HOW TO TERMINATE MITES

KATE B. SMITH
AULYN B. TANACIO
HANNAH LHYNE O. TAYAB
ROSANA L. TIANZA
ABELYN C. TIO-TIO
KENDRA B. TIWAKEN
JAZZYL KETH S. TONGAB
KRISTA DEE D. WAGAWAG
SHARALINA C. WALISEN

BENGUET STATE UNIVERSITY

LA TRINIDAD, BENGUET

BACHELOR OF SCIENCE IN NURSING

MARCH 2019
 ABSTRACT

Title: A CASE STUDY ON MASSIVE ASCITES

Authors: Nicoleen Mae D. Sibayan, Kate B. Smith, Aulyn B. Tanacio, Hannah Lhyne O. Tayab, Rosana L.
Tianza, Abelyn C. Tio-tio, Kendra B. Tiwaken, Jazzyl Keth S. Tongab, Krista Dee D. Wagawag, Sharalina C.
Walisen, BSN IV

Keywords: Decompensated, liver, cardiovascular disease, HC IIC, hemorrhage

Overview of the Case: Patient Bvm’s condition started two years ago, when patient underwent repair of
inguinal hernia and angiography due to infection with emergency evacuation of scrotal hemorrhage few
days after first surgery. Since then, patient noticed increasing abdominal girth with associated oliguria
and urinary frequency. Six months prior to admission, patient’s symptoms persisted that urged him to
seek consultation at the Out Patient Department (OPD). Parenthesis was done to decrease fluid
accumulation in the abdominal area that provided a temporary relief. One week prior to admission,
complaints of haemorrhage in scrotal area then sought consultation in our institution and testing was
done. However sudden movement of the patient increased bleeding and stitching was done. This
prompted patient to seek consultation for further evaluation and management.

Abridged Drug Study: Treatment was given such as Lactulose to treat constipation and help to eliminate
ammonia in the blood via the stools to prevent hepatic coma encephalopathy. Tramadol is given also to
manage the client complaint of severe pain. Spironolactone is given to the client mainly because of
edema due to liver cirrhosis and also this is given to the client of high blood pressure this was prescribed
because it is potassium sparing diuretic; this drug can decrease blood pressure at the same time it can
prevent the eliminating of potassium.Laboratory test such as Complete blood count (CBC) may be
ordered to evaluate a patient’s red and white blood cells and platelets; anemia may be present if
bleeding has occurred, and platelets are often decreased with cirrhosis. Alanine aminotransferase (ALT)
is an enzyme found mainly in the liver. Values are increased with all types of liver injury, including
cirrhosis. Alkaline phosphatase (ALP) is an enzyme found along bile ducts. ALP is usually normal or mildly
elevated in cirrhosis.

Course in the by Ward: January 27, 2019: Patient is a known case of massive ascites secondary to
decompensated liver disease, HCVD in HCIIC, accompanied by his son. The patient was admitted
because of persistent increase of abdominal girth associated with oliguria and urinary frequency. After
admission, patient claims to experienced further increase in abdominal girth, severe pain, and unstable
blood pressure. Patient was showed some signs and symptoms of weakness, cold and clammy
extremities.

Conclusions: Massive ascites is a serious condition that needs immediate medical intervention. The
prognosis for patient with ascites due to liver disease depends on the underlying disorder, the degree of
reversibility of a given disease process, and the response to treatment. Ascites tends to occurs in a long
standing rather than in short lived disorders. It occurs commonly in cirrhosis, especially in cirrhosis
caused by alcoholism. It may occur in other liver disorders, such as severe alcoholic hepatitis without
cirrhosis, chronic hepatitis, and obstruction in the hepatic vein.

In the case of patient BVM with liver disease, development of ascites is an important landmark in the
natural history of cirrhosis. Adequate management of ascites is important, not only because it improves
quality of life in patients with cirrhosis, but also prevents serious complication such as SBP. However,
treatment of ascites does not significantly improve survival. Therefore, development of ascites should
be considered as an indication for transplantation. Liver transplantation is the ultimate treatment of
ascites and its complications.

