I.

INTRODUCTION

Liver Cirrhosis (alcoholic)

Cirrhosis of the liver is a chronic disease that causes cell destruction and
fibrosis (scarring) of hepatic tissue. Fibrosis alters normal liver structure and
vasculature, impairing blood and lymph flow and resulting in hepatic
insufficiency and hypertension in the portal vein. Complications include
hyponatremia, water retention, bleeding esophageal varices. Coagulopathy,
spontaneous bacterial peritonitis, and hepatic encephalopathy.

Cirrhosis is a potentially life-threatening condition that occurs when scarring

damages the liver. This scarring replaces healthy tissue and prevents the
liver from working normally. Cirrhosis usually develops after years of liver
inflammation. When chronic diseases cause the liver to become permanently
injured and scarred, the condition is called Cirrhosis. Cirrhosis harms the
structure of the liver and blocks the flow of blood. The loss of normal liver
tissue slows the processing of nutrients, hormones, drugs, and toxins by the
liver. Also, the production of proteins and other substances made by the liver
is suppressed. People with cirrhosis often have few symptoms at first. The
person may experience fatigue, weakness, and exhaustion. Loss of appetite
is usual, often with nausea and weight loss. As liver function declines, water
may accumulate in the legs and the abdomen (ascites). A decrease in
proteins needed for blood clotting makes it easy for the person to bruise,
bleeding or infection. In the later stages of cirrhosis, jaundice (yellow skin)
may occur, caused by the buildup of bile pigment that is passed by the liver
into the intestines. The liver of a person with cirrhosis also has trouble
removing toxins, which may build up in the blood. Drugs taken usually are
filtered out by the liver, and this cleansing process also is slowed down by
cirrhosis. People with cirrhosis often are very sensitive to medications and
their side effects. The doctor often can diagnose cirrhosis from the patient’s
symptoms and from laboratory tests. During a physical exam, the doctor
could notice a change in how your liver feels or how large it is. If the doctor
suspects Cirrhosis, you will be given blood tests. The purpose of these tests
is to find out if liver disease is present. In some cases, other tests that take
pictures of the liver are performed such as the computerized axial
tomography (CAT) scan, and ultrasound. The doctor may decide to confirm
the diagnosis by putting a needle through the skin (biopsy) to take a sample
of tissue from the liver. In some cases, cirrhosis is diagnosed during surgery
when the doctor is able to see the entire liver.
II. OBJECTIVES

 General objectives:

This case study focuses on the advancement of my skills in managing

and administering the extensive range of my intervention to my client
with Liver Cirrhosis. This study will further help me to expand my
knowledge about the said disease.

 Specific objectives:

1. To established good rapport to the client and to get the physical

assessment.
2. To define what is Liver Cirrhosis.
3. To trace the pathophysiology of Liver Cirrhosis
4. To enumerate the different signs and systems of Liver Cirrhosis
5. To formulate and apply necessary nursing care plans utilizing the
nursing process.

III. DEMOGRAPHIC DATA

Name: Mr. KM

Age: 47

Gender: Male

Status: Widowed

Nationality: Filipino

Religion: Catholic Christian

Blood type: B
Address: # 143 BLK3 Brown Wood Vill., Cainta

Final Diagnosis: Liver Cirrhosis

Time admitted: 12:15am

Date admitted: February 27, 2011

 CLINICAL ABSTRACT

This is the case Mr. KM, 47 y/o ,Male 143 BLK3 ,Brown Wood Vill., Cainta. He
was born on June 10, 1963. He has 2 children. Mr. KM is a non smoker and an
alcoholic beverages drinker.

Mr. KM was admitted to GAMMC on February 27, 2011

12:15am in the morning. He was admitted due to enlargement of his lower

extremities.

 HISTORY OF PRESENT ILLNESS

One week prior to admission the patient had experienced fast

enlargement of his lower extremities because of edema then he was
brought to the ER of GAMMC.

 FAMILY MEDICAL HISTORY

(+) Hypertension

 LIFE STYLE

A. Personal Habit

The patient does not smoke but drinks alcoholic beverages.

B. Diet

He eats three times a day and drinks 4-6 glass of water per day
and sometimes he always drinks soft drinks. The patient’s usual diet
 includes rice, meats like pork, beef, chicken and fish. According to
the patient, he seldom eats vegetables.

C. Recreational Activity

His talking with his friends outside the house during his free
time after he had finish the household choirs. Sometimes he play
basketball.

