A Patient with Alcohol-Related Liver Cirrhosis

Introduction

This essay illustrates the understanding of nursing skills required to assess a patient's individual care needs. The paper provides a critical analysis and evaluation of clinical reasoning and decision-making to make informed, evidence-based decisions when diagnosing a patient's condition. An individual case study of a patient is handled. The patient has a history of alcoholism and has previously been diagnosed with liver cirrhosis (Wang et al., 2016). The state of his alcoholism has been managed for the last six years. However, the condition keeps on relapsing due to stress, anxiety, and fear. The patient was taken to the hospital as an emergency case end a priority list was made for his assessment. This essay discusses the priority list that was made critics it, and makes the necessary recommendations.

Clinical reasoning

Clinical reasoning refers to applying medical knowledge, interpreting the signs and symptoms of a patient, and integrating all these to develop a diagnosis. Clinical reasoning is about making an informed decision in the health industry by nurses. The process involves:

Collecting data.

Interpreting the data.

Analyzing the data, processing.

Evaluating to implement a solution.

Clinical reasoning challenges health practitioners or student nurses to think critically about all illnesses and diseases to diagnose. Evaluation of all the possible outcomes from the diagnosis arrived at is a crucial part of clinical reasoning in nursing (Stocchi et al., 2003). The role of nurses in health care is critical. Nurses have to be very careful in the clinical reasoning process to avoid fatalities. The clinical reasoning process should ensure the safety of the patient and prevent misdiagnosis. A clinical nurse should be good at critical thinking and problem solving to be proficient in clinical reasoning. Critical thinking is essential for the clinical reasoning process. Clinical reasoning is more of a skill and then a concept to be understood. The clinical reasoning cycle is used to make better-informed decisions on clinical reasoning and enable the nurse to diagnose the patient's condition better. The process facilitates decision-making and allows the formulation of a care plan. The cycle involves the following steps: Collection of information, Processing of data, Identify Problems, establish the goal, Take action, Evaluate outcomes, Reflect on the process and consider the patient's situation. Clinical reasoning is the most critical stage of treating a patient. A misdiagnosis would lead to a wrong medication being administered and consequently death.

Prioritization

Prioritization of a patient's health problem is dependent on the current status of their health and their very immediate needs. The initial assessment should prioritize checking the primary life-threatening condition for the patient. Nurses should always apply the ABC concept to every patient as the initial diagnosis stage. ABC assessment focuses on reviewing the airway for blockage followed by breathing and finally circulation. Should any of the ABC checkpoints have a problem, they should be addressed first before proceeding to any other steps. Nurses can use Maslow's hierarchy of needs to provide a guiding framework on the type of care given and what steps should be followed in the process. Having a prioritization framework helps the nurses to have the best tests and make the most appropriate decisions for their patients. Priorities in healthcare by the nurses should also include involving the patient and their caregivers in the decision-making process. As a nurse, one should always support the patient and their family, especially psychologically, and create an individual care plan for the patient that involves nutrition and hydration. Nurses should use an approach that considers a holistic care plan for patients; that is, the nurses should consider the medical procedures to the patient's condition and financial, psychological, and social.h5

Case study

In this essay, we look at the clinical reasoning and prioritization care process in-depth based on a case study of a patient provided for this assignment. Throughout the essay, the patient will be referred to as Mr. John, not his real name, for confidentiality purposes. The anonymous name is given to keep the privacy and confidentiality of the patient as per the NMC guidelines. According to the Nursing and Midwifery Council (2018), a patient's right to privacy should be respected at all times during the period of their care.

The basic details of the patient have to be taken first by the nurse on duty. Mr. John is male, 45 years of age, widowed, and lives alone. Forty-five years is slightly above middle age. Therefore, generally, his body gets prone to aging illnesses and conditions. The male gender immunity also tends to be somewhat weaker than the female gender of the same age.

The medical history of the patient is as follows;

Managed for alcohol dependence for six years

Previously been diagnosed with liver cirrhosis

Before his admission, Mr. John had suffered fever for four days accompanied by vomiting and abdominal pain in the upper right quadrant. Mr. John was taken to the hospital by the emergency hospital ambulance and admitted to the Medical Assessment Unit. In the medical assessment unit, the patient is monitored and receives intravenous fluids, antibiotics, analgesia, and antiemetics. The hospital organizes urgent abdominal ultrasound, CT scans, Liver function tests, and amylase (Ipser et al., 2009). Mr. John is also referred to Gastroenterology for further assessment. The initial assessment review on admission indicates that Mr. John is stressed and frightened.

Based on the initial assessment interview of the patient, the nurse identified the following priorities;

Anxiety and fright

Vomiting

Hypertensive

Slow response

Acute and continuous abdominal pain

Due to the unresponsive nature of Mr. John at the time of admission, the ABCDE evaluation tool is used to assess his condition. This tool is used on critically ill or unresponsive patients. Both assessment and treatment are carried out at the same time continuously using this evaluation tool. The approach could be sometimes invasive, especially to very critically sick patients. However, it is the best tool to administer life-saving treatment until a proper diagnosis is made.