Recommendations: The researchers recommend that the healthcare provider (HCP) be aware and
inform that liver disease is the leading cause of ascites. However, many serious conditions can lead to
the build-up of fluids in the abdomen. It is highly recommended to the patient to follow the discharge
plan given such as promote healthy diet especially sodium restrictions. Although dietary sodium should
be restricted to levels lower than urinary sodium excretion, sodium restriction to 2 g per day is realistic
goal particularly in an outpatient setting. Take diuretics as recommended by doctors. Patient should
limit the use of all medications including over-the-counter drugs, unless recommended by the doctors.
Bed rest is recommended for patients with ascites on the basis that upright posture increases
aldosterone levels, which is associated with sodium retention.

TABLE OF CONTENTS

Title Page . . . . . . . . . . . 1
Abstract . . . . . . . . . . . 2
Table of Contents . . . . . . . . . . 4
Acknowledgements . . . . . . . . . . 5
General Profile . . . . . . . . . . . 6
A. Chief Complaint . . . . . . . . . 6
B. Admitting Diagnosis . . . . . . . . 6
C. History of Present Illness . . . . . . . . 7
D. Past Medical History . . . . . . . . 7
E. Social and Environmental History . . . . . . . 7
F. Family History (Genogram) . . . . . . . . 8

Physical Examination . . . . . . . . . . 9
A. Review of Systems . . . . . . . . . 9-20
B. Gordon’s Typology Of 11 Functional Health Patterns . . . . . 21-22

Diagnostic and Laboratory Procedure . . . . . . . . 23-29

Case Study . . . . . . . . . . . 30-32

Pathophysiology . . . . . . . . . 30
Treatment. . . . . . . . . . . . 33-39
Discharge Plan . . . . . . . . . . . 40-42
Conclusions and Recommendations . . . . . . . . 43-44
Nursing Care Plans . . . . . . . . . . 45
References . . . . . . . . . . . 46

ACKNOWLEDGEMENT

We, the Group U Level IV nurse learners, would like to express our gratitude to all the people who, read
and offered comments and remarks in editing this case study especially Ma’am Doris Natividad.

This case study wouldn’t be possible without the aid of the following:

To Sir Gerard Rebolledo who guided us during our clinical duty and selecting a patient for our case
study.
 To our parents and guardians who have always been supportive all throughout the start of the
duty until the end.

Lastly, to God, for giving us the strength and wisdom in realizing and fulfilling our duties in the
clinical area.

GENERAL PROFILE

A. Personal Profile:

Name: Bvm

Age: 48

Sex: Male

Marital Status: Married

Occupation: Laborer

Address: Baguio City

Educational Attainment: High School

Nationality: Filipino

Religious Affiliation: Roman Catholic

Date of Birth: September 3, 1970

Place of Birth: Baguio City

A. Chief Complaint
Patient Bvm, a 48-year-old male, was accompanied by his mother for his medical check-
up due to abdominal pain on January 17, 2019.

B. Admitting Diagnosis

Massive ascites secondary to decompensated liver disease, hypertensive cardiovascular

disease in HC IIC.

C. History of Present Illness

Patient Bvm’s condition started two years ago, when patient underwent repair of inguinal
hernia and angiography due to infection with emergency evacuation of scrotal hemorrhage few
days after first surgery. Since then, patient noticed increasing abdominal girth with associated
oliguria and urinary frequency.
Six months prior to admission, patient’s symptoms persisted that urged him to seek
consultation at the Out Patient Department (OPD). Parenthesis was done to decrease fluid
accumulation in the abdominal area that provided a temporary relief.
One week prior to admission, complaints of hemorrhage in scrotal area then sought
consultation in our institution and testing was done. However sudden movement of the patient
increased bleeding and stitching was done. This prompted patient to seek consultation for further
evaluation and management.
D. Past Medical History
 Patient was admitted in the year 2017, hence underwent repair of inguinal hernia and
angiography. Few days after his surgery an emergency evacuation of scrotal hemorrhage was
done due to infection. Since then, he noticed an increasing abdominal girth with associated
oliguria and urinary frequency. He then consulted at the Out Patient Department due to persistent
increase of abdominal girth.

E. Social and Environmental History

Patient Bvm is a high school graduate at Baguio City National High School. Their house is located
at San Carlos Irisan, Baguio City where he lives with his family. To augment his family’s needs, he worked
as a laborer. Whenever someone calls for a workman, he volunteers himself. He stated that sometimes
he drinks liquor with his colleagues after