Care Plan
Patient: is a 55-year-old male, came into the hospital confused and incontinent, stated he had pain in his abdomen but could not state where exactly, pointed to the whole abdomen. Patient lives at home with a friend in an apartment that had beer bottles all over his apartment. Patient drinks 24 beers a day and smokes a pack a day. Blood tests were done when patient was admitted into the hospital: ammonia levels were high (79), Hemoglobin was low (105), Platelet count low (113), Magnesium normal (0.60), Potassium normal (4.9), Sodium normal (141), urea normal (4.0), ALT high (76), leukocytes high (8.1)
Nursing Diagnosis: Hepatic Encephalopathy secondary to cirrhosis due to alcohol abuse
Primary Diagnosis: Hepatic Encephalopathy-
…show more content…
· Occurs when the liver cannot detoxify ammonia and the ammonia enters the systemic circulation, which circulates to the brain (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2014).
· It is a neuropsychiatric manifestation of liver damage (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2014) (Miyoshi, K. & Morimura, Y., 2010).
Pathophysiology:
· Ammonia is a bacterial and enzymatic deamination of amino acids in the intestines (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2014).
· The ammonia that is created then goes to the liver through the portal circulatory and is converted to urea, which in the excreted by the kidneys. (when the liver is working normally and not damaged) (Gallbladder and hepatic portal system, 2014)
· When the liver is damaged and unable to covert ammonia to urea, the ammonia level builds up in the systemic circulation due to shunting of blood, passed the liver. The ammonia then crosses the blood brain barrier and produces neurotic manifestations (Lewis, Dirksen, Heitkemper, Bucher, & Camera,
2014) Main Concerns/Interventions · To lower the ammonia levels by putting the patient on laxatives to help flush the toxins out of the patient’s system, as ammonia is drawn into the colon and then removed through feces. · Putting the patient on a low protein diet as a lot of protein increases ammonia levels · Reducing psychosis by reducing ammonia levels · Risk of portal hypertension due to alcoholic cirrhosis possibly leading to bleeding- would use fall risk preventions, such as proper foot wear, making sure 1-2 people assist the patient when patient stands up, ensure patient uses a walker, ensure bed alarm is on, ensure bedrails are up at all times, call bell is in reach.
HPI: MR is a 70 y.o. male patient who presents to ER with constant, dull and RUQ abdominal pain onset yesterday that irradiate to the back of right shoulder. Client also c/o nauseas, vomiting and black stool x2 this morning. He reports that currently resides in an ALF; they called the ambulance after his second episodes of black stool. Pt reports he drank Pepto-Bismol yesterday evening without relief. Pt states that he never experienced similar symptoms in the past. Denies any CP, emesis, hematochezia or any other associated symptoms at this time. Client was found with past history gallbladder problems years ago.
...oermann et al, 2005). This has a tendency to lead to an insecure sense of one’s self. (Hoermann et al, 2005) A person with this disorder has a difficult time being reliable. This can be from constant career change, relationships and goals. These essential changes occur without any warning. (Hoermann et al, 2005)
The kidneys are located in the posterior section of the retroperitoneal cavity and are small, dark red kidney-bean shaped organs in the lower part of the rib cage (Marieb, The Urinary System, 2015). They are undervalued organs considering how essential they are for the body’s ability to maintain homeostasis. The kidneys filter about 120-150 quarts of blood to produce about 1-2 quarts of urine each day (NIH, 2014). Blood initially enters the kidneys through the renal artery. It then flows into the segmental artery before moving into the interlobar artery. From the interlobar artery the filtrate enters the arcuate artery before branching into the cortical radiate artery, which feeds into the afferent arteriole, before passing into the glomerulus where it begins to filter out waste. The filtered waste is then collected by renal tubule. The tubules drain to collecting ducts and all of these components together makes up a small unit called a nephron. Each kidney has over a million nephrons (Marieb, Blood Supply/ Nephrons, 2015). They filter out wastes that run through different body systems via blood; the majority of that waste is nitrogenous wastes, toxins, excess fluids, electrolytes, and drugs. These waste products are eliminated as urine. While waste are removed vital enzymes, hormones, and water are returned
A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
The patient is a 30 year old male with an active bacterial infection on his right leg attacking his Integumentary system. The patient is from Tanzania, Africa but came back to work in a factory that produces plastic. If he has Cellulitis, it can get bad enough to travel to other organs like the Liver and Kidney and cause failure. If this happens, Edema can form, usually on one half of the body; this is the Urinary system being attacked. The main system being attacked is the Lymphatic system because Cellulitis attacks the lymphatic draining system. For Cellulitis to travel to organs, it had to go through the blood, so the cardiovascular system is also in effect.
