65years old male brought in by ambulance. Diagnosis of End Stage Liver Disease ,Cirrhosis and Ascites. Hepatitis C not treated due to Noncompliance with plan of care. Parancenthesis done with guided Ultrasound,one liter of fluid removed. Doctor orders:
Ultrasound of the abdomen.
MRI of the abdomen.
EGD.
Antviral medication for hepatitis C.
Aldactone 50mg po Qday.
Lasix 80mg IV Bid.
Albumin IV ×1.
Bactrim 800mg po daily.
VAX : PNA/FLU,HAV/HBV.
Lactulose 30mg po Q8hours.
Laboratory:
Coagulation-PT/PTT/INR.AFP.
Almmonia level .
Weight 185lbs.
Height 5feet 3inches.
Alert and oriented x3.Abdomen and legs distended,yellowish skin color and eyes.(jaundice)
Diet: Hepatic Diet.
0.9NS @ 100ml/hour IV right forearm 20guage clean/Patent/Dry.
Discharge plans:
Discharge home with wife when medically stable.
Questions:
1.What are the Signs and Symptoms of End Stage Liver Disease?.Select all that applies:
A. risk of bruises and bleeding.
B.Yellow skin,eyes,tiredness, and intense itching.
C.Nausea,loss of appetite and Abdominal pain.
D.Persistent coughing and choking.
E.Swelling of abdomen and legs due fluid build up.
F.Difficulty with concentration and difficulty with falling asleep.
G.Frequent urination and urgency of urination.
2.As a Registered Nurse what laboratory values will you monitor for this patient?.
3.What is Hepatic diet consist of?.Select all that applies.
A.Fruits and vegetables such as kale,cabbage,garlic,lemon.
B.Lean protein such as poultry, fish,legumes and vitamins.
C.Uncooked meat and shellfish. D.Carbohydrate,salt sources, and salmon.
E.All of the above.
4.As a Registered Nurse why should you be concern about the distended abdomen and legs?.
5.The doctor ordered for patient to be vaccinated with Flu vaccine, Pneumonia vaccine, HAV and HBV.
As a Registered Nurse why is it important for end stage liver disease patient to recieve all the listed vaccine?.
6.What are contributing factors to End Stage Liver Disease?.Select all that applies.
A.Heavy drinking of alcohol.
B.A buildup of fat in the liver,Viruses.
C.Too much lemon juice and ice water which might be too cold for the liver.
D.Toxic effects of drug and autoimmune diseases.
E.None of the above.
NB: T he three methods of treatment for end stage liver disease are Medications, Procedures or Surgery.
The complications of Cirrhosis(ESLD) include Variceal hemorrhage, Ascites,Spontaneous bacterial peritonitis or hepatopulmonary syndrome and these can eventually lead to death.
Follow doctor orders , your facility policy and procedures.
Nurses You Move Me 
Grateful is my middle name.
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