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    CA Case 3 GI Ca Liver Failure

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    Nyeam Nyeam
    Mr. MJ is a 56-year-old man with a history of smoking, alcohol use, poor diet, stress and hepatitis A who presented with weakness, loss of appetite and decreased consciousness. He has a history of peptic ulcer disease, rectosigmoid cancer, cirrhosis of the liver and is currently taking medications for ascites, edema and disorientation. Tests show complications of his advancing liver disease. He began vomiting fresh blood and became comatose, requiring ICU care. The physician explained his condition is now irreversible and the family decided to enact a do not resuscitate order as MJ's condition continued to decline.

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    CA Case 3 GI Ca Liver Failure

    Uploaded by

    Nyeam Nyeam
    62 views2 pages
    Mr. MJ is a 56-year-old man with a history of smoking, alcohol use, poor diet, stress and hepatitis A who presented with weakness, loss of appetite and decreased consciousness. He has a history of peptic ulcer disease, rectosigmoid cancer, cirrhosis of the liver and is currently taking medications for ascites, edema and disorientation. Tests show complications of his advancing liver disease. He began vomiting fresh blood and became comatose, requiring ICU care. The physician explained his condition is now irreversible and the family decided to enact a do not resuscitate order as MJ's condition continued to decline.

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    Mr. MJ is a 56-year-old man with a history of smoking, alcohol use, poor diet, stress and hepatitis A who presented with weakness, loss of appetite and decreased consciousness. He has a history of peptic ulcer disease, rectosigmoid cancer, cirrhosis of the liver and is currently taking medications for ascites, edema and disorientation. Tests show complications of his advancing liver disease. He began vomiting fresh blood and became comatose, requiring ICU care. The physician explained his condition is now irreversible and the family decided to enact a do not resuscitate order as MJ's condition continued to decline.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    62 views2 pages

    CA Case 3 GI Ca Liver Failure

    Uploaded by

    Nyeam Nyeam
    Mr. MJ is a 56-year-old man with a history of smoking, alcohol use, poor diet, stress and hepatitis A who presented with weakness, loss of appetite and decreased consciousness. He has a history of peptic ulcer disease, rectosigmoid cancer, cirrhosis of the liver and is currently taking medications for ascites, edema and disorientation. Tests show complications of his advancing liver disease. He began vomiting fresh blood and became comatose, requiring ICU care. The physician explained his condition is now irreversible and the family decided to enact a do not resuscitate order as MJ's condition continued to decline.

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    of 2

    MEDIAL SURGICAL NURSING

    Case Scenario 3
    Care of Client with GI, PUD, Cancer, Liver Failure

    Mr. MJ , 56 years old was brought to the Emergency Room because of weakness, loss of
    apetite and decreasing level of consciousness. During the interview by the nurse, the wife
    revealed that he was a smoker, alcoholic drinker , since he was 17 and fond of eating fatty, less
    fiber food. He leads a stressful life because of his work in a multinational company. He had
    undergone many diagnostic exams and procedures like colonoscopy with biopsy , esophago
    gastrocopy, sclerotherapy, paracentesis for ascites , chemotherapy and radiotherapy. He had
    been fatigued and anemic for the past year and had taken vitamin and iron supplements. The
    wife narrated that he had undergone major abdominal surgery with colostomy, after which he
    was placed on PCA morphine, post op monitors and were taught to take care of his colostomy
    site.

    Past medical history of MJ also revealed the following

    2017 – Hepatitis A

    2018 – PUD ,managed by medications. BPH with dysuria. DRE revealed soft enlarged
    prostate

    2019 – Rectosigmoid cancer stage 3, underwent Abdominoperineal resection (APR) with


    colostomy, underwent radiotherapy and chemotherapy

    January 2020- Cirrhosis with portal hypertension.

    A. What are the other possible risk factors that can contribute to his
    present condition?

    B. When you assess Mr MJ having undergone APR, what kind of colostomy


    do you expect?

    C. What would you expect to drain from the colostomy? What are the
    different kinds of colostomies?

    D. How will he monitor his colostomy? Discuss colostomy care and


    colostomy irrigation.

    E. Having undergone this surgery, discuss your nursing care for MJ after
    this abdominal surgery.

    F. Having undergone chemo/radiotherapy, the nurse knows that side


    effects can occur with these therapy since these affect both abnormal
    and normal cells. What are these side effects that the nurse should
    focus on her health teachings whenever the nurse is taking care of
    patient with cancer ?

    G. What possible diagnostic exams and management were given to him


    when he was suffering PUD?
    PART II

    During your interview with the wife of MJ, he is also taking Aldactone, Lactulose. At times
    he has been disoriented and had memory problems. You noticed ascites, some edema on his
    lower extremities. Additional tests were done like serum enzyme tests, serum Bilirubin ., total
    protein A/G ratio, PT.

    H. What can cause MJ’s liver cirrhosis?

    I. Cite the complications of Liver cirrhosis that already exist with his
    presenting signs and symptoms?

    J. Give the rationale of the above management and diagnostic


    assesements for his cirrhosis..

    During the 4th week of MJ’s confinement, the nurse observed the patient to be restless and
    suddenly he vomited fresh blood.

    K. What would be your immediate management at this time?

    L. What could have caused the vomiting of fresh blood? What are your
    other parameters of assessment with these advancing liver condition?

    For the succeeding days, MJ became comatose, ascites and edema worsening and was
    hooked to dopamine for his dropping blood pressure and was confined in ICU with decreasing
    GCS everyday.. The physician explained the irreversible effects of his advanced liver disease
    and later on the family and relatives signed for DNR .

    M. What ethical concepts are related to issues at end of life happening to


    MJ.

    N. With what members of the interdisciplinary team does the nurse


    collaborate when caring for the dying patient and providing support for
    the family.?

    O. Give signs and symptoms related to the end of life.

    P. Discuss the ethical and legal obligations of the nurse with regard to
    end of life care.

    MN/2020

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