Dr. Bennet Omalu founder of Chronic Traumatic Encephalopathy (CTE) is a highly respected and renowned physician in medical communities around the world with high-level credentials to support his many accolades. Accordingly, Dr. Omalu’s achievements resulted in him becoming a Board Certified Physician Executive, which means that he has attained prominence in the medical community by surpassing the level of expertise in his field (UCDH 2-4). In 2005, Dr. Omalu caused disruption in the National Football League (NFL) with his research linking repetitive head trauma to Neuro-degenerative disease (Omalu, Hamilton et al 40). The medical term Neuro-degenerative covers a wide-range of medical conditions that affects the nerve cells in the brain,
Nurnberger JI Jr, Wiegand R, Bucholz K, O'Connor S, Meyer ET, Reich T, Rice J, Schuckit M, King L, Petti T, .Arch Gen Psychiatry. 2004 Dec; 61(12):1246-56.
Parton, A., Malhotra, P., & Husain, M. (2004). Hemispatial Neglect. J Neurol Neurosurg Psychiatry, 13-21. Plummer, P., Morris, M. E., & Dunai, J. (2003). The 'Secondary' of the 'Secondary'.
that caused seizures, hemiparesis, and dementia normally in the first ten years of life. The seizures that
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
Think about it, an average teen in this world has just been diagnosed with a type of incurable dementia which will forever change his or her life. Frontotemporal dementia (FTD) is one of the less common forms of dementia. It is when the nerve cells in the frontal lobe die and over time the brain tissue shrinks. Frontotemporal dementia is mostly found in people who are in their teens or twenties. It can affect young people in a very negative way. They start to get aggressive and as the disease gets worse they lose friends and have a difficult time in school and understanding things. Frontotemporal dementia is a rare disease that is on the rise and affects the people of the younger generation.
What is hepatic cirrhosis? According to the medical dictionary hepatic cirrhosis is when scar tissue replaces the liver’s healthy tissue. This disease changes the structure of the liver and blood vessels that nurture it. It reduces the liver’s capability to produce proteins and process hormones, nutrients, medications, and poisons. Cirrhosis is an illness that gets worse over time and possibly can become life threatening. This serious illness is ranked as the ninth leading cause of death in the U.S. It is the third most common cause of death for adults between 45 and 65 years of age. It occurs in more than fifty percent of undernourished chronic alcoholics. Unfortunately it kills about 35,000 people per year. In other country’s such as Africa and Asia death from cirrhosis is usually caused by hepatitis B.
The filtered blood leaves the kidney along the renal veins. The filtered waste products are excreted by the kidney as urine. A narrow tube called the ureter carries urine from the kidney to the bladder. From there the urine is excreted through a single tube, called the urethra. Kidney structure: If you cut a section through the kidney, three areas can be seen:
It has three functions which are to act as a food reserve, to break down food further whilst mixing it with digestive juices and to start protein digestion (Aspinall and Cappello, 2009). There are gastric pits within the gastric mucosa that produce hydrochloric acid, mucus and pepsin. The process of breaking down and mixing the food with digestive juices takes approximately two hours using the muscles to contract and mix the contents of the stomach. Once this is complete, chyme is produced which moves into the duodenum (Dallas, 2012).
Patient profile: Heterosexual Muslim Woman who has been in the United Stated for three years. She came from Pakistan. She is 42 forty-two years old, from low socioeconomic standing, English language barrier, and is Muslim rituals and practices. She came to emergency department with her husband due to shortness of breathing, high fever, severe cough. She was dignosed with new onset of pneumonia and currently on antibiotic. she also has history of Vitamin D deficiencies and diabetes mellitus type II. She admitted to medical-surgical floor for observation...