Case Study- PATHO PAPER

Case Study- PATHO PAPER

Academic Requirements:

  • 7-page APA formatted Paper
  • Must use 6 references with at least 3 of these references coming from and incorporating current original research literature.

Case Study/ PATHO PAPER:

This must BE a Patient Centered- Discharge focused paper reflecting the care of a patient who is experiencing complex medical/nursing needs correlating at least 3 co-morbidities to the primary medical diagnosis!

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Patient story:

  • This is a 55yr old patient who presented to the emergency department with weakness, dizziness, dyspnea (difficulty breathing).
  • stated he was feeling ill for the last 3 days. (malaise could be contributed to alcohol withdrawal, pt. states his last drink was 3 days prior, toxicology report, reveled ETOH: 0.034
  • Has a past medical history of Chronic Alcoholism, Hypertension, Morbid Obesity, Obstructive sleep apnea, and Atrial Fibrillation

Clinical Manifestations:

  • vitals: Fever: 101.7, SpO2 94%, Respiratory rate 18, HR: 122 BP: 160/99
  • bilateral lower extremities edematous 2+
  • abdominal pain, swelling, distention
  • has 3 major bruises (shoulder, flank, sacral area)
  • Pertinent assessment findings: large amount of Ascites, had bedside paracentesis, drained 2L and sent fluid for analysis (paracentesis alleviated symptoms of dyspnea/ shortness of breath)

Diagnostics:

  • Abdominal Ultrasound: Cirrhotic liver with perihepatic ascites
  • Peritoneal Fluid analysis: results pending, fluid being assed for risk of SBP
  • Chest X-ray: no anomalies, pt. admitted w/complaints of dyspnea (lungs clear)
  • 12-lead EKG: no ST-elevation or ST-depression (no MI, rhythm assessed per Hx: Afib)
  • toxicology negative: Ethyl alcohol 0.034 (pt. states last drink was 3days ago)

PATHO PAPER OUTLINE

1. Pathophysiology of primary disease/diagnosis

Primary disease/diagnosis  

Chronic Liver Disease & possible Spontaneous Bacterial Peritonitis          

Chronic Liver Disease (related to alcoholism)

  • describe the pathophysiology of how alcoholism causes chronic liver disease/ cirrhosis

Possible Spontaneous Bacterial Peritonitis

  • MD thinks there is risk due to Chronic Liver Failure and Ascites
  • describe pathophysiology of SBP and why this is a concern given the patients history of Chronic Liver Failure and Ascites

2. Correlate 3 co-morbidities to the primary diagnosis

Hypertension

  • describe the pathophysiology
  • describe the risk factors the patient exhibits:

Patients risk factors:

  • morbidly obese (BMI 40)
  • poor diet: consumes too much salt
  • sedentary lifestyle (retired, does not exercise)
  • how does this co-morbidity contribute to chronic liver disease (poor organ perfusion could be contributing to liver failure)

Alcoholism

  • describe pathophysiology

Risk factors patient exhibits:

  • claims he started drinking at age 14
  • drinks heavily on weekends
  • claims to drink 3 tall cans of beers and 4 shots
  • this co-morbidity directly relates to chronic live disease

Atrial Fibrillation (AFib) 

  • describe pathophysiology

Risk factors patients exhibits

  • age, hypertension, ETOH, obesity…
  • inconsistent blood flow = poor perfusion of organs (try to correlate w/ chronic liver dsiease or ascites)

*how are Co-morbidities related to the primary diagnosis

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3. Describe the clinical manifestations (S/S) of each disease and how your patient did/did not demonstrate these symptoms AND Discuss laboratory values and how these labs were related to these diseases. Case Study- PATHO PAPER

Chronic Liver Failure (caused by ETOH)

  • Ascites, required Paracentesis (drained 2L)
  • bilateral lower extremity edema
  • elevated ammonia
  • elevated liver enzymes
  • low albumin -low platelets (easily bruises)

Spontaneous Bacterial Peritonitis 

  • Ascites, required Paracentesis (drained 2L)
  • abdominal pain, swelling and distention
  • elevated WBCs

Hypertension

  • BP: 159/99
  • obesity:

Atrial Fibrillation

  • bassline sinus rhythm: 60-80 (current heart rate 84)
  • 12- lead EKG: no ST elevation or depression (normal)
  • hypercoagulable state

Laboratory values

  • WBCs elevated 17.6: (normal 5-10)

-indicates infection or inflammation

-elevated levels consistent with spontaneous bacterial peritonitis   and acute liver cirrhosis

  • Elevated Ammonia: 71 (normal 11-32)

-why is this elevated?

-byproduct of protein metabolism

-waste product not being metabolized due to liver failure

  • Elevated Liver Enzymes

-elevated AST: 216

-why is this elevated

  • Elevated bilirubin

-total bilirubin 1.9 (normal 0.1-1.2mg/dL)

-why is this elevated?

  • Low albumin 2.1

-why is it low

-how does this correlate w/ liver failure and ascites

  • Low platelets 80,000 (normal 150,000-300,000)

-thrombocytopenia (low platelet count)

-thrombocytopenia and chronic liver failure???

-thrombocytopenia and AFib (related to anticoagulant therapy       required to manage AFib)

  • Coagulation studies:

-PTT and INR elevated, this indicates therapeutic levels for                                                                         anticoagulant therapy (Heparin in hospital: warfarin at home)

-patient taking anticoagulants for management of Afib secondary to hypercoagulable state

4. Discuss the therapeutic management for this patient primary diagnosis and what is the impact to the patient’s care?

Therapeutic management

-Rocephin for empiric treatment of Spontaneous bacterial peritonitis

-Tylenol for fever

-Lactulose for ammonia (high ammonia risk for hepatic encephalopathy)

-Metoprolol for hypertension

-Heparin for VTE prophylaxis and Afib secondary to hypercoagulable state

-vitamin B12 and folate (deficient in alcoholics)

*do NOT need to elaborate on how the drugs work, just mention the drugs and why we   are using them

5. Present at least 2 research studies that examine the current practice techniques used to treat or manage Chronic Liver Disease   

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