I.

INTRODUCTION

Liver Cirrhosis (alcoholic)

Cirrhosis of the liver is a chronic disease that causes cell destruction and
fibrosis (scarring) of hepatic tissue. Fibrosis alters normal liver structure and
vasculature, impairing blood and lymph flow and resulting in hepatic
insufficiency and hypertension in the portal vein. Complications include
hyponatremia, water retention, bleeding esophageal varices. Coagulopathy,
spontaneous bacterial peritonitis, and hepatic encephalopathy.
Cirrhosis is a potentially life-threatening condition that occurs when scarring
damages the liver. This scarring replaces healthy tissue and prevents the
liver from working normally. Cirrhosis usually develops after years of liver
inflammation. When chronic diseases cause the liver to become permanently
injured and scarred, the condition is called Cirrhosis. Cirrhosis harms the
structure of the liver and blocks the flow of blood. The loss of normal liver
tissue slows the processing of nutrients, hormones, drugs, and toxins by the
liver. Also, the production of proteins and other substances made by the liver
is suppressed. People with cirrhosis often have few symptoms at first. The
person may experience fatigue, weakness, and exhaustion. Loss of appetite
is usual, often with nausea and weight loss. As liver function declines, water
may accumulate in the legs and the abdomen (ascites). A decrease in
proteins needed for blood clotting makes it easy for the person to bruise,
bleeding or infection. In the later stages of cirrhosis, jaundice (yellow skin)
may occur, caused by the buildup of bile pigment that is passed by the liver
into the intestines. The liver of a person with cirrhosis also has trouble
removing toxins, which may build up in the blood. Drugs taken usually are
filtered out by the liver, and this cleansing process also is slowed down by
cirrhosis. People with cirrhosis often are very sensitive to medications and
their side effects. The doctor often can diagnose cirrhosis from the patients
symptoms and from laboratory tests. During a physical exam, the doctor
could notice a change in how your liver feels or how large it is. If the doctor
suspects Cirrhosis, you will be given blood tests. The purpose of these tests
is to find out if liver disease is present. In some cases, other tests that take
pictures of the liver are performed such as the computerized axial
tomography (CAT) scan, and ultrasound. The doctor may decide to confirm
the diagnosis by putting a needle through the skin (biopsy) to take a sample
of tissue from the liver. In some cases, cirrhosis is diagnosed during surgery
when the doctor is able to see the entire liver.

II. OBJECTIVES
General objectives:

This case study focuses on the advancement of my skills in managing

and administering the extensive range of my intervention to my client
with Liver Cirrhosis. This study will further help me to expand my
knowledge about the said disease.
Specific objectives:

1. To established good rapport to the client and to get the physical

assessment.
2. To define what is Liver Cirrhosis.
3. To trace the pathophysiology of Liver Cirrhosis
4. To enumerate the different signs and systems of Liver Cirrhosis
5. To formulate and apply necessary nursing care plans utilizing the
nursing process.

III. DEMOGRAPHIC DATA

Name: Mr. KM
Age: 47
Gender: Male
Status: Widowed
Nationality: Filipino
Religion: Catholic Christian
Blood type: B

Address: # 143 BLK3 Brown Wood Vill., Cainta

Final Diagnosis: Liver Cirrhosis
Time admitted: 12:15am
Date admitted: February 27, 2011
CLINICAL ABSTRACT
This is the case Mr. KM, 47 y/o ,Male 143 BLK3 ,Brown Wood Vill., Cainta. He
was born on June 10, 1963. He has 2 children. Mr. KM is a non smoker and an
alcoholic beverages drinker.
Mr. KM was admitted to GAMMC on February 27, 2011
12:15am in the morning. He was admitted due to enlargement of his lower
extremities.
HISTORY OF PRESENT ILLNESS
One week prior to admission the patient had experienced fast
enlargement of his lower extremities because of edema then he was
brought to the ER of GAMMC.
FAMILY MEDICAL HISTORY
(+) Hypertension

LIFE STYLE
A. Personal Habit
The patient does not smoke but drinks alcoholic beverages.
B. Diet
He eats three times a day and drinks 4-6 glass of water per day
and sometimes he always drinks soft drinks. The patients usual diet
includes rice, meats like pork, beef, chicken and fish. According to
the patient, he seldom eats vegetables.
C. Recreational Activity

His talking with his friends outside the house during his free
time after he had finish the household choirs. Sometimes he play
basketball.
D. Sleep and Rest
He said that he spends 6 hours of sleep every night and he takes
naps if he had free time. He usually sleeps at 11:00 in the evening
and wakes up at 5:00 in the morning he said that it is continuous
and he feels refrehed after waking up.
E. Activities of Daily Living
The patient doesnt work everyday, every Wednesday and Friday
he is serving the church cause his a church worker. Every weekend
he allotted time to rest and to have bonding with his family. But in
night time of his weekend he spend a lot of time drinking beers with
his male friends.
PATIENTS SOCIAL HISTORY
A. Family Relationship and Friends
The patients family is extended type together with his mother
and one son and one daughter. According to him he has a good
relationship with each member of him family and also with him
friends. He allotted time to bond with him family.
B. Occupational History
The patient is a church server/worker.
C. Economic History
According to the patient him being a church server/worker is an
additional income to them and it satisfies their needs.

