Nursing care plan for a patient with lever cancer

Introduction:
Ms MCA, a 32-year-old female was evacuated from Guinea to the international university
hospital Sheikh Zaid, Morocco on September, 15 2015, at 03 Am with chief compliant of cramp
and chest pain, biological tests were normal but the liver ultrasound showed a probable hepatoma
or liver metastases. She was operated on May, 26 2010 for left mastectomy with axillary
dissection and bilateral oophorectomy taking 10 positive nodes of 14 collected following a
multifocal invasive ductal carcinoma grade III, poorly differentiated with hormone receptor
positive and HER2 negative. The lesion is classified PT3PN3MX. She was admitted HCZ on
02/07/10 for 1 times and she was under chemotherapy with Nolvadex for 5 years.
Readmitted to the HCZ on 03/29/13 for control had a good condition, she reported chest pain,
right breast and lymph nodes unremarkable.
Thoraco-abdominal CT scan, scintigraphy and laboratory tests were normal, she was ordered to
continue Nolvadex 1 tab/day.
Controlled at Kamsar hospital in Guinea on 02/11/14 she complained of some cramps. The locoregional exam seemed normal. Laboratory tests, as well as chest X-ray and liver ultrasound were
normal. Thoraco-abdominal CT scan was requested, the results did not show any abnormality.
Seven days prior to admission she was readmitted to Kamsar hospital in Guinea for cramps and
chest pain, biological tests were normal however, the liver ultrasound showed a probable
hepatoma or liver metastases.

TT: -doliprane 1GX 3 / d Primperan syrup if vmsmt

Tramal 50 1CP / 8 (21/09)

additiva

PATIENTS PROFILE

Clients name or Initials:

MCA

Age:

32 YEARS OLD

Civil Status:

Married + 2 children

Religion:

Islam

Address:

Conakry, Guinea

Birth Date and Place:

1984, Conakry

Race/Nationality:

Guinean

Usual Source of Medical Care:

HOSPITAL

Educational attainment:

3rd YEAR HIGH SCHOOL

Occupation:

Teacher

Chief Complaint:

Cramps and thoracic pain

Attending Physician:

DR. Mohamed Bouaajaji, M.D.

Admitting Diagnosis:

Suspicion of hepatoma or liver metastases

Gordons functional pattern of assessment

History of present illness
Seven days prior to admission the patient was readmitted to Kamsar hospital in Guinea for
cramps and chest pain, biological tests were normal however, the liver ultrasound showed a
probable hepatoma or liver metastases. Then she was evacuated to Sheikh Zaid hospital of
Morocco.
Medical history of past health
The patient underwent a left mastectomy with axillary dissection and bilateral oophorectomy on
May 26 2010, taking 10 positive nodes of 14 collected following a multifocal invasive ductal
carcinoma grade III, poorly differentiated with hormone receptor positive and HER2 negative.
She was admitted to Shiekh Zaid Hospital on July 02 2010 for the 1st time and she was under
chemotherapy with Nolvadex for 5 years.
Readmitted to Sheikh Zaid hospital on March 29 2013 for control, she reported chest pain, right
breast and lymph nodes unremarkable.
Thoraco-abdominal CT scan, scintigraphy and laboratory tests were normal, she was ordered to
continue Nolvadex 1 tab/day.
Controlled at Kamsar hospital in Guinea on 02/11/14 she complained of some cramps. The locoregional exam seemed normal. Laboratory tests, as well as chest X-ray and liver ultrasound were

normal. Thoraco-abdominal CT scan was requested, the results did not show any abnormality.

FUNCTIONAL PATTERN
Functional Pattern
Nutritional Pattern

Before Hospitalization
- MCA stated that she
has a loss of appetite

During
Hospitalization
Supplements and other
therapies

to

After
Hospitalization

support

optimal digestion and

nutrition, and help you
manage side effects.
Elimination Pattern

- Peed 4 to 6 times a day

- Defecated 1 time a day

- Pees 4 to 6 times a
day
- Defecates 1 time a
day

Activity/Exercise

- Upon interview, MCA

- She gets some times

Pattern

stated that she usually

out of her bed for a

do some exercises.

walk.

- Able to do ADLs

- Able to do ADLs

- MCA had sleep

- she sleeps 8 hours per

disturbances due to pain

day

Sleep/Rest Pattern

Cognitive/Perceptual
Pattern

Capable of reading
and writing.

No difficulty or

Capable of reading
and writing.

No difficulty or

problems in vision

problems in vision

or hearing,

or hearing,

Functional Pattern

Before Hospitalization

During
Hospitalization

Self-perception/Self-

- Patient MCA describes herself as a family

concept pattern

oriented person, kind, hardworking, and

After
Hospitalization

responsible.

Role-relationship
Pattern

- Patient MCA has 2 children and she has a good

relationship with her husband.

