BIODATA OF PATIENT

Name of Patient Age/ Sex Education Occupation Income Marital Status Religious Address Mr. Rameshwar S/o. Mr. Nathu Lal 29 Yrs/M 8th Auto Riksha Driver 5000/- month Married Hindu Subhash Nagar, Indore 11th Feb. 2009 Cirrhosis of Liver Dr. R.K. Jha Medicine ICU

Date of Admission Diagnosis Consultant Ward -

Present Complaints :
Patient having complaint of Pain in abdomen, Discomfort, Anorexia, Fatigue, Nausea, Vomiting.

History of Present Illness :

Patient admitted in SAIMS hospital with complain of pain in abdomen & vomiting.

Past Medical History:

He was previously admitted in government hospital before 3 months with same problem.

Past Surgical History:

Patients have no any past surgical history.

Socio Economic History:

Mr. Rameshwar lives in his own concrete house. There was adequate electricity & water supply is present. He has 3 rooms in his house they are proper ventilated. His income is 5000/- month. His relation with other member of family & with other relatives is good & healthy.

Family History:
S. No. 1 2 3 4 5 Name of Family Age/ Sex 52 yr./F 27 yr./F 23 yr./M 6 yr./M 3 yr./F Relation with Health Status Patient Mother Wife Brother Son Daughter Normal Normal Normal Normal Normal Member Mrs. Ganga Bai Mrs. Durga Devi Mr. Gangaram Sona Gaytri

Functional Health Pattern Hygiene :

He is doing brush in morning. He takes bath daily in morning. He changed clothing per days. He is going for hair cutting 2 times in a month. He is washing hands after toileting.

Dietetic History : He is non-vegetarian. He takes meal 2 times in a day.

He eats non-veg once in a month. He likes to eat chapatti, green vegetables, milk & egg. Some time he consumes fruits. He doesnt take any fast.

Activity and Exercise : His activity is normal in daily life. He was not
doing any exercise in his daily life.

Sleep and Rest :

He was sleeping at 6-7 hrs. in night & he take rest 1-2

hrs. in day time after taking meal.

Elimination Pattern :

He goes for defecation for once or twice a day

and 5-6 for urination. He has no complaint of constipation.

Values & believes :

He belongs to Hindu religion. He believes on god.

He participates in every holly festivals. He doesn't take any fast.

PHYSICAL EXAMINATION Height Weight Temperature Pulse Respiration Blood Pressure 5 ft 7" 60 kg. 98.8*F 72 / min. 22/ min. 130/70 mm Hg

Head:
Hair Scalp Face Black in Color No itching, no dandruff, no scar marks Slight pigmentation

Sinus Cranium

Normal symmetrical

Eyes :
Visual activity Ocular movement Lids Lacrimal gland Conjunctiva Sclera Normal Normal Clear Proper functioning Pale White

Ears:
External Structure Mucus membrane Tympanic membrane Hearing Normal No discharge Normal Normal

Nose:
Eternal Structure Septum Mucous Membrane Olfactory sense Short & round symmetrical pink colour Normal

Oral Cavity:
Lips Gums Oral cavity Teeth Tongue pink colour no swelling clean, pink colour Symmetrical & white pink in colour, center line is present.

Taste Voice

normal soft

Neck:
General Structure Trachea Thyroid Node Muscle Normal centered Normal no enlargement Flexible

Chest and respiratory systems

Chest Shape Type of respiration General palpation Percussion Breathe sound symmetrical normal normal normal slow

Abdomen
Scar marks Hernias Masses Liver Spleen Kidney Bladder Palpation absent absent absent tender ness is present normal normal normal not normal

Back
Scar mark absent

Deformities Infection

absent absent

Upper & Lower extremitiesMovement Scare marks Deformities Range of motion (ROM) is normal in upper & lower extremities. Not present in both extremities. Not present in both extremities.

Genitalia & rectal examination

No pus inflammation. No scars present. Any infection is not present.

DESCRIPTION OF DISEASE

Introduction:
Cirrhosis of liver is mainly characterized by the scarring. It is a chronic disease in which irreversible destruction & fibrotic regeneration of the liver cells occur. Cirrhosis of the liver is 12th leading cause of death all over the world. In adult age, after 25 years, however it is 8th leading cause of death. Cirrhosis of liver also may result from chronic hepatitis, prolonged obstruction of the bilory duct, long term sever health problems.

Definitions:
Cirrhosis of liver is progressive disease of the liver characterized by the extensive degeneration & degeneration & destruction of liver parenchyma cells. Or Cirrhosis of liver is end stage of liver disease. It is progressive, irreversible disorder leads to liver failure.