IV. PHYSICAL ASSESSMENT

Actual Findings

Normal Findings

Interpret
ation

 Head
Skull

Scalp

-Normocephalic
-No lumps

-No nits, lice and dandruff

-no baldness

-Whitish
-No nits, lice and dandruff
-no baldness

Hair
-Straight, Black with white
hair, oily hair

Face

Eyes

-Symmetrical with
movement
-Expressions appropriate
to situations
-Symmetrical
-No cloudiness
-No Lacrimation

Eyebrows
-Symmetrical
Eyelahes
Eyelids

-Normocephalic
-Smooth
-No lumps
-Absence of modules or
masses
-No area of tenderness
-Symmetrical with
protrusions on the lateral
part of parietal forehead
and occipital bone.

-Equally distributed
-Curved slightly outward
-Skin intact
-No discharge
-No discoloration
-Lids close symmetrically
-approximately 15-20
involuntary blinks per

-Normal

-Normal

-Normal

-Black or brown in color

-Hair is evenly distributed
-No area of baldness
-Thick
-Fine
-Curly/kinky/straight
-Dry/oily/shiny hair
-Normal
-Symmetrical with
movement
-Expressions appropriate
to situations
-Symmetrical
-No protrusions
-Dear or no Cloudiness
-No excessive Lacrimation
-Moves symmetrically
-Hair evenly distributed
-Skin Intact
-Equally distributed
-Curved slightly outward
-Skin intact
-No discharge
-No discoloration
-Lids close symmetrically

-Normal

-Normal

-Normal
-Normal

minute; bilateral blinking

-No secretions
-No erythema
-No redness
Lid margins
-Pink, shiny, with visible
blood vessels
-No discharges
Lower
palpebral
conjunctiva

Sclera

Iris

-White in color
-Clear
- No redness
-Flat
-Brown
-Round
-Transparent/Shiny

-PERRLA

-approximately 15-20
involuntary blinks per
minute; bilateral blinking
-No
-No
-No
-No

scaling
secretions
erythema
redness

-Pink, shiny, with visible

blood vessels
-No discharges
-White/yellowish in black
Americans
-Clear, No cloudiness
-No redness
-Flat
-Brown
-light brown and yellowish
-Symmetrical
-Round
-Transparent/Shiny

-Normal

-Normal

-Normal

-Normal

-Normal

-PERRLA(Pupils Equally
Round, Reactive to Light &
Accommodation
-Normal
Pupils

Eye
Movement

-Moves in unison
-coordinated

-Same as the color of the

face
-No swelling
-Hell shape

Field of
vision
*Visual acuity
- Waxy cerumen
-Presence of cilia

-Moves in unison
-coordinated

-Normal

-Good peripheral vision

-20/20 in both eyes

-Normal

-Parallel with outer

canthus of the eyes
-Same as the color of the
face
-No swelling
-No tenderness

 Ear

-With good hearing acuity

in both ears

Hearing
acuity

-Hell shape
-Firm cartilage

-Normal

-Yellowish
-Dry/waxy cerumen
-Presence of cilia
-No foreign body

-Normal

-With good hearing acuity

in both ears
-No lesions
-Presence of cilia

Ear Canal

-Darker lips
-Ability to purse lips

Lips

Gums

-Pink, moist
-No swelling
-No tenderness
-No discharges
-white

Teeth

Tongue

Frenulum

-Pink, even, rough dorsal

surface and moist
-Midline
-pinkish
-With visible veins

-Normal
-Symmetric and straight
-No discharge or flaring
-Uniform color
-No tenderness
-No lesions
-Presence of cilia
-Uniform pink
color(darker, e.g,Bluish
hue, in Mediterranean
groups and dark-skinned
clients)
-Soft, moist, smooth
texture
-Symmetry of contour
-Ability to purse lips
-No tenderness
-Pink, moist
-No swelling
-No tenderness
-No discharges
-No retraction(lower and
upper)
-32 in number
-White
-Upper teeth over-rides
lower teeth