Sexuality-Reproductive - MCA has a good sexual relasionship with her

Pattern

husband. And she has 2 children.

Coping/Stress

Tolerance Pattern
Value/Belief Pattern

She talks with her husband about her problems and concerns.

- MCA is a Muslim, and she state that she do her 5

prayers every day at time.

Nursing Physical Assessment

MCA was alert and oriented to person, place and time. The patients temperature was 101 F,
pulse rate was 66, respirations were 18, blood pressure was 123/73, oxygen saturation on room
air was 100%, apical pulse was 66, lungs were clear, and the patient stated her pain level was
five. The patient has an IV line in her left arm. The patients skin was warm and dry with a
moderate bilateral handgrip. The patients surgical incision was from the umbilicus to suprapubic
with staples and was intact with no erythema. The patients bowel sounds were hypoactive and
stated no bowel movement today but had passed flatus. The urine output from 0600-0800 was
200ml. The patient was on a liquid diet starting September 16 2015 and changed to a regular diet

on September 20 2015. The patient ate 70% of her breakfast and stated she did not have much of
an appetite. MCA appeared frail and thin with some general weakness. The patients height was
57 (1.70m) and her weight was 105 lbs. (47.7 kg). The patient was ambulatory and was able to
perform independent activities of daily living.

DIAGNOSTIC AND LABORATORY FINDINGS

Actual Findings:
Procedure

Normal Values

Red Blood
Cell

4.50 5.50 x 10 12 /L

Hematocrit

Implications

9:50 PM
08/19/15
4.13

Decreased

0.37 0.47 L

0.36

Decreased

Hemoglobin

110.00 150.00 g/l

96

Decreased.

White Blood
celles

4.50 10.00 x 10 9 /L

4.6

normal

Procedure

Normal Values

Actual
Findings:
1:22 AM
08/19/15

Implicat

Blood Urea Nitrogen

0.2- 0.4 g/L

0.242 g/l

normal

Creatinine

6-12 mg/L

12.09 mg/l

Increased

Ionized Calcium

1.05 1.25 mmol/L

1.11 mmol/l

normal

Potassium

3.5 5.1 mmol/L

4.1

normal.

3 36 U/L

40

Increased

0 35 U/L

37

Increased

ALT

AST

Hepatic serology was negative

Bone biopsy under CT scan and scintigraphy: bone metastases of poorly differentiated carcinoma
Immunolabeling:
Antibody anti-CK 7 : negative
Antibody Anti-RE : positive
Antibody Anti hercept : score 2 + inviting a control for in situ hybridization

CLINICAL FINDINGS
SIGNIFICANT SIGNS AND SYMPTOMS:
Liver metastases
Pain in the upper abdomen on the right side; it extends to the back and shoulder
Swollen abdomen (bloating)
Weight loss
Loss of appetite and feelings of fullness
Weakness or feeling very tired Nausea and vomiting
Yellow skin and eyes, and dark urine from jaundice
Fever

PROBLEM LIST AND PRIORITIZATION

ACTUAL PROBLEM
RAN
K
1

PROBLEM
Imbalanced
Nutrition less than
body requirements

CUES
Wight 47.7 kg
Loss of appetite
Weakness

JUSTIFICATION
to identify deficits in
nutritional intake and adequacy

Nausea and vomiting

of nutritional state
provides calories for energy,
sparing protein for healing
to prevent edema and ascites
formation
decrease feeling of fullness,
bloating
reduce discomfort from
abdominal distension and
decrease sense of fullness
produced by pressure of
abdominal contents and ascites

Activity intolerance
related to fatigue
and weakness

Weakness
Hemoglobin count of 96

g/L
Lack of energy
Anemia with and RBC
count of 4.13

on the stomach
provide baseline for further
assessment and criteria for
assessment of effectiveness
of interventions
promotes exercise and
hygiene within patients level
of tolerance
stimulates patients interest in
selected activities
conserve energy
provides calories for energy

and protein for healing

Left mastectomy
Disturbed Body
Image/Self-Esteem

Loss of hair

Patient is very sensitive to body

changes and may experience
feelings of guilt when cause is
related to body emage.

POTENTIAL PROBLEM
RAN
K
1

PROBLEM

CUES

JUSTIFICATION
. In order to prevent the

Risk for infective

birthing pattern

Risk factors may include

risk for infective birthing

pattern, we must monitor

-Intra-abdominal fluid
collection (ascites)

respiratory rate, depth, and

effort.

