciencedirect.com/science/article/pii/S0168827821003986
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