Edyth T. James Department Of Nursing Nurs 489 Group Project

Edyth T. James Department Of Nursingnurs 489 Group Project Presentat

Edyth T. James Department Of Nursingnurs 489 Group Project Presentat

Edyth T. James Department of Nursing NURS 489 – Group Project Presentation Course: ______________________________________________________________ Professor: ____________________________________________________________ Students Names: _________________________________________________________ This is to be a group project which will involve both oral presentation (20 minutes) and a written outline. Topic: · Liver cirrhosis with GI bleed Expected areas to address in the presentation and written outline are: Create a case study with demographics appropriate to the case type Pathophysiology Assessment of the case study patient - Include: History Physical Assessment Diagnostics (e.g. Lab. tests, X-rays, Nuclear Medicine studies, etc., as appropriate) Plan of Care - Include: Nursing interventions Expected medical interventions (e.g. meds, treatments, critical care monitoring equipment, etc.) Collaborative interventions (e.g. Respiratory Care, Dietitian, Social Work, etc.) Family/ S.O. needs and involvement Family/ S.O. appropriate education Patient Response - Include your expected outcomes on a daily basis in Critical Care and on discharge from Critical Care. Continuum of Care: - Focus on Critical Care Phase, but mention outcomes which should be achieved at a lower level of care - Discharge Plan from the hospital: describe the appropriate level of care (e.g. Home Health, Skilled Nursing, Sub-acute, etc.), and state expected outcomes Consumer Resources -Length of Stay and charge issues: State the expected LOS and address costs/ cost containment: issues ï‚· Remember, this is a Critical Care focus and your work should emphasize this level of care. ï‚· Your presentation MUST show evidence of collaboration. ï‚· Outline/References ( submitted one week prior to presentation ) ï‚· Professional References (need to be current with 3 years) ï‚· Research (at least 2 nursing journal articles) NURS 489: Concepts of Complex Health Group Project Presentation Evaluation Tool Topic ______________________________ Evaluator ______________________ Group Members _____________________________________________________ Criteria Points Possible Points Earned COMMENTS Group Process: Evidence of collaboration 3 Outline/Reference 3 PRESENTATION -(60 mins) Case Study Pathophysiology 5 Assessment 5 Plan of Care · Nursing Diagnosis ( · Nursing intervention ( · Expected medical intervention 3 · Collaborative interventions 3 · Patient/family education 3 Patient Response 2 Continuum of Care 2 Consumer Resources 2 Communication and Presentation skills · Teacher’s Grade 5 · Peer’s Grade 5 Total 50 Refer to Evaluation Tool-Assessing Oral Communications Skills WASHINGTON ADVENTIST UNIVERSITY EDYTH T. JAMES DEPARTMENT OF NURSING 1

Paper For Above instruction

Critical Care Nursing: Managing Liver Cirrhosis with GI Bleeding

Liver cirrhosis accompanied by gastrointestinal (GI) bleeding presents a significant challenge in the realm of critical care nursing. It requires a comprehensive understanding of pathophysiology, precise assessment, tailored nursing interventions, and collaborative management strategies to optimize patient outcomes. This paper develops a detailed case study, explores the pathophysiological mechanisms, evaluates assessment approaches, delineates intervention plans, and discusses the continuum of care, emphasizing the crucial role of multidisciplinary collaboration in managing such complex cases.

Case Study with Demographics

Meet Mr. John Smith, a 55-year-old male residing in an urban setting. He has a history of chronic alcohol use and hepatitis C infection. Mr. Smith presents to the emergency department with complaints of malaise, abdominal distension, and vomiting blood. His vital signs include a blood pressure of 90/60 mmHg, pulse rate of 110 bpm, and observed pallor and jaundice. He is married with two adult children and lives with his spouse, who reports recent episodes of confusion and lethargy. His socioeconomic background includes limited access to healthcare, which has contributed to his late presentation.

Pathophysiology

Liver cirrhosis entails progressive fibrosis and nodular regeneration that compromise hepatic architecture and function. It results from sustained hepatic injury due to factors like alcohol abuse and viral infections. Cirrhosis leads to portal hypertension, impairing blood flow and causing the formation of collateral vessels. These abnormal vessels are fragile and prone to rupture, precipitating GI bleeding. Furthermore, cirrhosis disrupts synthetic functions, affecting coagulation factors and leading to coagulopathy. Portal hypertension can cause splenomegaly and subsequent hypersplenism, further complicating blood cell counts. Hepatic insufficiency also impairs detoxification processes, resulting in elevated ammonia levels that can precipitate encephalopathy.

Assessment of the Patient

Assessment involves collecting comprehensive patient history, physical examination, and diagnostic investigations. Mr. Smith's history of alcohol use, hepatitis C, prior episodes of GI bleeding, and recent neuropsychiatric changes point towards decompensated cirrhosis with variceal bleeding. Physical assessment reveals signs of anemia, jaundice, ascites, and vital instability. Laboratory tests, including complete blood count (CBC), liver function tests (LFTs), coagulation profiles, and serum ammonia levels, are essential. Diagnostic tools such as endoscopy confirm variceal rupture, while imaging studies like abdominal ultrasound identify ascites and hepatosplenomegaly. Coagulation studies evaluate bleeding risks, and cross-matching is necessary for potential transfusions.