-Normal

-Normal

-Normal

-Normal
-Pink, even, rough dorsal
surface and moist

-Pink, moist, no

Decrease
of
oxygen
supply

swelling/No tenderness
Soft Palate

Hard Palate

-Bony, Light pink in color,

moist
-Midline moves when the
client says Aah

Uvula

Tonsils

Neck

Upper
Extremities
Skin

Nails

-Normal
-Midline
-pinkish
-With visible veins
-Normal
-Pink, moist, no
swelling/No tenderness
-Bony, Light pink in color,
moist

-Pinkish
-No discharge
-No inflammation

-Pink, moist
-Midline moves when the
client says Aah

-Same as the skin color

-No lymphs, No mass

-Normal

-Normal
-Pinkish
-No discharge
-No inflammation

-No abrasions or other

lesions
-When pinched, skin
springs back to previous
state
- with edema

-Convex curvature

-Erect & midline

-Same as the skin color
-No tenderness
-No lymphs, No mass
-Symmetrical
-Muscles equal in size;
head centered
-Coordinated, smooth
movements with no
discomfort

-Varies from light to deep

brown; from ruddy pink to
light pink; from yellow
overtones to olive
-No edema
-No abrasions or other
lesions
-Freckles, some

-Normal

-white

Chest and back

Posterior
Thorax

Anterior
Thorax

-No tenderness
-No masses

-Full expansion
-Tachypnea

-Unblemihed skin
-Uniform color
Abdomen

birthmarks, some flat and

raised nevi
-When pinched, skin
springs back to previous
state

-Convex curvature
-Smooth texture
-Highly vascular and pink
in light-skinned clients;
dark-skinned clients may
have brown or black
pigmentation in
longitudinal streaks
-Intact epidermis
-Prompt return of pink or
usual color(generally less
than 4 seconds)
-Chest symmetric
-Skin Intact; uniform
temperature
-Chest wall intact
-No tenderness
-No masses
-Full and symmetric chest
expansion
-Vesicular and
bronchovesicular sounds

accumul
ation of
excess
fluid

Decrease
O2
supply

-Normal

Difficulty
of
breathin
g
-Quiet, rhythmic, and
effortless respirations
-Full symmetric excursion
-Bronchial and tubular
breath sounds in the
trachea
-Vesicular and

bronchovesicular breath
sounds
Lower
extremities

-Brown in color
- with edema
- No abrasions or other
lesions
- with edema

Skin

- Concave curvature
-Brown pigmentation in
longitudinal streaks

-Unblemihed skin
-Uniform color
-Silver-white striae or
surgical scars
-Flat, rounded(convex),or
scaphoid (concave)
- Symmetric movements
caused by respiration
- Audible bowel sounds
- No tenderness
- Relaxed abdomen with
smooth, consistent
tension

accumul
ation of
excess
fluid

Nails

Motor
functions:

-Normal

- Repeatedly and
rhythmically touches the
nose
- Rapidly touches each
finger to thumb with each
hand
- Can readily determine
the position of fingers and
toes

Varies from light to deep

brown; from ruddy pink to
light pink; from yellow
overtones to olive
- No edema
- No abrasions or other
lesions
- Freckles, some
birthmarks, some flat and
raised nevi
- when pinched, skin
springs back to previous
state
- Concave curvature
- Smooth texture
- highly vascular and pink
in light-skinned clients;
dark-skinned clients may
have brown or black
pigmentation in

-Normal

-Normal

longitudinal streaks
- Intact epidermis
- Prompt return of pink or
usual color (generally
less than 4 secs.)

Has upright posture and

steady gait with opposing
arm swing; walks unaided,
maintaining balance
- May sway slightly but is
able to maintain upright
posture and foot stance.
- Maintain stance for at
least 5 secs
- maintains heel-toe
walking along straight line
- Repeatedly and
rhythmically touches the
nose
- Rapidly touches each
finger to thumb with each
hand
- Can readily determine
the position of fingers and
toes

GORDONDS

a. activityexercise
pattern
- hobbies

Before
hospitalizatio
n

During
hospitalizatio
n

Interpretation

According to
him he does
the
household
choirs and at
the same

During his
hospitalizatio
n he is in
complete bed
rest.

He was not
able to
perform the
activities
because of
the disease

Analysis

Exercise is
very
important to
our body
because it
promotes

time it is her
way of
exercising
and he can
perform
different
activities.
Elimination
pattern
Prior to
hospitalizatio
n he
defecates
every day.
She urinates
normal
amount and
normal color.
urinates

process.

For the period

of
hospitalizatio
n his
defecation
does not vary
but her urine
output
decreases.

The patients
elimination
pattern
changed
during
hospitalizatio
n because
she is under
medication.

Sleep and
rest pattern

Cognitiveperceptual
pattern

Before he
sleeps 6
hours every
day

Throughout
his
hospitalizatio
n sleeps 12
hours and
can take
naps.