Treatment plan

The ABCDE assessment tool is used as follows:

A represents the airway. The patient's airway is checked for blockage. In case the airway is blocked, it is to be cleared up immediately. An airway check can be done by engaging the patient in a conversation, and if he responds clearly, then a conclusion is made that his airway is clear. If he fumbles in his response or keeps on coughing to clear his voice, it is an indication that his airway could be blocked and that immediate action should be taken to ensure that the blockage is cleared. Noisy breathing and breathing deeply and heavily is a sign that Mr. John's airway could be partially blocked.

B represents breathing. Mr. John's respiratory rate is checked through observation of chest movements or pulse oximetry. The average respiratory pulse rate ranges from 97% to 100 %.

C stands for circulation. Circulation is checked by observation of the skin color. Paleness of the skin may be an indication that there is no enough circulation in the body (Yoshinaga et al., 2016). Excessive sweating is an indication of poor circulation. After the blood circulation is checked, blood pressure should also be considered and checked. Normal blood pressure should range between 100 and 140

D represents disability. This refers to the ability of a patient to respond. The medical officer in charge should ensure that the level of consciousness of Mr. John should be average. There should be no unresponsiveness, pain, or interruption in the production of voice.

Lastly, the letter E stands for exposure. Mr. John's skin should be checked whether it has bruises, marks, or bleeding. The temperature of the patient is checked using a thermometer. The average temperature of a human being is 36 degrees Celsius.

Considering Mr. John's past medical history and the present symptoms at the Medical Assessment Unit, the priorities identified for his condition could be different. Anxiety and freight are not a significant priority considering an unresponsive patient (Bandelow et al., 2017). Mr. John must have been afraid and anxious just due to the upcoming death anniversary of his family. With the history of liver cirrhosis and alcoholism, it was only average for the patient to get anxious (Xu et al., 2003). According to Walkup et al. (2008), anxiety disorder caused by a medical condition makes the patient have symptoms such as panic attacks directly caused by a physical health condition. Treatment of the primary disease of the patient will automatically lead them to stop being afraid or anxious.

Consequently, anxiety can also cause vomiting. Mr. John had been suffering from vomiting at the time of admission. This could have been caused by the fear and anxiety he was facing in anticipation of the death anniversary of his family (Connor et al., 2006). The meeting is also an easily treatable condition by administering fluids to the patient that does not have to be on the priority list of the patient assessment form. The main priority that will be included in the assessment of the patient will be unresponsiveness (Breese et al., 2005). Mr. John was becoming less responsive when brought into the hospital. The problem with a patient being unresponsive is that you may not know precisely where the problem is and conduct numerous tests to identify the patient's condition.

The primary condition when Mr. John’s health is liver cirrhosis which he had been previously diagnosed with. Liver cirrhosis is a condition caused by excessive alcohol consumption. The disease causes damage to the liver. Mr. John was diagnosed with a secondary infection of pancreatitis. Both liver cirrhosis and pancreatitis cause some of the symptoms that Mr. John exhibited, including vomiting, abdominal pain, and unresponsiveness.

Liver cirrhosis is caused by liver damage, mainly due to alcoholism. The causes of liver cirrhosis, however, are defined geographically. In the Western world, where Mr. John hails from liver cirrhosis is mainly caused due to excessive use of alcohol and chronic hepatitis C. The only cure for liver cirrhosis is a liver transplant. Failure to get a donor a patient suffering from severe liver cirrhosis dies. The show way to diagnose liver cirrhosis is through screening for oesophageal variance and hepatocellular carcinoma (Osna et al., 2017).

Pancreatitis is a condition where the pancreas of a human being is damaged or cannot perform its functions typically. Pancreatitis involved enlargement of the pancreas tissues. The disease could be caused by chronic alcoholism, gallstones, abdominal surgery, or some medications that react with the body and affect the pancreas (Becker, 2008). Some of the symptoms of pancreatitis involve vomiting, abdominal pain, and unresponsiveness (Hetrick et al., 2012). The signs stated above match the symptoms that methadone exhibited during and before his admission. The symptoms were probably the main reason why the secondary diagnosis for Mr. John has pancreatitis.

Prioritizing vomiting and abdominal pain by administering painkillers and increasing the fluid content in the body is essential (Wennberg et al., 1989). Increasing the amount of fluid in the patient's body helps to also regulate the blood pressure of the patient and improve circulation. The medication also helps the patient overcome anxiety and fear, preventing them from getting into acute shock (Anton et al., 2006).. Patients are treated better when they are not in shock because they can be asked questions and respond to help in a better diagnosis of the air condition

Recommendations

Following the signs and symptoms exhibited by the patient, the following treatment plans could be considered: The meeting should be treated first by administering more fluids to the body. Vomiting causes excessive loss of water from the body leading to dehydration. Dehydration is dangerous, especially when it's severe. Hydration could be the cause why Mr. John gets less responsive with time. Increasing the body volume in the body is ensured by administering more intravenous fluids to maintain electrolytes and acid-base balance in the body. Nurses will also help with an injection of anti-vomiting medication such as metoclopramide. Acute abdominal pain is relieved by giving the patient painkillers.

Conclusion

Clinical reasoning and care prioritization are a process that is more skill-based the knowledge-based. Nurses should be thorough in this process to ensure that misdiagnosis does not happen as this can cause severe consequences such as death. Clinical reasoning is probably a process that should be done by more than one nurse. Brainstorming will ensure that a higher accuracy in diagnosis is arrived at. Nevertheless, a nurse can practice clinical reasoning and care prioritization over the years to perfect the art.

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