Anatomy & Physiology

The liver is the largest gland in the body. It weight about 100 gm in an average adult. The liver is located behind the ribs in upper right portion of the abdominal cavity. The liver is almost covered by visceral layer. Liver is divided into four lobes. The lobe of liver are made up of many functional units called 'lobules', A lobule is six cone structure which is made up of epithelial tissue. Lobules are formed by cuboidal shaped cells called 'hepatocytes'.

Blood Supply

The blood supply to the liver is mainly from two source approx 75% blood come to liver from the portal vein. Rest blood supply is by the abdominal artery which supply. G.I. tract. Venous return is alone by the hepatic portal vein.

Function of the liver

There are 3 major function of liver they are given below: 1. Storage - The substance include : Glycogen Fat soluble vitamin Essential fatty acid Glycerol Some water soluble vitamin eg - vitamin B 12 Iron & copper 2. Secretion The hepatocytes synthesis is the constituent of the bile from the mixed & venous blood of the liver. It includes bile salt, pigment & cholesterol. 3. Protein metabolismLiver plays a vital role in the metabolism of protein. It degenerate the protein molecule in to the simple form amino acid & excrete the end product of protein metabolism (N2 waste) through the kidney. 4. Other It also helps in Breakdown of fatty acid Heat production Detoxification of the drug Carbohydrate metabolism

Etiology in General:

 Alcoholism Smoking Lacnneis (macronodular) also called alcoholic cirrhosis. Fibrosis -mainly around central veins & portal area. Post necrotic cirrhosis - because of previous acute viral hepatitis. Malnutrition Billary cirrhosis Billary duct obstruction.

In patient:
In my patient etiological factory may be: Alcoholism Mr. Rameshwar is alcohol user. He used to drink wine from last 5 yr. because of using alcohol, metabolic changes occur in liver which has affected the liver cells. Smoking It may be another factor of liver cirrhosis in my patient. Mr. Rameshswar have poor economic condition so the malnutrition may be cause to liver cirrhosis. Malnutrition-

Pathophysiology:
Alcoholic cirrhosis is characterized by episode of necrosis involving the liner cells. Some time occurring rapidly through out the cells & decreased the function of liver cells. Hyper activity to portal vein develops some cirrhosis. IT received blood from spleen & this is an increase in pressure resistance & enlargement of esophageal umbilical & superior rectal veins which may result in bleeding from various organs.

Continuation of the process as a result of unknown causes or alcohol, smoking, substance abuse usually result in death of hepatic cells which result in destruction & degeneration of liver parenchymal cells.

Clinical Manifestation in General

Anorexia Dyspepsia Nausea Vomiting Change in bowl habit (constipation) Dull abdominal pain Gastritis Haematomasis Peripheral oedema Ascities Jaundice Anemia Hepatic encephalopathy Peripheral neuropahty

In patient
Abdominal pain Change in bowel habit Anxiety Depression Restlessness Cynosis

 Anorexia Fatigue Nausea Vomiting

Diagnostic Evaluation In General

History :
Nurse should take history for collection of data to confirm the diagnosis.

Physical Examination:
In physical examination nurse should observe the condition of patient, check the abdomen through inspection, palpation, auscultation & identify the severity of infection.

Liver biopsy Liver Function test

a) Pigment studies Serum bilurubine Urine bilinogen Total serum protein Serum albumine Serum globuline SGOT SGPT

b) Protein studies

c) Serum alkaline phosphate

USG whole abdomen X-Ray

 CT-Scan & MRI Blood Culture

In General
History taking Physical examination

S. No. 1 2 3 4 5 6 7 8

Investigation Hb Total R.B.C. Packed cell volume Nuetrophils Lymphocytes Monocytes Eiosinophils Platelet Count

Unit 12.3 gm/100 3.92 mill/cum 33.5 71 25% 02% 02% 0.174 lacks

Remark 13-17 gm/100 4.5-6.5 mill/cum 40-70 40-70% 20-45% 2-10% 1.5-4 lacks

Management in General
a) Medical Management :
Rest is significant to reduce the metabolic demand of liver. Avoiding of alcohol Diuretic therapy to control oedema. High carbohydrate, protein, amoino acid rich diet & low fat, low sodium diet. Treatment with fluid & electrolyte balance. Antibiotic

Medical Management In S. N. Name of Drug

Patient
Action Side effect Nursing responsibility

Dose Route Time

Inj. Aciloc

50 mg.

I/V

T.D.S. Antacid, Inhibit histamine receptor, which inhibit gastric acid secretion.

Dizziness Confusion Constipation Diarrhea Rashes

Check before

the

doctors order administratio n Assess therapeutic response.

Inj. Ampicilline

1gm

I/V

T.D.S. Antibiotic

Skin rashes GI alteration Nausea

Check before

the

doctors order administratio n Administered slowly. Check Explain medication.

Syp. Dulphalac

30 ml

Oral

T.D.S. It n

relive Cramps Nausea

the to

constipatio

doctors order patient about

Tab. Ciplox 10 mg

Oral

B.D.