Same

Self
perception
and selfconcept
pattern

The patient is
a 2nd year
high school
undergraduat
e. he is
literate.
During her

Due to
confinement
the patient
has no
problem with
his sleep.

Due to
confinement
the patient
has no
problem with
understandin
g

good health
and helps us
build and
maintain
healthy
muscles,
bones, and
joints and it
reduces
depression
and anxiety.
Good
elimination
pattern
reduces the
risk of having
cancer. It
helps us to
detoxify
waste in our
body to free
ourselves
from
complications

Enough and
good sleep
and rest
pattern can
reduce stress,
helps us to
think better.
Good
education is
important to
overcome

Rolerelationship
pattern

Prior to
hospitalizatio
n he is not
that cheerful
and
approachable
.

The patients
family is
extended
type. They
are 4 in the
family. They
are 4 in the
family to
bond. He is
sociable to
everyone.

hospitalizatio
n he is
irritable
inside the
hospital.

Throughout
his
hospitalizatio
n his family is
with his side
at all times to
support his.

poverty.
Due to
confinement
he changed.

Due to his
hospitalizatio
n the family
becomes
closer to one
another and
become
stronger.

Coping-stress
tolerance
pattern

Health
perception

Ever time he
encounters
difficulties he
asks
guidance and
help from
God.

During his
hospitalizatio
n she just
prays every
time shes in
pain.

Her coping
stress is the
same as what
she is doing
before.

During his
hospitalizatio
n he still
believes that
health is

His health
perception is
the same as
what she
believes

Good selfperception
and selfconcept
pattern helps
us to
overcome
problems and
trials.
Good
relationship
to each
member of
the family
creates unity
and compact
relationship
with each
other. Good
relationship
with other
people can
gain trust,
acceptance,
support, and
someone to
Call On When
You Need a
Hand.

Having a
good coping
to stress can
overcome

Sexualityreproductive
pattern

According to
him health is
very
important
because it is
wealth.

wealth.

before.

Same

NA

During his
hospitalizatio
n her
husband and
her always
prays for her
health.

His valuesbelief pattern

does not
change and
her faith to
God become
stronger.

He dont want
to talk about
Values- belief it.
pattern

Roman
Catholic.
They go to
church every
Thursday and
Sunday.

stressors and
depressions.

Good health
perception
can maintain
health, the
body can
function
properly and
it acts as
personal
strength.

Good
sexualityreproductive
can easily
determine the
fertilization
and can
prevent
cancers in
reproductive
system.

Strong
values-beliefs
help us to
overcome
difficulties
and trials.

V. ANATOMY

The liver is located in the upper right-hand portion of the abdominal cavity, beneath the
diaphragm and on top of the stomach, right kidney and intestines. The liver, a dark reddishbrown organ that weighs about 3 pounds, has multiple functions.

There are two distinct sources that supply blood to the liver:

oxygenated blood flows in from the hepatic artery

nutrient-rich blood flows in from the portal vein

The liver holds about one pint (13 percent) of the bodys blood supply at any given moment.
The liver consists of two main lobes, both of which are made up of thousands of lobules. These
lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic
duct. The hepatic duct transports the bile produced by the liver cells to the gallbladder and
duodenum (the first part of the small intestine).

VI. PATHOPHYSIOLOGY

VII. LABORATORY

IX. Discharge plan

Clients with Upper Gastrointestinal Bleeding are instructed to take the
following plan for discharge.
M- Medications should be taken regularly as prescribed, on exact dosage,
time, & frequency, making sure that the purpose of medications is fully
disclosed by the health care provider.
FeSo4 + Folic acid TID
Tranexamic acid 50gm/cap TID
Omeprazole 40g/cap TID
E- Exercise should be promoted in a way by stretching hand and feet every
morning. Encourage the patient to keep active to adhere to exercise program
and to remain as self sufficient as possible
- bed rest
T- Treatment after discharge is expected for patients and watcher with UGIB
to fully participate in continuous treatment.
H- Health teachings regarding the importance of proper hygiene and hand
washing, intake of adequate water and vitamins especially vitamin C-rich
foods to strengthen the immune response and increasing of oral fluid intake
should be conveyed. Avoid spicy foods, carbonated beverages and coffee.
O- OPD such as regular follow-up check-ups should be greatly encouraged to
clients with UGIB as ordered by physician to ensure the continuing
management and treatment.
D- Diet which is prescribed should be followed.
S- Pray for faster healing and dont losses hope.

 Drug study

University of Perpetual Help College of Manila

214 V Concepcion Street Sampaloc Manila

Case Study: Upper Gastrointestinal Bleeding

Submitted to: Ms. Ma. Evelyn Lumio

William Roy Agoncillo A3D

Submitted

by:

Grp. 1 M-W
6am-2pm