-Decreased lung expansion,

accumulated secretions
-Decreased energy, fatigue
2

Risk for acute

confusion

Inability of liver to
detoxify certain
enzymes/drugs

Adverse drug reactions or

interactions (e.g., cimetidine
plus antacids) may potentiate
and/or exacerbate confusion

NURSING CARE PLANS

ASSESMENT

NURSING

PLANNING &

NURSING

CUES

DIAGNOSIS

OUTCOME

INTERVENTIONS

Subjective:
I cant eat
because of loss of
appetite, stated the
pt.
Objective:
(+) weight loss
(+) The patient ate
70% of her breakfast
-

Short term:

RAT

Independent:
-

After 7 hours of nursing Nutrition less than interventions, the pt

will verbalize
body requirements understanding and
related to anorexia, demonstrate behaviors
to maintain appropriate nausea and
nutrition.
vomiting evidenced
Long term:
by weight loss
Demonstrate
progressive weight gain
toward goal with
patient-appropriate
normalization of
laboratory values.
Imbalanced

Experience no further
signs of malnutrition.

Established rapport

To gain

coopera

with client and

family.

For bas

observe

Monitored VS.

distress
Measure dietary intake

Provides

by calorie count.

informat

Encourage patient to

needs an
Improve

eat; explain reasons for

diet is vi

the types of diet. Feed

Patient m

patient if tiring easily,

family is

or have SO assist

preferred

patient. Include patient

included

in meal planning to

possible

consider his/her
preferences in food
choices.

Dependent:
- Administered
medications as
prescribed by Doctor.

For the

pharma

manage

symptom

ASSESMENT

NURSING

PLANNING &

NURSING

CUES

DIAGNOSIS

OUTCOME

INTERVENTIONS

RAT

INEFFECTIVE AIRWAY CLEARANC

ASSESMENT CUES

Subjective:
MCA stated that she
has cramps.
Pain scale of 5
Objective:
She gets out of bed

NURSING

PLANNING &

NURSING

DIAGNOSIS

OUTCOME

INTERVENTIONS

Activity intolerance

Short term:

related to fatigue and

After 7 hours of

weakness as

nursing interventions,

evidenced by rare

the pt will report

movements

improved sense of

rarely
She is frail with

energy & perform

ADLs

general weakness

Independent:
- Established rapport
-

with pt and relatives.

Monitored VS.

RA

To gai

coope
For ba

assess
Encouraged adequate and
frequent bed rest
Minimized environmental

distres
To pro

conser

stimuli, dim lighting and

Hemoglobin count of

Long term:

96 g/L

After 1 day of nursing

promo

Lack of energy

interventions done,

conser

Anemia with and RBC

patient will be able to

count of 4.13

apply energy

ensure quiet environment

To fac

conservation
techniques.

RISK FOR INFECTION

RISK FOR ALTERED NUTNUTRITION: LESS THAN BODY REQUIREMENTS

ASSESMENT CUES

NURSING

PLANNING &

NURSING

DIAGNOSIS

OUTCOME

INTERVENTIONS

RA

Subjective:
I have lost my
appetite
As verbalized by pt.

Risk for altered

Independent:
- Determine pts ability

nutrition: less than

body requirements

Objective:
(+) Anorexia
(+) N/V
DRUG
NAME

ACTION

Generic
tamoxif
en
Dosage
1
tablette

- is an anti-

Route
Oral
Frequen
cy
QD

estrogen
that
prevents the
effects of
estrogens
on tissues.
The precise
mechanism
of its action
is unknown,
but one
possibility
is that it
binds and
blocks
estrogen
receptors on
the surface
of cells,
preventing
estrogens
from
binding and
activating
the cell.

INDICAT
ION
-

Women
taking
Nolvad
ex to
decreas
e the
risk of
develop
ing
breast
cancer
have
develop
ed
cancer
of the
uterus,
stroke,
and
blood
clots in
the
lung.

.
-

These

to chew, swallow and

can a

taste food.

and/o

nutrie
CONTRAINDI
CATION
Do NOT use
Nolvadex if:

ADVERSE
REACTION

amenorrhea,

vaginal
you are allergic to
discharge, hot
any ingredient in
flash, fluid
Nolvadex
you are using
Nolvadex to
reduce your risk
of breast cancer
and you have a
history of blood
clots in the lung
or leg
you are using
Nolvadex to
reduce your risk
of breast cancer
and you also take
certain
anticoagulants
(eg, warfarin)
you are taking
anastrozole

retention,
vaginal
hemorrhage,
nausea, weight
loss, and skin
changes. Other
side effects
include sepsis,
infection,
ostealgia,
increased serum
aspartate
aminotransferase
, cough,
oligomenorrhea,
edema, diarrhea,
constipation,
weight gain,
alopecia,
menstrual
disease, and
vomiting.

Assess understanding

of individuals
NURSING
nutritional needs.
RESPONSIBIL
ITIES
- Discuss food
Assess pts vital
preferences &
signs for baseline
intolerances.
data especially
- Encourage pt to
CBC
choose foods
Teach pt about
appropriate for her
the medications
prescribed diet.
action and
- Administer antipossible adverse
emetics as prescribed.
reactions.
Give a selection

. to de

inform
of pt.

