Case Study Assessment and Management of Carl Vinson- Riverside City College

Case Study, Chapter 49, Assessment and Management of Patients With Hepatic Disorders – Carl Vinson Carl Vinson, a 65-year-old Caucasian man, was admitted today with increased shortness of breath, fatigue, and decreased level of consciousness. Mr. Vinson has a history of liver disease, most likely related to a long history of alcohol use. Upon arrival to the unit, he is somnolent and responds only to shouting and shaking. Upon arousal, he is only able to state his first name. His wife accompanies him to the unit, and describes that he has become increasingly restless over the last 3 days, and she is concerned for his safety. Additionally, he has not eaten or taken in any fluids in 24 hours. a. Correlate the patient’s presenting clinical manifestations and identify a probable diagnosis based on the information provided. - Early S&S of hepatic encephalopathy include mental changes (he has decreased LOC) and motor disturbances (he is somnolent and has had increasing restlessness per his wife) b. What blood tests would you anticipate for Mr. Vinson? Give the rationale for each lab test and how it relates to the patient’s condition. - CBC: to check for bleeding and infection - CMP: to check electrolytes and kidney functioning - Ammonia level: to determine his ammonia level given hepatic disease c. The physician orders Mr. Vinson to receive lactulose (Cephulac) 30g po now. Supplied as 20g/30ml, how much would the patient get? What is the rationale for this medication? Any concerns related to this order that you would consider? - 45 mL of lactulose - The lactulose binds to the ammonia, allowing it to be excreted. d. Based on the above information, what is your priority nursing diagnosis? - Imbalanced Nutrition e. List 3 interventions that you would do that address your concerns - Maintain protein intake 1.2-1.5 g/kg/day - Correct any electrolyte abnormalities (potassium) - provide vitamin therapy as indicated