Cirrhosis Patient: Lisa History of present illness:

Cirrhosis Patient: Lisa History of present illness: You are caring for Lisa Ramsey, a 47-year-old Caucasian female who works in the hospitality industry. She arrived at the ED complaining of hematemesis, nausea, and abdominal distention. She reports feeling “sick” for a while and has a temperature of 39.2°C, is intermittently confused and is accompanied by her husband, Ken. She has not vomited since being in the ED. Social History: (from her husband, Ken) Ken and Lisa own a restaurant downtown and spend most of their time there as they do not have any children together. Lisa is a trained bartender and Ken manages the restaurant on the business end. Ken denies that Lisa has a drinking problem but does confirm she drinks a “bottle or two” of wine every evening. Medical: ETOH use, HTN, hysterectomy 15 years ago. Subjective History: (from Ken): Lisa has put all of her time and effort into the business since she was 32 years old. Ever since Lisa found out she could not carry children and had a total hysterectomy, she focused more on her career. Lisa has been drinking more over the past five years or so. Ken noticed that Lisa has been acting “off” the past few weeks but attributed it to stress. She has become more intermittently confused and forgetful. Ken finally decided to bring Lisa into the hospital once he noticed she vomited blood. Her last known alcoholic drink was one day ago. Medications: None Based on Lisa’s history, what assessment data is important to collect and why? (Not all might be needed) Clinical Significance/Impact Vital Signs Can identify issues such as fever, infection, hemodynamic instability or breathing issues. Neuro Increased levels of ammonia can alter mental status. Prolonged use of alcohol can also cause mental status changes over time. Confusion can be due to hepatic encephalopathy. Cardiac Lisa has a high fever and is at risk for sepsis and significant circulatory changes. palmar erythema and digital clubbing are signs of circulatory changes due to alcohol use. GI Lisa reports hematemesis which is a sign of upper GI bleeding. Abdominal distention can be a sign of ascites. Muscular Asterixis is a tremor of the hand when the wrist is extended and is a motor disorder often seen with prolonged alcohol abuse. Integumentary Physical exam may include jaundice on the mucus membranes, sclera, or skin. Why did the doctors place these orders: Orders: Why: NPO now and then Low sodium diet 2G per day Diuretic therapy Abstinence from alcohol Antibiotic therapy Avoid hepatotoxins Frequent record of vital signs Measure and record the nature, time, and amount of vomitus

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