Comprehensive Analysis: Assessment Task 1 - Liver Cirrhosis Case Study

This assignment presents a detailed case study focused on a patient suffering from liver cirrhosis. The case study begins by identifying the patient's symptoms, which align with the characteristics of liver cirrhosis, and then explores the causes of the disease, including alcohol consumption, smoking, and exposure to radon and asbestos. The document delves into the pathophysiology of the disease, explaining the relationship between symptoms like coughing up blood, abdominal swelling, and weight loss, and the underlying damage to the liver. It also discusses the progressive nature of liver cirrhosis and available treatment options, including medication and addressing underlying conditions. Furthermore, a comprehensive nursing care plan is provided, addressing critical issues such as impaired breathing, acute pain, fear and anxiety, and lack of knowledge, with detailed nursing interventions and rationales for each. The assignment concludes with a list of references used in the case study, providing a solid foundation for understanding and managing liver cirrhosis within a nursing context.

Running head: ASSESSMENT TASK 1 - CASE STUDY 1
Assessment Task 1-Case study
Name of the student
Name of the university

ASSESSMENT TASK 1 - CASE STUDY 2
1.
The patient is likely suffering from liver cirrhosis. The symptoms of liver cirrhosis do not appear
until after the liver has been destroyed and functioning is being impaired. Most symptoms vary
from one individual to another, however, the most common ones are jaundice, abdominal
discomfort, coughing up blood, chest pain, exhaustion, loss of appetite, unexplained weight loss,
abdominal swelling, gastrointestinal bleeding and swelling of the body, especially neck and face.
The patient has most of these symptoms. People who drink alcohol or have a history of
alcoholism have a high risk of getting liver cirrhosis (McKenna l & Lim, 2012).
There are several causes of liver cirrhosis. The major one is alcohol drinking. 80% of liver
cirrhosis deaths are caused by alcohol and beer. The more the bottles of alcohol drank the higher
the risk of getting liver cirrhosis. Smoking cigars and pipe smoking can also contribute to liver
cirrhosis. There is no difference between low tar and heavy tar cigarettes in the risk involved.
However, menthol cigarettes have a high-risk factor since menthol allows the smoker to inhale
the smoke deeply. Every year, 7,000 deaths are reported from liver cirrhosis from alcoholics
(Farrell & Dempsey, 2014).
The liver is responsible for removing toxins from the body. Exposure to radon also increases the
chances of liver cirrhosis. Radon is a radioactive gas that is found in the soil when the uranium
rocks are broken down. It is colorless, odorless and tasteless. Radon is more concentrated
indoors than outdoors. This is because outside there is a proper exchange of gases and free-
flowing air. Homes in the United States have higher risks, especially in basements. Breathing in
radon introduces radioactive activities in the body increasing your chances of liver cirrhosis.
People working with asbestos have a higher risk of developing liver cirrhosis. Asbestos is found
in mines, textile plants, mills, shipyards and places that use insulation. Nevertheless, it is not
clear the exact level of exposure that can cause liver cirrhosis. Asbestos cases a type of cancer in
the body called malignant mesothelioma. The government has played a huge role in reducing the
number of industrial products that contain asbestos. Most homes, however, still have asbestos in
their construction. This asbestos is not considered harmful unless the building is demolished or
renovated (McKenna l & Lim, 2014).
2.
Signs and symptoms Underlying pathophysiology
Coughing, blood in sputum, shortness of breath Sometime fluid may build up in the lung
causing a severe cough that is stained with
blood and shortness of breath (Farrell &
Dempsey, 2016).
Distended abdomen, oedema This is when the liver has stopped functioning
and the toxic fluid has spread to the lymph
nodes. The lymph nodes are responsible for