To ap

client

To sti

To co

and v

greatl

appet

of foods that pt
likes.
Instruct patient
to immediately
report any
adverse
reactions.
DRUG
STUDY

DRUG
NAME

ACTION

Generic Is a
tramado centrally
acting
l
Brand
tramal
Dosage
1Tab
500mg
Route
Oral
Frequen
cy
TID

synthetic
opioid
analgesic.
Although
its mode of
action is not
completely
understood,
from animal
tests, at
least two
complemen
tary
mechanism
s appear
applicable:
binding of
parent and
M1
metabolite
to -opioid
receptors
and weak
inhibition
of reuptake
of
norepinephr
ine and
serotonin.

INDICAT
ION
Tramadol
is used to
treat
moderate
to severe
pain.

CONTRAINDICAT
ION

- Hypersensitivity,
acute intoxication

with any of the

following: alcohol,
hypnotics,
centrally acting
analgesics, opioids
or psychotropic
drugs. It may
worsen central
nervous system
and respiratory
depression in
these patients.

ADVERS
E
REACTI
ON
- Hives,

NURSING
RESPONSIBILI
TIES
-

vital signs for

swelling of

baseline data.

face, lips,
tongue or

medications

Dyspnea;

action and

mood

possible

swings;

adverse

depression;

reactions.

anxiety;
-

Do not crush
or chew,

hallucinati

swallow

ons;

whole.

Dizziness;
nausea

Teach pt about
the

throat;

irritability;

Asses patients

If advised to
stop, taper
dosage.

Store at a
room
temperature
area.

Do not handle
heavy
machinery

after taking
medication.
-

Instruct patient
to immediately
report any
adverse
reactions.

DRUG
NAME

Generic
Prednis
one

ACTION

INDICATI
ON

- Suppresses - SLE
the immune
system by
reducing
Dosage activity and
5mg
volume of
the
Route
lymphatic
Oral
system;
suppresses
Frequen adrenal
cy
function at
OD
high doses.
Antitumor
effects may
be related to
inhibition of
glucose
transport,
phosphoryla
tion, or
induction of
cell death in
immature
lymphocytes
. Antiemetic
effects are
thought to
occur due to
blockade of

CONTRAINDICA
TION

Hypersensitivity
Systemic fungal
infection

ADVERS
E
REACTIO
N
-

Fluid &
electrol
yte
imbalan
ces, Na
retentio
n, K
loss;
HPN;
CHF;
insomni
a; mood
swings;
persona
lity
changes
;
Muscle
weakne
ss;

NURSING
RESPONSIBILI
TIES
- Assess pts vital
signs for baseline
data.
- Monitor I & O
- Monitor pts
sleeping pattern
- Teach pt about
the medications
action and
possible adverse
reactions.
- Encourage
adequate bed rest.
- Advise pt to do
bedtime routine;
shower or a glass
of warm milk
- If ordered to
stop, taper
dosage.

cerebral
innervation
of the
emetic
center via
inhibition of
prostaglandi
n synthesis.

petechi

- If medication is

ae;

stopped monitor

vertigo;

for withdrawal

headac

syndrome; fever,

he;

arthalgia, malaise

indigest

- Report to

ion

physician any
mental change;

Classificatio
n
Glucocortic
oid

mood swings,
personality
changes.
- Instruct pt to
immediately
report any
adverse reactions.

DRUG
NAME

ACTION

Generic
Calciu
m
Carbon
ate

Neutralizes
hydrochlori
c acid in
gastric
secretions.
It also
inhibits the

Brand

INDICATI
ON

- Relief of
heartburn &
acid
Ingestion
-

CONTRAINDICA
TION

ADVERS
E
REACTI
ON

NURSING
RESPONSIBILI
TIES

- Hypersensitivity

- hives;

- Hypercalcemia

itching;

Vital signs for

dyspnea;

baseline data.

Assess pts

tightness

Monitor I & O

of chest;

Teach pt about

Caltrate
Plus

action of
pepsin by
increasing
the pH and
Dosage via
1 Tab
adsorption.
Neutralizati
Route
on of
Oral
hydrochlori
c acid
Frequen results in
cy
the
BID
formation
of calcium
chloride,
carbon
dioxide and
water.

Hypocalce

swelling

the

mia

of mouth,

medications

face, lips

action and

or tongue;

possible

confusion;

adverse

polyuria;

reactions.

loss of

Place in a high

appetite;

fowler/ sitting

mood

position of

changes;

DOB persists.

N/V;

constipati
on;

Classificati
on
- Calciu
m
supple
ment
- Antacid

Instruct to do
DBE.

Encourage

stomach

adequate bed

pain;

rest.

weakness

Report to
physician any
mental
changes; mood
changes.

Instruct to
report any
adverse
reactions.