D. Sleep and Rest

He said that he spends 6 hours of sleep every night and he takes

naps if he had free time. He usually sleeps at 11:00 in the evening
and wakes up at 5:00 in the morning he said that it is continuous
and he feels refrehed after waking up.

E. Activities of Daily Living

The patient doesn’t work everyday, every Wednesday and Friday

he is serving the church cause his a church worker. Every weekend
he allotted time to rest and to have bonding with his family. But in
night time of his weekend he spend a lot of time drinking beers with
his male friends.

 PATIENT’S SOCIAL HISTORY

A. Family Relationship and Friends

The patient’s family is extended type together with his mother

and one son and one daughter. According to him he has a good
relationship with each member of him family and also with him
friends. He allotted time to bond with him family.

B. Occupational History

The patient is a church server/worker.

C. Economic History

According to the patient him being a church server/worker is an

additional income to them and it satisfies their needs.
 IV. PHYSICAL ASSESSMENT

Actual Findings Normal Findings Interpret

ation
 Head
• Skull -Normocephalic -Normocephalic -Normal
-No lumps -Smooth
-No lumps
-Absence of modules or
masses
-No area of tenderness
-Symmetrical with
protrusions on the lateral
part of parietal forehead
• Scalp -No nits, lice and dandruff and occipital bone. -Normal
-no baldness
-Whitish
• Hair -No nits, lice and dandruff
-no baldness -Normal
-Straight, Black with white
hair, oily hair -Black or brown in color
-Hair is evenly distributed
-No area of baldness
-Thick
-Fine
-Curly/kinky/straight
-Dry/oily/shiny hair
• Face
-Symmetrical with -Normal
movement
-Expressions appropriate -Symmetrical with
to situations movement
• Eyes
-Expressions appropriate -Normal
-Symmetrical to situations
-No cloudiness
-No Lacrimation -Symmetrical
-No protrusions
• Eyebrows -Dear or no Cloudiness -Normal
-Symmetrical -No excessive Lacrimation

-Moves symmetrically
• Eyelahes -Hair evenly distributed -Normal
 -Equally distributed -Skin Intact
-Curved slightly outward
• Eyelids -Equally distributed -Normal
-Skin intact -Curved slightly outward
-No discharge
-No discoloration -Skin intact
-Lids close symmetrically -No discharge
-approximately 15-20 -No discoloration
involuntary blinks per -Lids close symmetrically
minute; bilateral blinking -approximately 15-20
involuntary blinks per -Normal
-No secretions minute; bilateral blinking
-No erythema
-No redness -No scaling
-No secretions
• Lid margins -No erythema -Normal
-No redness
-Pink, shiny, with visible
blood vessels
-No discharges -Pink, shiny, with visible
• Lower blood vessels -Normal
palpebral -White in color -No discharges
conjunctiva -Clear
- No redness -White/yellowish in black
Americans
-Clear, No cloudiness -Normal
• Sclera -Flat -No redness
-Brown
-Round -Flat
-Transparent/Shiny -Brown
-light brown and yellowish
-Symmetrical
-Round -Normal
-PERRLA -Transparent/Shiny
• Iris
-PERRLA(Pupils Equally
Round, Reactive to Light
& Accommodation
-Normal
-Moves in unison
• Pupils
-coordinated
-Moves in unison
-coordinated -Normal

-Same as the color of the

• Eye face -Good peripheral vision
 Movement -No swelling -20/20 in both eyes -Normal
-Hell shape

-Parallel with outer

• Field of canthus of the eyes
vision -Same as the color of the
*Visual acuity face
- Waxy cerumen -No swelling
-Presence of cilia -No tenderness
• Ear -Hell shape -Normal
-With good hearing acuity -Firm cartilage
in both ears
• Hearing -Yellowish -Normal
acuity -Dry/waxy cerumen
-Presence of cilia
-No foreign body

-With good hearing acuity

in both ears
-No lesions -Normal
-Presence of cilia
• Ear -Symmetric and straight
Canal -No discharge or flaring
-Uniform color
-No tenderness -
-No lesions Decrease
-Darker lips -Presence of cilia of
-Ability to purse lips oxygen
-Uniform pink supply
color(darker, e.g,Bluish
• Lips
hue, in Mediterranean
groups and dark-skinned
clients)
-Soft, moist, smooth
-Pink, moist texture
-No swelling -Symmetry of contour -Normal
-No tenderness -Ability to purse lips
-No discharges -No tenderness
• Gums
-Pink, moist
-white -No swelling -Normal
-No tenderness
-No discharges
-No retraction(lower and
• Teeth upper)
 -Pink, even, rough dorsal -32 in number -Normal
surface and moist -White
-Upper teeth over-rides
• Tongue -Midline lower teeth
-pinkish -Normal
-With visible veins
-Pink, even, rough dorsal
• Frenulum surface and moist
-Pink, moist, no
swelling/No tenderness -Normal
-Midline
-pinkish
• Soft Palate -Bony, Light pink in color, -With visible veins
moist -Normal

