Hepatic cirrhosis care plan example with answers

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Hepatic cirrhosis care plan example with answers

REQUIRED SECTIONS

 

  1. A comprehensive Nursing Care Plan:
    1. Typed (single spaced).
    2. Not exceeding 3 pages.
    3. Grammatically correct with proper sentence structure.
    4. Relevant format (Use the care plan template).
    5. APA format.

 

  1. Other documents:
    1. A cover page with student’s and professor’s names.
    2. Reference page (for NCP).

 

CASE STUDY SCENARIO 

Mr. McClaren is a 48-year-old man who is admitted to the emergency department (ED) with abdominal pain and general weakness.  He reports that he drinks “one bottle of scotch whisky every week for the past one year, and one to two cans of beer during the weekends.”  For the past three months, his condition has started to deteriorate. His wife claims that “he has not been eating well for the past three months”.  Mr. McClaren reports he has passed dark red stool on three occasions – the last one being  just one day before coming to ED. On examination, Mr. McClaren has an enlarged abdomen with tenderness upon palpation.  He also presents with the following clinical manifestations: peripheral edema, pale yellow skin color, dry mucus membranes and body weakness. The physician suspects that Mr.  McClaren has hepatic cirrhosis.  His vital sign findings include: Temperature 37.8 Celsius, BP 94/52, Pulse 110, Oxygen saturation 94%.  From your nursing classes, you know that some of the treatments Mr. McClaren may receive are paracentesis, ultrasound and CT scan of the abdomen, as well as vitamin K administration.

 

 

Nursing Care Plan                                                   

 

Part 1: Identify one priority nursing problem (actual problem not “at risk”) and formulate one appropriate NANDA nursing diagnosis based on the case study. Provide rationale to explain why this is a priority problem based on the case study (One paragraph, Max. 8 sentences). Use appropriate source of information (from case study and literatures) to support your answer.

 

Part 2:  Develop a comprehensive Nursing Care Plan using the Nursing Care Plan Template. Follow the evaluation criteria of the rubric when formulating the Nursing Care Plan.

 

 

 

 

 

 

Malnutrition in Hepatic Cirrhosis

 

 

Name

Student number:

Institution:

Instructor:

Course:

Word Count: 900

Date:

 

                                                              

 

Nursing Care Plan

 

Nursing Diagnosis: inadequate nutrition less than body requirement

Liver cirrhosis is also known as hepatic cirrhosis, which is a disease that often results from excessive consumption of alcohol and leads to hepatocytes which are liver cells necrosis that regenerate to form fibrous tissue, which alters the anatomy of the liver, its normal structure and blood supply (Roerecke et al., 2019). As a result, the normal functioning of the liver is lost and leads to effects like malnutrition, jaundice and fluid accumulation in the abdomen. The most urgent nursing diagnosis is impaired nutrition, which is less than body requirement related to anorexia and inability of the patient to process nutrients, evidenced by the general weakness of the body and the patient’s wife verbalizing that he had been feeding poorly for the last three months. Meeting the body’s nutritional requirement is among the most vital ways to promote health and wellness in the human body; thus, any compromise in the provision and absorption of the nutrients may delay healing and cause further health deterioration. As a result, it is vital for a nurse to identify and put in place interventions that will help the patient meet the body’s nutritional requirements, which makes the nursing diagnosis stated above a priority. In addition, the patient presents with general body weakness and reports of poor feeding habits and health decline, which could be related to inadequate nutrition, which needs to be addressed to ensure that the health and wellness of the patient improve and is maintained.

 

Assessment Goals/Objectives Interventions

 

 Evaluation
Objective Data:

The patient presents with general body weakness

 

Subjective Data:

The patient’s wife verbalizes the decline in health and the poor eating habits in the past three months.

The patient reports the passing of black stool on three occasions, the last time being the day before reporting to the emergency department, which indicates abnormal bowel function, which may contribute to the inadequate absorption of nutrients.

 

 

 Long term Goal

The goal and the objective is to ensure that the patient does not present with current signs of malnutrition like general body weakness and show progressive improvement in their health, which will result from interventions that enhance proper and adequate nutrition by the end of the hospital stay.

 

Short term goals

Help improve the patients eating habits to increase their food intake and nutritional supply since admission in one week.

 

The patient will learn and practice techniques that help digest and absorb nutrients by the end of one week.

 

The patient will understand the importance of adequate nutritional supply to their health and recovery and the types of foods to avoid which would upset his stomach and hinder absorption by the end of the week.