DRUG
NAME

Generic
Sevela
mer

ACTION

- It contains
multiple
amines
separated
Dosage
by one
800 mg
carbon
from the
Route
polymer
Oral
backbone.
These
Frequen
amines
cy
exist in a
BID
protonated
form in the
intestine
and interact
with
phosphate
molecules
through
ionic and
hydrogen
bonding.
By binding
phosphate
in the
gastrointest
inal tract
and
decreasing
absorption,
sevelamer
carbonate
lowers the
phosphate
concentrati
on in the
serum
(serum
phosphorus
).

INDICATI
ON

CONTRAINDICA
TION

ADVERS
E
REACTI
ON

NURSING
RESPONSIBILI
TIES

- ESRD

- Hypersensitivity

-bloating;

- low phosphate

diarrhea;

vital signs for

levels

passing

baseline data.

- Ciprofloxacin or

gas; Tarry

mycophenolate

stools;

O; especially

mofetil decreases the

heartburn;

feces

medications effect

indigestio

characteristics.

n; N/V;

Assess pts

Monitor I &

Teach pt about

abdominal

the

pain;

medications

abdominal

action and

cramping;

possible

constipati

adverse

on;

reactions.

dyspnea;

acidity;

Instruct to take
with meals.

Do not break
or crush, if pt
is able,
medication
should be
swallowed.

If missed dose,
take it
immediately
unless its
almost time

for the next

Classificati
on
- Phosphate
Binders

dose.
-

If there is
presence of
DOB, place pt
in a high
fowler or
sitting
position.

Instruct to do
DBE.

Instruct to
report any
adverse
reactions.

DRUG
NAME

Generic
Captopr
il

ACTION

- blocks
the action
of ACE
which
Dosage produces
Tab angiotensi
25 mg
n II which
causes
Route
constrictio

INDICATIO
N

CONTRAINDICA
TION

- Hypersensitivity

Hyperten
sion

ADVERS
E
REACTI
ON

NURSING
RESPONSIBILI
TIES

Assess pts

Dizziness;

vital signs for

urinary

baseline data.

changes,

Monitor I&O.

oliguria or -

Instruct to take

polyuria;

1 hour before

Oral

n and
narrowing
Frequen of the
cy
blood
TID
vessels
thereby
increasing
blood
pressure.
By
blocking
ACE,
production
of
angiotensi
n II
decreases
allowing
the blood
vessels to
relax and
widen
resulting
in
decrease
blood
pressure.

SOB;
chest pain

meal.
-

Teach pt about

or

the

tightness;

medications

bradycard

action and

ia;

possible

bradypnea

adverse

reactions.

weakness;

Instruct to

fever;

increase fluid

chills;

intake.

cough;

Encourage

flushing;

adequate bed

loss of

rest.

taste

Instruct pt to

sensation;

immediately

itching;

report any

loss of

adverse

appetite

reactions.

Classificat
ion
- ACE
inhibitor
DRUG
NAME

ACTION

INDICATI
ON

CONTRAINDICA
TION

ADVERS
E
REACTI
ON

NURSING
RESPONSIBILI
TIES

Generic
Pantopraz
ole

Suppresse
s the final
step in
gastric
acid
productio
n by

- Increased
acid in
stomach

- Hypersensitivity

Dosage
40 mg
Route

Assess pts

- anti-diarrheal drugs Headache;

vital signs for

unless prescribed by

fever;

baseline data.

doctor.

stuffy
nose;

Monitor I &
O.

Oral
Frequenc
y
OD

covalently
binding to
the (H+,
K+)ATPase
enzyme
system at
the
secretory
surface of
the gastric
parietal
cell.
Inhibition
of both
basal and
stimulated
gastric
acid
secretion,
irrespectiv
e of the
stimulus.
The
binding to
the (H+,
K+)ATPase
results in
a duration
of
antisecret
ory effect
that
persists
longer
than 24
hours for
all doses
tested
Classificat
ion
- Proton
pump

sneezing;

Do not crush

sore

or chew

throat;

swallow it

stomach

whole.

pain; gas;

Teach pt about

N/V; mild

the

diarrhea;

medications

joint pain;

action and

urinary

possible

changes

adverse

oliguria or

reactions.

polyuria;

Encourage

convulsio

adequate bed

ns

rest.
-

Instruct to
report any
adverse
reactions.

inhibitor

DRUG
NAME

ACTION

Generic
Furosem
ide

- Inhibits
water
reabsorpti on in the
nephron
by
blocking
the
sodiumpotassiumchloride
cotranspor
ter
(NKCC2)
in the
thick
ascending
limb of the
loop of
Henle.
This is
achieved
through
competitiv
e
inhibition
at the
chloride
binding
site on the
cotranspor

Brand
Dosage
40 mg
Route
Oral
Frequen
cy
OD

INDICATI
ON

Fluid
retention
Hyperten
sion

CONTRAINDICA
TION

- Hypersensitivity
- Hypotension

ADVERS
E
REACTI
ON

NURSING
RESPONSIBILI
TIES

- diarrhea;

constipatio
n; stomach

signs.
-

pain;
dizziness;

Monitor vital
Monitor I &
O.