-Pink, moist, no
• Hard Palate -Midline moves when the swelling/No tenderness
client says “Aah”

-Bony, Light pink in color,

• Uvula
moist

-Pinkish
-No discharge -Pink, moist -Normal
-No inflammation -Midline moves when the
• Tonsils
client says “Aah”

-Same as the skin color

-No lymphs, No mass -Normal
-Pinkish
 Neck -No discharge
-No inflammation

-Erect & midline

-Same as the skin color
-No tenderness
-No lymphs, No mass
-Symmetrical
-No abrasions or other -Muscles equal in size; -Normal
lesions head centered
-When pinched, skin -Coordinated, smooth
 Upper springs back to previous movements with no
Extremities state discomfort
• Skin - with edema
 -Varies from light to deep
brown; from ruddy pink to
light pink; from yellow
overtones to olive
-No edema
-No abrasions or other
lesions
-Convex curvature -Freckles, some -
• Nails -white birthmarks, some flat and accumul
raised nevi ation of
-When pinched, skin excess
springs back to previous fluid
state

-Convex curvature
-Smooth texture
 Chest and back -Highly vascular and pink -
• Posterior -No tenderness in light-skinned clients; Decrease
Thorax -No masses dark-skinned clients may O2
have brown or black supply
pigmentation in
longitudinal streaks
-Intact epidermis
-Prompt return of pink or
usual color(generally less
than 4 seconds)

-Full expansion
-Tachypnea -Chest symmetric
• Anterior -Skin Intact; uniform
Thorax temperature -Normal
-Chest wall intact
-No tenderness
-No masses
-Full and symmetric chest
-Unblemihed skin expansion
-Uniform color -Vesicular and
bronchovesicular sounds
-
 Abdomen
Difficulty
of
 breathin
g
-Quiet, rhythmic, and
effortless respirations
-Full symmetric excursion
-Bronchial and tubular
breath sounds in the
trachea
-Vesicular and
bronchovesicular breath
sounds
-Brown in color
- with edema -Unblemihed skin
 Lower - No abrasions or other -Uniform color
extremities lesions -Silver-white striae or
- with edema surgical scars
-Flat, rounded(convex),or
scaphoid (concave)
• Skin - Symmetric movements -Normal
caused by respiration
- Audible bowel sounds
- No tenderness
- Relaxed abdomen with
- Concave curvature smooth, consistent
-Brown pigmentation in tension
longitudinal streaks

-
• Nails accumul
ation of
excess
fluid

Varies from light to deep

- Repeatedly and
rhythmically touches the
nose
- Rapidly touches each
finger to thumb with each
hand
 Motor - Can readily determine
functions: the position of fingers and
toes
brown; from ruddy pink to
light pink; from yellow
overtones to olive
- No edema
- No abrasions or other
lesions
- Freckles, some
birthmarks, some flat and -Normal
raised nevi
- when pinched, skin
springs back to previous
 state

- Concave curvature
- Smooth texture
- highly vascular and pink
in light-skinned clients;
dark-skinned clients may
have brown or black
pigmentation in -Normal
longitudinal streaks
- Intact epidermis
- Prompt return of pink or
usual color (generally
less than 4 secs.)

Has upright posture and

steady gait with opposing
arm swing; walks unaided,
maintaining balance
- May sway slightly but is
able to maintain upright
posture and foot stance.
- Maintain stance for at
least 5 secs
- maintains heel-toe
walking along straight line
- Repeatedly and
rhythmically touches the
nose
- Rapidly touches each
finger to thumb with each
hand
- Can readily determine
the position of fingers and
toes