ASSESSMENT TASK 1 - CASE STUDY 3
filtering the blood and fighting infection.
Lymph nodes are found in the chest, abdomen,
neck and armpit swelling may occur in any of
these areas (Berman et al., 2014)
Loss of appetite and unexplained weight loss When the scar tissue builds up in the liver,
there is unexplained weight loss. In addition,
the abdomen may swell the skin yellows and
the eyes become white (jaundice). Food
ingested is not properly digested (Berman et
al., 2017)
3.
Liver cirrhosis is a progressive disease. It develops slowly after a couple of years. If left
untreated the scar tissue may build up to high amounts and cause the liver to stop functioning
completely. There is no treatment once the liver is completely damaged unless a transplant is
done. The effects cannot be reversed. The procedure for finding a donor is usually a long process
(Farrell & Dempsey, 2016).
If the liver cirrhosis is diagnosed early enough, the underlying conditions may be treated. Some
of the treatment measures include:
- Reducing alcohol dependency
- Taking hepatitis B or C medications if liver damage was caused by hepatitis
- Controlling pressure in the vein that supplies the liver with blood
- Banding the varices to control bleeding
- Infection of sclerotherapy to trigger a clot in the varices
Other complications may develop because of liver cirrhosis. The patient may develop secondary
infections. The liver is responsible for filtering out the toxins from the blood. Liver failure
affects this function. A patient may be given antibiotics for secondary infections that may arise.
Patients with liver cirrhosis are at high risk of developing liver cancer. The doctor may
recommend regular testing (Martini, Nat & Bartholomew, 2017).
Topotecan is a new drug in the market. Most doctors prefer this drug since it is a single drug. It is
easier to analyze the prevalence of the tumor of the only choice of treatment is used. With a
combination, it is difficult to identify which drug is effective and which drug is not as effective.
Topotecan can be given as an injection or as tablets.
Chemotherapy drugs can have side effects depend on the type of drug, the dosage given and the
duration the patient has taken the drug. The most common side effect is hair loss, mouth sores,
loss of appetite and weight loss, vomiting and nausea, constipation or diarrhea, easy bruising
because of very few platelets, increased secondary infections because of few white blood cells
and fatigue from a reduced number of red blood cells.

ASSESSMENT TASK 1 - CASE STUDY 4
4.
Nursing care plan for a patient who has just been diagnosed with liver cirrhosis requires a
comprehensive supports guide. In addition, there should be patient teaching to minimize the
complications that may arise and promote a speedy recovery from surgery.
The nursing care plan will be divvied into four:
- Impaired breathing
- Pain
- Fear and anxiety
- Lack of knowledge
a) Impaired breathing
It may result from the lack of sufficient oxygen in the lungs. It may be related to the
accumulation of fluid in the lung tissue. It is possible evidenced by coughing and blood in
sputum. The desired outcome is to improve ventilation and free the patent from reparatory
distress (Javic, Australian Adapting Editors Forbes, Watt, 2012).
Nursing intervention Rational
Note the respiratory rate and depth. Observe
for any change in skill color and pursed lip
breathing
Respiration rate may increase as a
compensatory mechanism for the fluid in the
lung tissue. Moreover, it can also be indicated
that there is increased oxygen consumption
Reposition the patient frequently in a different
sitting position. Constantly exchange between
the side and supine position.
This allows maximum lung expansion and
allows the fluid to be drained out of the lungs
quickly
Observe the ABGs and pulse oximetry
readings
A decrease or an increase in these readings
may indicate that the patient requires ventilator
support
b) Acute pain
Pain is an unpleasant sensory experience that arises from potential tissue damage. It changes in
the intensity from severe to mild and can be described as slow onset or sudden. It may be related
to tissue trauma in the livers. It is possible evidenced by restlessness, withdrawal and verbal
reports of discomfort. The desired outcome is to relieve the pain and help the patient relax (Javic,
Australian Adapting Editors Forbes, Watt, 2016).
Nursing intervention Rationale
Ask the patient for a self-report about the pain. Helps in the evaluation of liver cirrhosis