Encourage

headache;

adequate bed

hyponatre

rest.

mia,

confusion,
muscle

Assist in
ADLs

Teach pt

weakness,

about the

malaise;

medications

hypocalce

action and

mia,

possible

muscle

adverse

tightness,

reactions.

overactive

Instruct

reflexes;

relative to not

wt loss;

leave pt

oliguria;

unattended.

ter, thus
preventing
the
transport
of sodium
from the
lumen of
the loop of
Henle into
the
basolateral
interstitiu
m.
Conseque
ntly, the
lumen
becomes
more
hypertonic
while the
interstitiu
m
becomes
less
hypertonic
, which in
turn
diminishes
the
osmotic
gradient
for water
reabsorpti
on
throughout
the
nephron.
Because
the thick
ascending
limb is
responsibl
e for 25%
of sodium
reabsorpti
on in the

loss of

Instruct to

appetite;

immediately

jaundice;

report any

tinnitus

adverse
reactions.

nephron,
furosemid
e is a very
potent
diuretic.
Classificat
ion
- Loop
Diuretic

DRUG
NAME

ACTION

Generic
Acetylsali
cylic
Acid;
ASA

- Inhibit the
synthesis of
prostaglandi
ns,
important
mediators of
inflammatio
n.
Antipyretic
effects are
not fully
understood,
but aspirin
probably
acts in the
thermoregul
atory center
of the
hypothalam
us to block
effects of
endogenous
pyrogen by
inhibiting

Dosage
80 mg
Route
Oral
Frequency
OD

INDICATI
ON

CONTRAINDIC
ATION

Pain
reliever
Inflamm
ation
Fever
ACS

Hypersensitivit
y
Hypersensitivit
y to NSAIDs

ADVERS
E
REACTI
ON
- upset

NURSING
RESPONSIBIL
ITIES
-

signs.

stomach;
heartburn;

Teach pt
about the

headache;

medications

tinnitus;

action and

mental

possible

changes,

adverse

confusion

reactions.

and
hallucinati

Monitor I &
O.

drowsines
s; mild

Monitor vital

Do not crush

ons; rapid

or chew,

breathing;

must

N/V;

swallow

fever;

whole.

synthesis of
the
prostaglandi
n
intermediar
y. Inhibition
of platelet
aggregation
is
attributable
to the
inhibition of
platelet
synthesis of
thromboxan
e A2, a
potent
vasoconstric
tor and
inducer of
platelet
aggregation.
This effect
occurs at
low doses
and lasts for
the life of
the platelet
(8 days).
Higher
doses
inhibit the
synthesis of
prostacyclin
, a potent
vasodilator
and
inhibitor of
platelet
aggregation.
Classificatio
n
- Analgesi
cs
- Anti-

tarry

Administer

stools;

with meal if

increased

it causes GI

bleeding

disturbances

time

in pt.
-

If pt will
undergo
surgery, tell
surgeon/
physician
that pt is
taking
aspirin.

Report to
physician
mental
changes such
as confusion
and
hallucination
s.

If fever
persists
report to
physician.

Encourage
adequate bed
rest.

Assist in
ADLs

Instruct pt to

DRUG
NAME

inflamm
atory
Platelet
aggregat
ion
inhibitor
s

ACTION

Generic Ticagrel Ticagrelor

or
and its
major
Dosage metabolite
90 mg
reversibly
interact
Route
with the
Oral
platelet
P2Y12
Frequen ADPcy
receptor to
BID
prevent
signal
transductio

immediately
report any
adverse
reactions.

INDICATI
ON

CONTRAINDICAT ADVERS
ION
E
REACTI
ON

NURSING
RESPONSIBILI
TIES

- ACS

Hypersensitivity
Any active
bleeding
problems

signs.

headache;
mild

Teach pt about
the

dizziness;

medications

cough;

action and

N/V;

possible

diarrhea;

adverse

bleeding

reactions.

tendencies
; bloody/

Monitor Vital

Should be

n and
platelet
activation.
Ticagrelor
and its
active
metabolite
are
approximat
ely
equipotent.

tarry

administered

stools;

with aspirin.

Classificati
on
- Platelet
inhibitor

fever;

coughing

Bleeding

up blood;

precautions,

chest

avoid sharp

pain;

edges by

weakness;

putting

pale skin;

padding.
-

Encourage

jaundice;

adequate bed

SOB

rest.
-

Provide a
therapeutic
environment,
room temp and
bedsheets
clean.

If patient has
SOB, instruct
to do DBE.

Assisst in
ADLs

Instruct to
immediately
report any
adverse
reactions.