 GORDONDS

Before During Interpretation Analysis

 hospitalizatio hospitalizatio
n n

a. activity- According to During his He was not Exercise is

exercise him he does hospitalizatio able to very
pattern the n he is in perform the important to
- hobbies household complete bed activities our body
choirs and at rest. because of because it
the same the disease promotes
time it is her process. good health
way of and helps us
exercising build and
and he can maintain
perform healthy
different muscles,
activities. bones, and
joints and it
For the period reduces
Elimination of depression
pattern hospitalizatio The patient’s and anxiety.
Prior to n his elimination
hospitalizatio defecation pattern
n he does not vary changed Good
defecates but her urine during elimination
every day. output hospitalizatio pattern
She urinates decreases. n because reduces the
normal she is under risk of having
amount and medication. cancer. It
normal color. helps us to
urinates detoxify
waste in our
body to free
ourselves
from
Sleep and complications
rest pattern
Throughout Due to
his confinement
hospitalizatio the patient
Before he n sleeps 12 has no
sleeps 6 hours and problem with
hours every can take his sleep.
Cognitive- day naps. Enough and
perceptual good sleep
pattern and rest
 Due to pattern can
Same confinement reduce stress,
the patient helps us to
The patient is has no think better.
a 2nd year problem with
Self – high school understandin
perception undergraduat g Good
and self- e. he is education is
concept literate. important to
pattern During her overcome
hospitalizatio poverty.
n he is Due to
Prior to irritable confinement
hospitalizatio inside the he changed.
n he is not hospital.
that cheerful
and
approachable Good self-
Role- . perception
relationship and self-
pattern concept
Throughout Due to his pattern helps
his hospitalizatio us to
hospitalizatio n the family overcome
n his family is becomes problems and
The patient’s with his side closer to one trials.
family is at all times to another and
extended support his. become
type. They stronger. Good
are 4 in the relationship
family. They to each
are 4 in the member of
family to the family
bond. He is creates unity
sociable to and compact
everyone. relationship
with each
other. Good
Coping-stress relationship
tolerance with other
pattern people can
During his Her coping gain trust,
hospitalizatio stress is the acceptance,
n she just same as what support, and
prays every she is doing someone to
time she’s in before. Call On When
 Ever time he pain. You Need a
Health encounters Hand.
perception difficulties he
asks
guidance and
help from During his His health
God. hospitalizatio perception is Having a
n he still the same as good coping
believes that what she to stress can
health is believes overcome
According to wealth. before. stressors and
him health is depressions.
Sexuality- very
reproductive important
pattern because it is
wealth. Good health
perception
Same NA can maintain
health, the
body can
function
properly and
He don’t want it acts as
to talk about personal
Values- it. strength.
belief pattern

During his His values- Good

hospitalizatio belief pattern sexuality-
n her does not reproductive
husband and change and can easily
her always her faith to determine
prays for her God become the
Roman health. stronger. fertilization
Catholic. and can
They go to prevent
church every cancers in
Thursday and reproductive
Sunday. system.

Strong
values-beliefs
 help us to
overcome
difficulties
and trials.

V. ANATOMY
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. The liver, a dark reddish-
brown organ that weighs about 3 pounds, has multiple functions.
There are two distinct sources that supply blood to the liver:
 oxygenated blood flows in from the hepatic artery
 nutrient-rich blood flows in from the portal vein
The liver holds about one pint (13 percent) of the body’s blood supply at any given moment.
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).

VI. PATHOPHYSIOLOGY
VII. LABORATORY
IX. Discharge plan

Clients with Upper Gastrointestinal Bleeding are instructed to take the

following plan for discharge.

M- Medications should be taken regularly as prescribed, on exact dosage,

time, & frequency, making sure that the purpose of medications is fully
disclosed by the health care provider.
• FeSo4 + Folic acid TID
• Tranexamic acid 50gm/cap TID
• Omeprazole 40g/cap TID

E- Exercise should be promoted in a way by stretching hand and feet every

morning. Encourage the patient to keep active to adhere to exercise program
and to remain as self –sufficient as possible
- bed rest

T- Treatment after discharge is expected for patients and watcher with UGIB
to fully participate in continuous treatment.

H- Health teachings regarding the importance of proper hygiene and hand

washing, intake of adequate water and vitamins especially vitamin C-rich
foods to strengthen the immune response and increasing of oral fluid intake
should be conveyed. Avoid spicy foods, carbonated beverages and coffee.

O- OPD such as regular follow-up check-ups should be greatly encouraged to

clients with UGIB as ordered by physician to ensure the continuing
management and treatment.

D- Diet which is prescribed should be followed.

S- Pray for faster healing and don’t losses hope.

 Drug study
University of Perpetual Help College of Manila
214 V Concepcion Street Sampaloc Manila

Case Study: Upper Gastrointestinal Bleeding

Submitted to: Ms. Ma. Evelyn Lumio Submitted by:
William Roy Agoncillo A3D

Grp. 1 M-W
6am-2pm