Cirrhosis & Hepatic Encephalopathy Case Study | Nursing NCLEX Prep | John Richards 45-Year-Old PDF | Liver Failure Assessment

Master the comprehensive nursing assessment and clinical reasoning of a 45-year-old male presenting with decompensated cirrhosis using this detailed case study PDF (John Richards). Perfect for nursing students, NCLEX-RN preparation, medical students, and RN refresher courses, this guide walks you through the full emergency department encounter—chief complaint (abdominal pain, worsening nausea/vomiting for 3 days, fatigue, poor appetite), relevant history (episodic binge drinking, past heroin use in remission for 2 years, hepatitis C diagnosed 10 years ago with minimal follow-up, unemployed, no insurance, lives alone), abnormal vital signs (temperature 100.5°F, HR 110, orthostatic HR increase of 22), and physical exam findings (RUQ/epigastric pain 6/10, scleral icterus, tacky dry mucous membranes, abdominal distension firm to touch, 1+ pitting edema, softball-sized ecchymosis on abdomen, loss of pubic hair, light orange urine). The case covers interpretation of relevant labs (WBC 12.8, Hgb 10.2, platelets 98, neutrophils 88%, bands 3%, sodium 135, potassium 3.5, BUN 38, creatinine 1.5, albumin 2.5, total bilirubin 4.2, alk phos 285, ALT 128, AST 124, ammonia 35, INR 1.5), pathophysiology of cirrhosis (hepatocyte destruction → fibrosis → portal hypertension → ascites → hepatic encephalopathy), nursing priorities (fluid status, bleeding risk, neurological status), collaborative care (IV access, NS bolus, ondansetron, orthostatic monitoring), and a six-month follow-up showing worsening status (disoriented, homeless, BP 88/50, HR 118, sodium 127, potassium 2.8, BUN 55, creatinine 1.8, Hgb 8.9, platelets 47) consistent with hepatic encephalopathy. Includes SBAR handoff, nursing reflection, and discharge planning. Instant digital download—ideal for medical-surgical nursing, NCLEX-RN liver disorders, or clinical rotation assignments.