DRUG
NAME

ACTION

INDICATI CONTRAINDICA
ON
TION

Generic
- The
- Nausea &
Domperid antiemetic
vomiting
one
properties of
domperidone
Brand
are related to
its dopamine
receptor
Dosage
blocking
1 Tab
activity at
both the
Route
chemorecept
Oral
or trigger
zone and at
Frequenc the gastric
y
level. It has
TID
strong
affinities for
the D2 and
D3 dopamine
receptors,
which are
found in the
chemorecept
or trigger
zone, located
just outside
the blood
brain barrier,

- Hypersensitivity

ADVER
SE
REACTI
ON
-

NURSING
RESPONSIBILI
TIES
-

signs.

headache;
dry

medications

mastalgia

action and

; pruritus;

possible

stomatitis

adverse

reactions.

asthenia;
-

Proper oral
hygiene care.

irritabilit
y;

Teach pt
about the

flushes;

N/V;

Monitor I &
O.

mouth;
hot

Monitor vital

Encourage

nervousn

adequate bed

ess;

rest.

edema;
abdomina

Provide a safe
and
therapeutic

which among others

- regulates
nausea and
vomiting.

l cramps;

environment,

constipati

place side

on;

rails up,

malaise;

adjust room

Classificatio
n

weakness

temp, quiet,

; dysuria;

and dim lit.

palpitatio

Antiemetic
Dopamin
ergic
blocking
agent

ns

Assist in
ADLs

Instruct
relative to not
leave pt
unattended.

- Instruct pt to
immediately
report adverse
reactions.

DISCHARGE PLANNING
Medication
-

Should be taken regularly as prescribed, strictly follow exact dosage, time, & frequency,
making sure that the patient and relatives fully understand the importance of taking
medications.

Instruct patient and relatives to immediately report any side effects/adverse reactions.

Exercise

Exercise at least 30 minutes daily.

Should be promoted in a way by stretching all body parts every morning. Patient should
be encouraged to keep active through light exercises.

Maintain rest periods in between activities.

Treatment
-

Hemodialysis Treatment should still be followed. 2 x a week.

Health Teaching
-

Adhere to treatment regimen. Adherence to treatment regimen is essential in order to

prevent relapse. Most common cause of relapse is loss to compliance. Medications should
be administered at proper times and with proper dosages.

Rest when you feel it is needed. Slowly start to do more each day. Return to your daily
activities as directed.

Protect your skin from UV light. Sunlight can make your lupus symptoms worse. Avoid
the sun between 10 am and 4 pm, when the rays are strongest. Apply sunscreen with a
SPF of 30 or more every 2 hours when you are outside. Do this even on cloudy days.
Wear pants and long sleeves to cover your body. A hat with a wide brim can protect your
face, head, and neck.

Eat healthy foods. Healthy foods include fruits, vegetables, whole-grain breads, low-fat
dairy products, beans, lean meats, and fish.

Exercise. This will help decrease your symptoms and prevent depression. At least for 30
minutes.

Maintain a healthy weight. Ask your primary healthcare provider how much you should
weigh. Ask him to help you create a weight loss plan if you are overweight.

Do not smoke. If you smoke, it is never too late to quit. Ask for information about how to
stop smoking if you need help.

Manage your stress. Stress may slow healing and lead to illness. Learn ways to control
stress, such as relaxation, deep breathing, and music. Talk to someone about things that
upset you.

Out Patient
-

Follow-up check-up as ordered by the physician should be greatly encouraged for the
patient to determine if his progression on treatment, and if he will have to continue on his
medications/treatments which were ordered during hospitalization.

Come back 2x a week for hemodialysis.

Diet
-

Increase fluid/water intake, should be 8 glasses/day.

Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy products,
beans, lean meats, and fish.

Spiritual
-

Encourage family and friends to pray and remain by patients side.

Encourage client to build a strong faith and intimacy with God through prayers.

Encourage to attend mass and prayer sessions with family, for added emotional and
spiritual support.

Advise to continue spiritual practices.

The liver is located in the upper right-hand portion of the abdominal cavity, beneath the
diaphragm, and on top of the stomach, right kidney, and intestines. Shaped like a cone, the
liver is a dark reddish-brown organ that weighs about 3 pounds. There are two distinct sources
that supply blood to the liver, including the following:oxygenated blood flows in from the
hepatic artery nutrient-rich blood flows in from the hepatic portal vein The liver consists of
two main lobes, both of which are made up of thousands of lobules. These lobules are
connected to small ducts that connect with larger ducts to ultimately form the hepatic duct.
The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine).
Cancer is uncontrolled replication of damaged cells. This condition usually produces a mass
called a tumor. Cancer is a direct result of either a mutation of the cellular DNA or some sort
of damage to the cellular DNA. For the cancerous cells actually develop into tumor, it must be
able to grow and to replicate itself .A cancerous cell that cannot grow or make a copy of itself
will die or lick dormant for an extended period.
> Carcinogenesis is a multistage process that begins when a carcinogen causes a genetic
change or damages the DNA in a normal cell. This makes the cell more vulnerable to