Antibiotic

Nausea GI upset Headache Restlessness Constipation

Check Explain

the to

doctors order patient about medication

c)

Surgical Management :
Labectomy : Removal of the affected lobe of the liver is common procedure.

Liver transplantation : it is done to relive the life threatening conditions & end stage of liver disease for which there is not other treatment is available. The success of liver transplantation is depending upon the immuno suppression.

Surgical Management :
In this case no surgical management is applied.

Nursing Management Assessment

I assess the patient according there priority needs. The priority needs of my patient are given below & I assess my patient for. 1. 2. 3. 4. 5. 6. 7. 8. Assess for pain, pain duration, intensity & level of pain. Assess for self care deficit. Assess for complication. Assess for risk of infection. Assess for anxiety. Assess for nutritional level. Assess for hygiene Assess for knowledge deficiency.

Nursing Diagnosis
Abdomen pain R/T tissue damage

Expected Outcome
Patient will have no complaint of abdomen pain.

Intervention
Assess general condition of patient. Assess type, severity & location of pain. Give comfortable position to the patient. Give patient. Keep calm & quite diversion therapy to pain.

Rational
To know about the causes of To know about the pain. To give comfort to patient. To divert the mind. To provide comfort To reduce pain.

environment. To give analgesic as per doctor order.

Evaluation
Pain is reduced and patient feels comfort.

Nursing Diagnosis
Impaired nutrition less than body requirement related to anorexia, vomiting.

Expected Outcome
Patient will have improved in his nutritional status. He will have adequate body weight.

Intervention
Check the patient body weight. Determine dietary intake of patient. Encourage to patient for take proper nutritional diet. Ask to patient about his like & dislike related to food. Give the knowledge about nutritional diet. Recommended small, frequent small to patient. Restrict intake of caffeine, gasproducing & spicy food.

Rational
To identify variation in patient body weight. To get information to input. To maintain nutritional level. To make a interesting menu plan for patient. To encourage patient for taking nutritional diet. To prevent intra-abdominal pressure. To reducing Gastric irritation & abdominal discomfort.

Evaluation
Patient have improved in nutritional status.

Nursing Diagnosis
Risk for injury (hemorrhage) R/T portal hypertension

Expected Outcome
Patient will have prevent chance of risk for injury.

Intervention
Assess for sign & symptom of GI bleeding. Check the conscious level of patient. Use small needle for injection, apply pressure on venipuncture site. Avoid to aspirin-containing products. Give the medication as by doctors order. injury.

Rational
To know the sign of internal To know the cerebral perfusion to hypovolemia, hypoxemia. To minimize damage risk to of tissues, bleeding. To prevent risk of hemorrhage. To prevent hemorrhage. reducing

Evaluation
Now patient is well he have not chance of risk for injury.

Nursing Diagnosis
Knowledge deficiency R/T disease process.

Expected Outcome
Patient will have adequate knowledge about disease condition.

Intervention
Assess the learning capacity of the patient. Encourage to patient for more verbalize. Listen patient's talk. Give knowledge about the disease including relatives. Give health education to patient & his family regarding diseases processes.

Rational
To make effective teaching program. To know the standard of knowledge condition. To know the doubt of patient. It increases knowledge and remove all doubts. To give adequate knowledge to patient & his family. about disease

Evaluation
Patient has adequate knowledge about disease processed.

HEALTH EDUCATION :
I give the health education to my patient & his family. I include several points in health education, they are given below : 1. I instructed to patient for follow up the medication which is prescribed by doctor.

2. 3. 4. 5. 6. 7. 8. 9.

I instructed to patient for taking high caloric diet which is rich in protein & vitamin diet for the early recovery. I told to patient for avoid spicy food & fatty diet I advised for proper rest & sleep to patient. I advised to stop heavy work. I instructed to patient to avoid bad habit. I told to patient for maintain proper hygiene. I instructed to patient & his family members if they have seen any complication then immediate contact with doctor. I gave the health education to patient & his relatives. I explain the all aspect of disease to patient & his family members.

STUDENT EVALUATION :
After going through the case as well as care of the patient, I came to know many things regarding cirrhosis of liver like risk factor, clinical manifestation, basic treatment & care of the patient with cirrhosis of liver.

Now I can care for a patient with cirrhosis of liver, with my own individual decision & can follow the doctor's order.

BIBILIOGRAPHY:
Bruner & suddharth's "text book of medical surgical nursing" 10th edition, 2006, page no. 1387- 1390.

 Mosby's, "text book for medical-surgical nursing" 7th edition, 2003, page no. 809-812. Joyce & black, medical surgical nursing, 8th edition, page no. 13471350. Lippincot, medical surgical nursing, 8th edition 2006, page no.12761280.