 Include the patient in planning meals and involve the family members during the feeding process and meal plans. This is because it will help the patient cooperate during the feeding process because the patients autonomy is preserved and hence feel involved which cultivates their motivation and cooperation. Involving their family members is also vital because they also feel involved and motivate the patient make a healthy diet plan. They also help the patient adhere to the plan and this way offer support and enhance recovery of the patient. The patient also has the privilege to include and plan for meals they like and prefer which enhances their appetite (Palmer et al., 2019). As a result, the patient will increase their food intake and the nutritional requirement that will better their health and recovery process.

 

Encourage the patient during meal times through positive reinforcement from the health care worker and the family members who act as the source of support to the patient and explain the importance of feeding to their health and recovery. This is where the nurse as the health care worker educates the patient on the importance of nutrients and their roles to enhance recovery. The nurse should mention the importance of nutrients like glucose in the provision of energy for day to day activities. This is important because the patient will have the knowledge and understand the importance of nutritional supply in recovery and be motivated to feed and improve their health and enhance their recovery. Positive reinforcement encourages the patient to consume more food (Chapman et al., 2020).

 

Encourage the patient to rest before meal times. A state of rest reduces the metabolic requirement of the liver whereby when the body is resting it does nor require a lot of glucose or nutrients required to produce energy and maintain activity. The liver therefore rests and promotes cellular regeneration and makes it easier for it to metabolize the food ingested during meal time. (Gao & Zhuge, 2021).

 

Offering and advising the patient to take small frequent meals because the patient may not tolerate a heavy meal due to the presence of ascites which is the acumlation of fluid in the abdomen which is caused by malfuncytioning of the liver that will require paracentesis to relieve. This fluid accumulation causes abdominal pressure which then reduces room for stomach expansion.; thus, small frequent meals may be easily digested and absorbed because they require les room for digestion and absorption as compared to large, heavy ones because the stomach cannot expand fully due the fluid accumulation. (Chapman et al., 2020).

 

Monitor the patient’s laboratory results like the total protein and ammonia levels, serum glucose, albumin and pre-albumin levels, which help guide the nutritional requirements and thus the diet required. In that, the depletion of glucose due to depleted glucagon stored in the liver and impaired gluconeogenesis due to impaired liver function may warrant intake of carbohydrates. An increase in ammonia levels may indicate a restriction of proteins as it may lead to encephalopathy or a decrease in protein levels in the blood like albumin or pre-albumin caused by impaired metabolism may suggest protein intake (Roerecke et al., 2019).

 

Advise patients on foods taken where the nurse can advise the patient against taking caffeinated drinks, spicy foods, and extremely cold and hot foods and drinks which cause gastric irritation and abdominal discomfort, reducing appetite and hindering nutrient absorption (Palmer et al., 2019). Avoiding those foods prevents the irritation which allows maximum absorption of nutrients that ultimately enhance the recovery and wellness of the patient.

 By the end of the hospital stay, the patient’s health improved, and he no longer presented with general body weakness and could tolerate most activities. He looked more active and energetic. The goal was met.

 

By day three after admission, the patient had significantly increased his food intake and could complete the served portion. The goal was met.

 

By the end of the week, the patient was practising techniques that enhanced his nutritional absorption where he would take small frequent meals and would rest before meal times. The goal was fully met.

 

By the end of the week, the patient verbalized the importance of the proper dietary intake to his health and recovery and avoided caffeinated drinks, extremely cold and hot foods, and spicy foods that prevented stomach discomfort during the week. The goal was met fully.

 

 

 

References

Chapman, B., Sinclair, M., Gow, P. J., & Testro, A. G. (2020). Malnutrition in cirrhosis: More food for thought. World Journal of Hepatology, 12(11), 883–896. https://doi.org/10.4254/wjh.v12.i11.883

Gao, B., & Zhuge, Y. (2021). Malnutrition in liver cirrhosis: Benefits from improving portal hypertension. Journal of Clinical Hepatology, 2767–2769. https://pesquisa.bvsalud.org/portal/resource/pt/wpr-906856

Palmer, L. B., Kuftinec, G., Pearlman, M., & Green, C. H. (2019). Nutrition in Cirrhosis. Current Gastroenterology Reports, 21(8). https://doi.org/10.1007/s11894-019-0706-5

Roerecke, M., Vafaei, A., Hasan, O. S. M., Chrystoja, B. R., Cruz, M., Lee, R., Neuman, M. G., & Rehm, J. (2019). Alcohol Consumption and Risk of Liver Cirrhosis. The American Journal of Gastroenterology, 114(10), 1574–1586. https://doi.org/10.14309/ajg.0000000000000340