other genetic changes. This stage is called "initiation." If the process ended here, and the
cancerous cell did not grow and replicate, no cancer would form. The next stage of
carcinogenesis is called "promotion." This occurs when the initiated cell is exposed to an
agent that enhances its growth into a larger mass. When a tumor actually forms, it has all of
the same basic needs as a normal cell. Because the tumor cells are genetically damaged, they
are inefficient and rob normal cells of important oxygen and nutrients. In addition, a
malignant tumor grows uncontrollably and can eventually interfere with the function of vital
organs, such as the liver.
Metastatic tumors form when large progressive tumors shed tumor cells. These tumor cells
must be able to grow and function apart from the primary tumor Move throughout the body,
usually through the circulatory system or the lymphatic system. Often lodge in a blood
capillary, where they may or may not grow. The tumor cells that actually grow are somehow
more suited to the new location. Tend to mutate more quickly than normal cells, giving them
a greater ability to adapt to their environment as well as a greater ability to resist therapy.
More likely to infect places they can easily reach. Because the liver is close to or actually
connected to several significant organs, and because the liver plays an important role in blood
circulation by acting as a filter, metastatic liver cancer occurs in over 75% of all terminal
cancer patients.
Causes: Primary liver cancer (hepatocellular carcinoma) alcohol abuse chronic infection
with diseases such as hepatitis B and C hemochromatosis (too much iron in the liver)
cirrhosis (a scarring condition of the liver. Other risk factors include
SEX
(Men are more likely to get hepatocellular cancer than women)
Anabolic steroids

(Male hormones used by athletes to increase muscle can slightly increase liver cancer risk
with long-term use)
Birth control pills

Liver Cancer Symptoms

Liver cancer is sometimes called a "silent disease" because in an early stage it often does not
cause symptoms. However, as the cancer grows, symptoms may include: Pain in the upper
abdomen on the right side; the pain may extend to the back and shoulder Swollen abdomen
(bloating) Weight loss Loss of appetite and feelings of fullness Weakness or feeling very
tired Nausea and vomiting Yellow skin and eyes, and dark urine from jaundice
Fever

Nursing Management
Watch out for potential problem related to cardiopulmonary involvement include vascular
complications and respiratory and liver dysfunction. Careful attention to metabolic
abnormalities* Patient undergo cryosurgery should monitored closely for: > Hypothermia>
hemorrhage or bile leak> myoglobinuria may occur as a result of tissue necrosis

.
Nursing diagnosis
Activity intolerance related to fatigue and weakness
Planning

Patient will report decrease in fatigue and increased ability to participate in activities
Intervention
Assess level of activity tolerance and degree of fatigue and malaise
Assist with activities and hygiene
Assist with selection and pacing of desired activities and exercise
Encourage rest when fatigued felt
Advice diet high in carbohydrates with protein intake
Rationale
provide baseline for further assessment and criteria for assessment of effectiveness
of interventions
promotes exercise and hygiene within patients level of tolerance
stimulates patients interest in selected activities
conserve energy
provides calories for energy and protein for healing

Evaluation
improved nutritional status by increased weight without fluid retention
identifies foods in carbohydrates and within protein requirements
report improved appetite
Nursing diagnosis
Imbalanced Nutrition less than body requirements related to abdominal distention and loss
of appetite
Planning
to meet nutritional requirements

Intervention
Assess dietary intake and nutritional status through diet history
Advice diet high in carbohydrates with protein intake
Advice patient of low sodium foods
Provide smaller, frequent meals
Elevate the head of the bed during meals
Rationale
to identify deficits in nutritional intake and adequacy of nutritional state
provides calories for energy, sparing protein for healing
to prevent edema and ascites formation
decrease feeling of fullness, bloating
reduce discomfort from abdominal distension and decrease sense of fullness produced by
pressure of abdominal contents and ascites on the stomach

Nursing Diagnosis

Disturbed Body Image/Self-Esteem

May be related to

Biophysical changes/altered physical appearance

Uncertainty of prognosis, changes in role function

Personal vulnerability

Self-destructive behavior (alcohol-induced disease)

Possibly evidenced by

Verbalization of change/restriction in lifestyle

Fear of rejection or reaction by others

Negative feelings about body/abilities

Feelings of helplessness, hopelessness, or powerlessness

Desired Outcomes

Verbalize understanding of changes and acceptance of self in the present situation.

Identify feelings and methods for coping with negative perception of self.

Nursing Diagnosis

Risk for acute confusion

Risk factors may include

Alcohol abuse

Inability of liver to detoxify certain enzymes/drugs

Desired Outcomes

Maintain usual level of mentation/reality orientation.

Initiate behaviors/lifestyle changes to prevent or minimize recurrence of problem.