Case Study: Nursing Management of Hepatic Encephalopathy & Cirrhosis

This case study examines a 41-year-old patient admitted with syncope and diagnosed with hepatic encephalopathy secondary to liver cirrhosis and hospital-acquired pneumonia. The report details the pathophysiology of liver cirrhosis, its causes (ethanol abuse), diagnosis, and treatment modalities, emphasizing a patient-centered care approach. It discusses the complications of liver cirrhosis, including hepatic encephalopathy and nosocomial infections like MRSA. The management focuses on eliminating the cause (alcohol abuse), providing palliative care, and considering liver transplant options. The report highlights the importance of discussing the patient's condition, involving family (if available), and providing ethical treatment planning to enhance the patient's quality of life. The study also underscores the relevance of informed nursing practices in managing liver diseases and preventing hospital-acquired infections, ensuring better care and services.

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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discuss the condition with the patient and educate and inform him regarding the treatment
modalities and decision making for the care planning. The main aim is to fulfil all the
requirements as in given case the patient is suffering from the liver cirrhosis and altered
brain activity and there is no family support to him he should be given the care as in social
and health services or care centre. The patient should be provided with the symptomatic
relief and counselling to restrict the habit of alcohol abuse that will further worsen the
condition and lead to fatal conditions. Hepatic encephalopathy is to be treated as
symptomatic relief and palliative care as the liver function diminishes there is no way to
reverse the functioning (Poonja et al, 2014). To achieve the family centred care the patient’s
sister can be contacted by his consent and provided a support in palliative care. The care
should also include the ethical treatment planning that includes the respectful and
confidential record keeping and sharing procedures. In given case, as there is no family
member present other than the patient’s sister the power of attorney provision should be
discussed with the patient in case he is unable to make the decision for his health and
medical treatment. Proper health care and domestic care services should be discussed with
him to grant him an improved quality of life (Leise et al, 2014).
This case highlights the aspects of the disease that is liver cirrhosis and its pharmacological
aspects and management strategies to enhance the care and quality of life. This topic is
relevant to the current nursing practice in order that it provides the care strategies and
approaches that are relevant for the use to manage a leading disease in the country. The
care planning and new aspects of this care provides better base and developed and
informed nursing practices. The cause of the nosocomial infection its complications and its
prevention is to be studied through this case that is essential for current practices as the
hospital is the place from where most of infections can spread easily and the nursing staff
should be trained effectively to prevent any cross-contamination and infection by use of
proper asepsis and infection control measures.This will enhance the quality of care and
services provided by the health and social care in current times (Vlaisavljevic and Rankovic,
2015.)
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Conclusion
In the given scenario the patient is cared for liver cirrhosis followed by hepatic
encephalopathy that is a disease at its terminal stages with severe complications. At this
stage providing the care that can prevent the disease or cure it is not possible as the liver
function is decompensated but the palliative care and the care for the symptomatic relief of
the individual should be provided that imparts good quality of life and provides a patient
centred care for the individual in the decompensated stages of the disease. Liver transplant
can be an option in case and can be effective in enhancing the life span of an individual.
Thus, it can be concluded that the advanced and informed nursing practice has made it
more appropriate to address the needs of an individual in terminal stages of the disease and
provide better care.
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References
Behnia, M., Logan, S.C., Fallen, L. and Catalano, P., 2014. Nosocomial and ventilator-
associated pneumonia in a community hospital intensive care unit: a retrospective review
and analysis. BMC research notes, 7(1), p.232.
Leise, M.D., Poterucha, J.J., Kamath, P.S. and Kim, W.R., 2014, February.Management of
hepatic encephalopathy in the hospital.In Mayo Clinic Proceedings (Vol. 89, No. 2, pp. 241-
253).Elsevier.
Mokdad, A.A., Lopez, A.D., Shahraz, S., Lozano, R., Mokdad, A.H., Stanaway, J., Murray, C.J.
and Naghavi, M., 2014. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a
systematic analysis. BMC medicine, 12(1), p.145.
Poonja, Z., Brisebois, A., van Zanten, S.V., Tandon, P., Meeberg, G. and Karvellas, C.J., 2014.
Patients with cirrhosis and denied liver transplants rarely receive adequate palliative care or
appropriate management. Clinical Gastroenterology and Hepatology, 12(4), pp.692-698.
Romero-Gómez, M., Montagnese, S. and Jalan, R., 2015.Hepatic encephalopathy in patients
with acute decompensation of cirrhosis and acute-on-chronic liver failure.Journal of
Hepatology, 62(2), pp.437-447.
Tsochatzis, E.A., Bosch, J. and Burroughs, A.K., 2014. Liver cirrhosis.The Lancet, 383(9930),
pp.1749-1761.
Vlaisavljevic, Z. and Rankovic, I., 2015. Specific Nursing Care Rendered In Hepatic
Encephalopathy: Contemporary Review and New Clinical Insights. J Nurs Care, 4(264),
pp.2167-1168.
Zhou, W.C., Zhang, Q.B. and Qiao, L., 2014. Pathogenesis of liver cirrhosis. World journal of
gastroenterology: WJG, 20(23), p.7312.
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