Patient-Centered Care for Hepatic Encephalopathy Secondary to Liver Cirrhosis: A Case Study

Contents
Introduction...........................................................................................................................................1
Body......................................................................................................................................................2
Conclusion.............................................................................................................................................5
References.............................................................................................................................................5
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Introduction
Nursing care not only tries to treat the patient's condition but also manages to enhance the
quality of life for the remaining span of an individual.In this report the discussion regarding
the disease, diagnosis, pathology, management and patient centred care approach is done
for a 41-year-old patient who is being admitted to the emergency department due to an
episode of syncope and is managed to be diagnosed with hepatic encephalopathy secondary
to liver cirrhosis and hospital-acquired pneumonia.As in current era liver cirrhosis is
presentedas widely occurring disease that causes at least 2 cases in every 1000 people, this
involves leading nursing practices to adopt various improved techniques and approaches to
provide care to the patient with end-stage liver disease This report consistsof the disease
pathophysiology, causes, diagnosis and treatment modalities that will enhance the life
quality of the individual and improve the condition caused due to ill care.
Body
The patient is presented with the syncopal signs and symptoms and has a history of liver
cirrhosis. The disease presented is suspected due to ethanol abuse and considered as liver
cirrhosis due to alcoholic liver disorder. Ethanol abuse causes the damage to the liver cells
causing fibrosis of liver (Tsochatzis, Bosch and Burroughs, 2014). As the patient has
developed alcoholic liver diseasethat is due to the chronic alcohol consumption, further
complication of disease that is hepatic encephalopathy is also present. Hepatic
encephalopathy is the damage to the brain due to severe fibrosis of liver cells and the
inability of the liver to excrete the toxins from blood that act on the brain and causes ill-
functioning. The syncopal signs reveal the traces of initiation of hepatic encephalopathy in
current case scenario. The pathophysiology of liver cirrhosis involves damage toliver cells
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preceded by hepatitis and fatty liver disease. The scar tissue as a result of fibrosis is
developed in the liver that replaces normal parenchyma. This scar obstructs the portal flow
of liver and raises the blood pressure in the organ that disturbs the normal liver functioning
(Zhou, Zhang and Qiao, 2014). As the disease progresses the normal liver cells are been
replaced by the fibrous bands and the liver blood flow is obstructed that makes the organ
functionless. The inability of the hepatic cells to excrete out the toxinsand proteins
producing nitrogen in blood through urea cycle from the body dueto increased portal
hypotension causes hepatic encephalopathy. The main toxic element is ammonia that can
cross the blood-brain barrier and reach brain to be absorbed by the brain cells that become
swollen due to increased glutamine. This inflammation of brain cells causes various
symptoms and signs of encephalopathy in the patient (Romero-Gómez, Montagnese and
Jalan, 2015).The patient presents the signs of hospital-acquired pneumonia and MRSA that
is the infection that can be caught from hospital environment and ill practices that
encourage cross contamination.The liver damage from cirrhosis is irreversible but it can be
halted and stopped to a certain stage from increasing further. The main element of
management of this disease is elimination of the chief cause; in this case the cause is alcohol
abuse. As in given case the cirrhosis has reached a decompensated stage and cannot be
prevented or reversed back, it has tobemanaged as apalliative care to enhance the quality
of life of an individual. The treatment of such kind involves the admission of the patient to
the hospital for close monitoring and fluid balance therapy as the cirrhosis can cause
encephalopathy and consume much of the energy. The mental status of an individual is also
monitored and medical treatment is given with diuretics, antibiotics, laxatives, thiamine etc.
Saline is avoided in cirrhosis patient as to avoid the sodium level that is already high in the
body. To treat or manage the nosocomial pneumonia the medication provided are
Fluoroquinolones antibiotic or amoxicillin that will reduce the infection acquired (Behnia et
al, 2014).As the patient is not very old aged option for liver transplant is also viable and
relevant that can lead to maximize the normal functioning of body.
The patient centred care approach is advocated in the given case, as the patient requires
the care that can provide and enhance the quality of life of the individual. The prognosis of
the patient in the end-stage liver disease is poor and does not respond to the treatment in a
much better way. (Mokdad et al, 2014). To provide a patient centred care the main stepis to
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