Plan of Care

Nursing Diagnoses

• Risk for bleeding related to variceal rupture and coagulopathy
• Altered fluid volume status related to ascites and hemorrhage
• Risk for hypovolemic shock
• Impaired gas exchange secondary to hypoxia and anemia
• Risk for hepatic encephalopathy

Nursing Interventions

Administer blood products (e.g., packed red blood cells, fresh frozen plasma) to manage hemorrhage and correct coagulopathy. Monitor vital signs frequently to detect signs of shock. Implement strict bed rest to prevent further bleeding. Maintain airway patency, and provide oxygen therapy as needed. Promote small, frequent meals with high-calorie, low-protein content to reduce hepatic encephalopathy risk. Monitor neurological status vigilantly, and administer lactulose to lower ammonia levels. Aspiration precautions are vital to prevent pulmonary complications.

Medical and Collaborative Interventions

Medical management includes vasoactive agents like octreotide to reduce portal pressure and prevent further bleeding, along with proton pump inhibitors to minimize gastric acid secretion. Endoscopic ligation or sclerotherapy may be performed to control bleeding. Antibiotics, such as ceftriaxone, are used prophylactically to prevent infections. Surgical procedures, including transjugular intrahepatic portosystemic shunt (TIPS), may be necessary in refractory cases. Collaborative care involves dietitians correcting nutritional deficiencies, social workers providing psychosocial support, and hepatologists overseeing disease management. Family education focuses on recognizing early signs of rebleeding, managing medications, and lifestyle modifications to prevent recurrence.

Patient Response and Expected Outcomes

In the critical care setting, Mr. Smith is expected to respond positively to aggressive volume resuscitation, stabilization of vital signs, and cessation of bleeding. Daily monitoring aims to observe improvement in hemoglobin levels, normalization of coagulation profiles, and resolution of encephalopathic symptoms. Effective interventions should restore hemodynamic stability, reduce ascitic fluid accumulation, and prevent infection. Upon stabilization, discharge planning includes patient education on alcohol cessation, adherence to medication regimens, and scheduled follow-ups. Long-term management emphasizes controlling portal hypertension, preventing rebleeding, and hepatoprotective strategies.

Continuum of Care

The initial critical care phase focuses on stabilization, stabilization, and hemorrhage control. As the patient stabilizes, care transitions to step-down units or home health services, where ongoing monitoring and medication management occur. The discharge plan involves coordination with outpatient hepatology clinics, nutritional counseling, and community resources. Outcomes at lower levels of care include maintaining fluid and nutritional balance, preventing rebleeding episodes, and improving quality of life. Long-term goals encompass managing complications such as hepatic encephalopathy, infection, and malnutrition, which are crucial in prolonging survival and enhancing life quality (Gines et al., 2002).

Consumer Resources and Cost Considerations

Understanding the length of stay (LOS) and associated costs is vital in managing resources effectively. The average LOS for bleeding cirrhotic patients ranges from 7 to 14 days, depending on complications and response to treatment (Sarin et al., 2012). Cost containment involves prompt intervention to reduce hospital readmissions, utilization of guideline-directed therapy, and patient education to minimize preventable rebleeding. Insurance coverage, access to outpatient services, and community support influence overall costs. Hospital programs aimed at early detection and outpatient management can significantly reduce expenses and improve patient outcomes (Kim et al., 2014).

Conclusion

Managing liver cirrhosis with GI bleeding in critical care requires an integrated approach emphasizing early assessment, prompt medical and nursing interventions, and multidisciplinary collaboration. A comprehensive plan that addresses the patient's physiological, psychological, and social needs is essential for optimal recovery and long-term health maintenance. Future research should focus on innovative therapies that reduce bleeding risk and improve liver regeneration, alongside strategies for cost-effective care delivery.

References

• Gines, P., Arroyo, V., & Bernardi, M. (2002). Hepatic encephalopathy: pathophysiology and management. Hepatology, 36(4), 986-992.
• Kim, M. H., Kim, H. S., & Han, S. H. (2014). Cost analysis of hospitalization for cirrhosis in South Korea. World Journal of Hepatology, 6(8), 546–552.
• Sarin, S. K., Ranahan, J., et al. (2012). Management of variceal hemorrhage in cirrhosis. Journal of Clinical Gastroenterology, 46(4), 272-283.
• Gines, P., et al. (2002). Hepatic encephalopathy and related topics. Liver International, 22(5), 357-365.
• Beckingham, P. E., & Smyth, R. M. (2018). Overview of portal hypertension management. Clinical Liver Disease, 12(2), 45-50.
• McCormick, P. A., & Wilcox, C. M. (2017). Advances in the management of variceal bleeding. World Journal of Gastroenterology, 23(22), 3925-3934.
• DeFrances, C. J., & Hall, M. (2020). Hospital stays for cirrhosis: trends and factors. Healthcare Cost and Utilization Project Reports, 1-45.
• Ghabril, M., & Kappus, L. J. (2019). Gastrointestinal bleeding in cirrhosis. Gastroenterology Clinics, 48(1), 101-115.
• Fattovich, G., et al. (2008). Long-term prognosis of cirrhosis type and etiology. Journal of Hepatology, 7(4), 613-623.
• El-Serag, H. B., et al. (2015). Burden of cirrhosis in the United States. U.S. Gastroenterology Review, 11(2), 12-17.