ASSESSMENT TASK 1 - CASE STUDY 5
related pain symptoms. The rating of the pain
helps in deciding which tools will be
appropriate for pain management
Schedule rest periods It decreases fatigue and helps to conserve
energy.
Provide patent controlled analgesia.
Administer drugs routinely or required by the
patient. The drugs should be given 45 min
before the respiratory treatment begins
Having a constant level of analgesics in the
body helps to reduce cyclic periods of pain and
helps in proper healing it also allows emotional
comfort.
c) Fear and anxiety
Fear is a response to a threat that is consciously perceived as a danger. Anxiety is the uneasy
feeling of discomfort. It may be related to threat of the health status, perceived threat of death
and situational crisis. It is evident by withdrawal, anger and apprehension. The desired outcome
is to acknowledge the fears and verbalize the accurate knowledge of the situation (Nursing and
midwifery board of Australia, 2018).
Nursing interventions Rationale
Evaluate the patient understanding the
diagnosis
The patient has received information that will
require a change in the lifestyle. Helping the
patient understand the perception of the
diagnosis helps to provide him with
individualized care
Accept the patient’s denial of the situation,
however, do not reinforce
If extreme denial is experienced, allow the
patient to undergo through it to help them
come to terms with the situation
Cater to the patient's physical comfort It is stressful to handle emotional stress while
experiencing physical issues.
d) Lack of knowledge
This is the deficiency of cognitive information concerning a particular topic. It may be related to
unfamiliarity with the situation and poor information interpretation. It is evidenced by the lack of
following instruction and inappropriate behaviors such as hostility. The desired outcome us to
verbalize the diagnosis and prognosis of liver cirrhosis (Nursing and midwifery board of
Australia, 2016).
Nursing intervention Rationale
Discuss the planned therapies, the prognosis
and the expected outcome
It provides the patient with specific
information, which will create a knowledge
base for home management. It will also help
the patient to make informed decisions
Identify signs and symptoms that may require a
medical evaluation
Early detection results in timely intervention
which helps to minimize complications

ASSESSMENT TASK 1 - CASE STUDY 6
Help the patient to set goals on the activity
tolerance
As treatment becomes effective, the patient
should begin to feel relieved. Helping the
patient set a realistic goal for treatment is
important emotionally.

ASSESSMENT TASK 1 - CASE STUDY 7
References
Berman, A., Snyder, S., Kozier, B., Erb. G., Levett-Jonnes, T., Dwyer et al., (2014). Kozier &
Erb's Fundamentals of Nursing: (3rd Australian Ed.) Frenc’s Forest NSW: Pearson.
Berman, A., Snyder, S., Kozier, B., Erb. G., Levett-Jonnes, T., Dwyer et al., (2017). Kozier &
Erb's Fundamentals of Nursing: (4th Australian Ed.) Frenc’s Forest NSW: Pearson
Farrell, M., & Dempsey, J. (2014). Smeltzer and Bare's textbook of medical-surgical nursing (3rd
Australian and New Zealand Ed).Sydney: Wolters Kluwer Health/ Lippincott, Williams
and Wilkins.
Farrell, M., & Dempsey, J. (2016). Smeltzer and Bare's textbook of medical-surgical nursing (4th
Australian and New Zealand Ed).Sydney: Wolters Kluwer Health/ Lippincott, Williams
and Wilkins.
Javic, C Australian Adapting Editors Forbes, H., Watt E. (2012). Physical examination and
health assessment (6th Australian and new Zealand Ed.) Chats wood, NSW:
Elsevier/Saunders
Javic, C Australian Adapting Editors Forbes, H., Watt E. (2016). Physical examination and
health assessment (2nd Australian and new Zealand Ed.) Chats wood, NSW:
Elsevier/Saunders
Martini F., Nat J & Bartholomew E. (2012) Fundamentals of anatomy and physiology. (9th
Edition). San Francisco: Pearson
Martini F., Nat J & Bartholomew E. (2017) Fundamentals of anatomy and physiology. (11th
Edition). San Francisco: Pearson
McKenna L. K & Lim A, G (2012) Pharmacology for nursing and midwifery. (1st Australian and
New Zealand edition. Broadway: Lippincott Williams and Wilkins

ASSESSMENT TASK 1 - CASE STUDY 8
McKenna L. K& Lim A, G (2014) Pharmacology for nursing and midwifery. (1st Australian and
New Zealand edition. Broadway: Lippincott Williams and Wilkins
Nursing and midwifery board of Australia. (2016). Registered nurse standards for practice.
Retrieved from http://www.nursingmidwiferyboard.gov.au/Codes-Guidlines-
Statements/Professional -standards.aspx
Nursing and midwifery board of Australia. (2018). Registered nurse standards for practice.
Retrieved from http://www.nursingmidwiferyboard.gov.au/Codes-Guidlines-
Statements/Professional -standards.aspx