You are the triage nurse in the Emergency Department. Your patient, Mr. Sawyer,

Question

You are the triage nurse in the Emergency Department. Your patient, Mr. Sawyer, is a 48 year old man who presents with severe abdominal pain, poor appetite, and fatigue. He states the pain awakened him from sleep and he began vomiting. He denies any relief from the pain and he can’t get comfortable as the pain radiates to his back and right shoulder. He rates his current pain level as 10/10. He denies any previous medical or surgical history. He denies any tobacco or drug use. States he drinks “just a beer or two after work each day” though he reports to “more than usual” alcohol consumption this past weekend after attending a bachelor party. He lives with his wife and 2 children and works fulltime as a construction foreman. Initial vital signs: BP 160/94, resp 24, pulse 100, temp 99.6 orally, pulse ox 99%.

Question 1: What information from above would you conclude to be subjective data? (5 points)

Mr. Sawyer states the pain awakened him from sleep and he began vomiting.

Question 2: Based on the Review of Systems (ROS) questions for the abdominal system what additional information would you want to elicit from Mr. Sawyer to assist you in analyzing his symptoms? (5 points)

Question 3: Based on Mr. Sawyer’s chief complaint describe your physical assessment. Be thorough & detailed in your answer. (20 points)

Question 4: Based on Mr. Sawyer’s chief complaint what additional physical exam techniques / tests would you want to include in your physical assessment of him? Be thorough & detailed in your description. (20 points)

Question 5: After you have completed your physical assessment on Mr. Sawyer you receive orders from the ER provider to draw bloodwork for laboratory studies and send them to the lab stat for processing. Within a few minutes you receive a call from the laboratory technician with the following results:

Amylase

418 U /L

Lipase

307 U/L

White Blood Cells

15.5 bc/L

Hemoglobin

13.8 g/dl

Hematocrit

39.2 %

Platelets

300 b/L

a. Interpret the above laboratory orders and indicate their meaning in the body. State whether Mr. Sawyer’s lab values are normal or abnormal. (10 points)

b. Now that you have reviewed Mr. Sawyer’s laboratory values and have a better understanding of their meaning what do think is wrong with him? (What is his potential medical diagnosis?) (10 points)

Question 6: Now that you have reviewed Mr. Sawyer’s laboratory studies and were able to identify the likely cause of his abdominal pain discuss in detail the pathophysiology of his medical diagnosis. (You will need to utilize your patho text to appropriately answer this question, you may also utilize additional references, please cite all resources). (15 points)

Question 7: Based on Mr. Sawyer’s medical diagnosis what teaching will you, as his nurse, provide to him to improve his condition and help in his recovery? Be detailed, holistic in approach and include short-term and long-term planning. (15 points)
  

Amylase

418 U /L

Lipase

307 U/L

White Blood Cells

15.5 bc/L

Hemoglobin

13.8 g/dl

Hematocrit

39.2 %

Platelets

300 b/L

Explanation / Answer

Nursing management for the patient with cirrhosis of the liver should focus on promoting rest, improving nutritional status, providing skin care, reducing risk of injury, and monitoring and managing complications.

Nursing Assessment

Assessment of the patient with cirrhosis should include assessing for:

Nursing Diagnosis

Based on the assessment data, the major nursing diagnosis for the patient are:

Nursing Care Planning & Goals

Main Article: 8 Liver Cirrhosis Nursing Care Plans

The major goals for a patient with cirrhosis are:

Nursing Interventions

The patient with cirrhosis needs close observation, first-class supportive care, and sound nutrition counseling.

Promoting Rest

Improving Nutritional Status

Providing Skin Care

Reducing Risk of Injury

Monitoring and Managin

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