Nursing Interventions for Pain and Depression in a Patient with Alcoholic Liver Disease

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NURSING INTERVENTIONS: PAIN AND DEPRESSION
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Introduction
The case scenario talks about Ravi Maharaj, a 59-year-old patient diagnosed with
alcoholic liver disease. The complication has impaired the functions of the liver beyond
treatment. However, the liver consultant has advised the family of Mr. Ravi to assist him in
managing the symptoms. The district nurses and the palliative care team will help the family to
care for the patient. The patient feels a generalized pain especially in the left abdomen due to the
liver disease. Additionally, he is jaundice in appearance and experiences depression and stress.
The district nurse observes that Mr. Ravi has a tearful mood indicating that he has developed a
major depressive disorder. This paper will use the Roper, Logan, Tierney model to assess the
condition of the patient, the model discuses the activities of life (ALs) which include sleeping,
eating, movement, communication, breathing among others. Alcoholic liver disease limits the
ability of Ravi to perform the ALs. Additionally, the pain limits him from having adequate sleep
at night. Ravi cannot perform all the activities of life due to his condition. The assessment model
forms part of the care plan in the appendix section. The essay will explore the etiology and
symptoms of the two clinical issues. It will explore clinical interventions for two nursing
problems including pain and depression. It will also discuss the objective and subjective data on
the general pain affecting the patient. Pain and depression stand out as the two significant
symptoms that require active management in palliative care. Therefore, the caregivers must
prioritize care for them.
The Roper, Logan, and Tierney model
The model explores the activities of life (AL) and the ability of an individual to conduct
them (Williams, 2017). Individuals who can perform the actions lead a comfortable life full of
satisfaction and independence. However, ailments limit the ability of a person to live an
independent life. Therefore, essential clinical interventions are necessary to restore the

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independence of an individual. Examples of activities of life include sleeping, mobilization,
working, and eating. According to the case scenario, Ravi becomes exhausted after small tasks
insinuating that the complication interferes with his ability to work. The drainage of ascites
prevents the patient from sleeping forcing him to sleep on the chair. The patient cannot have a
proper meal as he is tolerating a small portion of food. The client also finds difficulty in
movement without the use of a walking stick. The care plan in the appendix section uses the
model to suggest proper interventions for the patient.
Pathophysiology of Alcoholic Liver Disease (ALD)
ALD is a broad term for liver complications due to excessive alcohol consumption
(Petrasek et al., 2015). Alcoholic liver complications include alcoholic hepatitis, fatty liver,
cirrhosis, and chronic hepatitis. During alcohol consumption, a majority of the drink undergoes
detoxification in the liver. Excessive alcohol intake leads to pro-inflammatory cytokines
secretion. The cytokine factors cause liver complications like inflammation and apoptosis of the
cells.
Clinical Problems
Pain
Etiology
According to the case study, Ravi experiences general pain mainly in the left upper
abdomen due to liver disease. Therefore, it is right to conclude that the patient has abdominal
pains.
Subjective and Objective Data
The subjective data include decreased appetite and nausea. According to the case
scenario, Ravi is tolerating small portions of food. At times, he remains nauseous throughout the

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data. Other subjective data include muscle tension and rebound tenderness (Jangland, Kitson,
and Muntlin Athlin, 2016). Abdominal pain also causes the patient to be restless. The objective
data include diarrhea, constipation, and vomiting. Since Ravi is nauseous, he can vomit easily.
The patient also experiences a recurrent accumulation of fluids in his abdomen.
In the case study, Ravi experiences general pain in the upper abdominal section.
Laboratory tests and physical examination always follow the cross-examination between the
patient and the caregiver. The laboratory tests seek to examine the pancreatic and liver enzymes.
Other diagnostic tools include abdominal x-rays and radiographic studies (Sidhu et al., 2015).
Ultrasound, MRI, and capsule endoscopy are also useful in assessing abdominal pain. Additional
diagnosis can rely on endoscopic ultrasound, colonoscopy, and CT.
Symptoms
The symptoms include dehydration, fever and bloating (Viniol et al., 2014). The patient
cannot store food in the system for more than three days. Dehydration signs and the inability to
urinate or pass stool are also associated with the pain. According to the case study, Ravi passes
small amounts of urine. The patient experiences pain when passing urine. The pain always
persists for many hours during the day and night. Belching, bloating and ingestion are the other
symptoms of pain in the left upper abdomen. Heartburn, GERD, and diarrhea are also associated
with abdominal pain. Therefore, appropriate pharmacological and non-pharmacological
interventions are necessary to manage the pain.
Nursing Interventions
Pharmacological Intervention
Pain relievers issued over the counter can help in reducing the severity of the pain
(Camilleri, and Boeckxstaens, 2017). The physician can also prescribe medications of general
pain to patients experiencing abdominal discomfort. Antibiotics are also efficient remedies for