WEEK 14: CASE STUDY ASSIGNMENT CHAPTER 42
The patient is a 55-year-old alcoholic who scheduled an appointment to see his family nurse practitioner. He tells the nurse practitioner that he has been experiencing a persistent cough and has been experiencing pronounced fatigue and nausea. In addition, he shares that he has been very irritable and is experiencing more memory lapses. His stomach is distended, but on palpation, his liver is small in size and firm, indicating cirrhosis. Lab tests indicate a decrease in hemoglobin, albumin, and prothrombin levels with elevated serum bilirubin and ammonia levels.
Describe the various stages through which the patient’s liver has progressed and the implications of the current stage.
Provide a specific rationale for each of the patient’s manifestations and blood values.
Is it possible to reverse the damage to the liver at this stage? What is the prognosis by nurse practitioner? Choose four significant complications that likely to occur and discuss the predisposing factors and effects on the liver.
Week 14 Case Study 1
Describe the various stages through which the patient’s liver has progressed and the implications of the current stage.
The patient’s liver has progressed through various stages. They include inflammation, fibrosis, and cirrhosis. Inflammation is the first stage where the liver is inflamed. The patient is asymptomatic. Fibrosis is the second stage characterized by scar tissue formation from cycles of inflammation. Liver cannot function optimally and patients are still asymptomatic. Cirrhosis is the third stage characterized by severe scaring and development of symptoms since the liver does not function optimally. The stage of liver disease the patient is currently in is end-stage liver disease. End-stage liver disease has characteristics such as drastic deterioration in liver function and complications such as hepatic encephalopathy, ascites, and anemia (Peng et al., 2019). The implications of this stage of liver disease are that the disease process cannot be reversed except through liver transplant.
Provide a specific rationale for each of the patient’s manifestations and blood values.
The patient has been experiencing persistent cough because of increased body fluid volume level. The increase results in excess fluid buildup in the lungs, hence, the cough. End-stage liver failure cause massive failure of other organs such as the kidneys and immunosuppression. Immunosuppression affects the production of red blood cells from the bone marrow, hence, fatigue and nausea. End-stage liver disease is also characterized by the buildup of ammonia in the body. The ammonia crosses the blood brain barrier to cause mental and behavioral changes such as restlessness, irritability, memory lapses, and even coma. The liver plays the role of storing and producing iron. Liver disease affects iron stores and production, hence, anemia. The liver also produces clotting factors; translating into elevated prothrombin levels in the disease. The serum bilirubin levels increase because of low conjugation(McCance & Huether, 2018). The liver produces albumin, which is lowered in end-stage renal disease.
Is it possible to reverse the damage to the liver at this stage? What is the prognosis by nurse practitioner? Choose four significant complications that likely to occur and discuss the predisposing factors and effects on the liver.
Liver damage in end-stage liver disease is irreversible. The patient’s prognosis is poor. The complications likely to occur include kidney failure, immunosuppression, esophageal varices, and hepatic encephalopathy. The predisposing factors include increased body fluid volume, multiple organ failure, and elevated ammonia levels (Peng et al., 2019). These complications depress the liver functions further, hence, death.
References
McCance, K. L., & Huether, S. E. (2018). Pathophysiology Online for Pathophysiology (Access Code and Textbook Package): The Biologic Basis for Disease in Adults and Children. Elsevier – Health Sciences Division.
Peng, J.-K., Hepgul, N., Higginson, I. J., & Gao, W. (2019). Symptom prevalence and quality of life of patients with end-stage liver disease: A systematic review and meta-analysis. Palliative Medicine, 33(1), 24–36. https://doi.org/10.1177/0269216318807051