Liver Cancer Case Study

8/17/2019 Liver Cancer Case Study

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Nursing care plan for a patient with lever cancer

Introduction:

Ms MCA, a 32-year-old female was evacuated from uinea to the international university

hospital !hei"h #aid, Morocco on !eptem$er, %& 2'%&, at '3 Am with chief compliant of cramp

and chest pain, $iological tests were normal $ut the liver ultrasound showed a pro$a$le hepatoma

or liver metastases( !he was operated on May, 2) 2'%' for left mastectomy with a*illary

dissection and $ilateral oophorectomy ta"ing %' positive nodes of %+ collected following a

multifocal invasive ductal carcinoma grade III, poorly differentiated with hormone receptor

positive and .2 negative( /he lesion is classified 0/30N3M1( !he was admitted C# on

'2 ' %' for % times and she was under chemotherapy with Nolvade* for & years(

.eadmitted to the C# on '3 24 %3 for control had a good condition, she reported chest pain,

right $reast and lymph nodes unremar"a$le(

/horaco-a$dominal C/ scan, scintigraphy and la$oratory tests were normal, she was ordered to

continue Nolvade* % ta$ day(

Controlled at 5amsar hospital in uinea on '2 %% %+ she complained of some cramps( /he loco-

regional e*am seemed normal( 6a$oratory tests, as well as chest 1-ray and liver ultrasound were

normal( /horaco-a$dominal C/ scan was re7uested, the results did not show any a$normality(

!even days prior to admission she was readmitted to 5amsar hospital in uinea for cramps and

chest pain, $iological tests were normal however, the liver ultrasound showed a pro$a$le

hepatoma or liver metastases(

//: -doliprane % 1 3 d 0rimperan syrup if vmsmt

/ramal &' %C0 8 92% '4


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additiva

PATIENT’S PROFILE

Client’s name or Initials : MCA

Age : 32 ; A.! 2 children

Religion: Islam

Address : Cona"ry, uinea

Birth ate and Pla!e: %48+, Cona"ry

Ra!e"Nationalit# : uinean

$sual Sour!e o% &edi!al Care:

Edu!ational attainment: 3rd ; A. I !C


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ordon s functional pattern of assessment

istory of present illness

!even days prior to admission the patient was readmitted to 5amsar hospital in uinea for

cramps and chest pain, $iological tests were normal however, the liver ultrasound showed a

pro$a$le hepatoma or liver metastases( /hen she was evacuated to !hei"h #aid hospital of

Morocco(

Medical history of past health

/he patient underwent a left mastectomy with a*illary dissection and $ilateral oophorectomy on

May 2) 2'%', ta"ing %' positive nodes of %+ collected following a multifocal invasive ductal

carcinoma grade III, poorly differentiated with hormone receptor positive and .2 negative(

!he was admitted to !hie"h #aid ospital on Buly '2 2'%' for the %st time and she was under

chemotherapy with Nolvade* for & years(

.eadmitted to !hei"h #aid hospital on March 24 2'%3 for control, she reported chest pain, right

$reast and lymph nodes unremar"a$le(

/horaco-a$dominal C/ scan, scintigraphy and la$oratory tests were normal, she was ordered to

continue Nolvade* % ta$ day(

Controlled at 5amsar hospital in uinea on '2 %% %+ she complained of some cramps( /he loco-

regional e*am seemed normal( 6a$oratory tests, as well as chest 1-ray and liver ultrasound were


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normal( /horaco-a$dominal C/ scan was re7uested, the results did not show any a$normality(

F$NCTIONAL PATTERN

Fun!tional Pattern Be%ore (os'itali)ation uring(os'itali)ation

A%ter(os'itali)ation

Nutritional 0attern * MCA stated that she

has a loss of appetite

!upplements and other

therapies to support

optimal digestion and

nutrition, and help you

manage side effects(

limination 0attern - 0eed + to ) times a day

- =efecated % time a day

* 0ees + to ) times a

day

- =efecates % time a

day

Activity *ercise

0attern

- pon interview, MCA

stated that she usually

do some e*ercises(

- A$le to do A=6s

* !he gets some times

out of her $ed for a

wal"(

- A$le to do A=6s

!leep .est 0attern - MCA had sleep

distur$ances due to pain

- she sleeps 8 hours per

day

Cognitive 0erceptual

0attern

- Capa$le of reading

and writing(

- No difficulty or

pro$lems in vision

or hearing,

- Capa$le of reading

and writing(

- No difficulty or

pro$lems in vision

or hearing,

-


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Fun!tional Pattern Be%ore (os'itali)ation uring(os'itali)ation

A%ter(os'itali)ation

!elf-perception !elf-

concept pattern

- 0atient MCA descri$es herself as a family

oriented person, "ind, hardwor"ing, andresponsi$le(

.ole-relationship

0attern

- 0atient MCA has 2 children and she has a good

relationship with her hus$and(

!e*uality-.eproductive

0attern

- MCA has a good se*ual relasionship with her

hus$and( And she has 2 children(

Coping !tress

/olerance 0attern

- !he tal"s with her hus$and a$out her pro$lems

and concerns(

-

Dalue ?elief 0attern - MCA is a Muslim, and she state that she do her &

prayers every day at time(

Nursing 0hysical Assessment

MCA was alert and oriented to person, place and time( /he patient s temperature was %'% E,

pulse rate was )), respirations were %8, $lood pressure was %23 3, o*ygen saturation on room

air was %''F, apical pulse was )), lungs were clear, and the patient stated her pain level was

five( /he patient has an ID line in her left arm( /he patient s s"in was warm and dry with a

moderate $ilateral handgrip( /he patient s surgical incision was from the um$ilicus to suprapu$ic

with staples and was intact with no erythema( /he patient s $owel sounds were hypoactive and

stated no $owel movement today $ut had passed flatus( /he urine output from ')''-'8'' was

2''ml( /he patient was on a li7uid diet starting !eptem$er %) 2'%& and changed to a regular diet


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on !eptem$er 2' 2'%&( /he patient ate 'F of her $rea"fast and stated she did not have much of

an appetite( MCA appeared frail and thin with some general wea"ness( /he patient s height was

& G 9%( 'm and her weight was %'& l$s( 9+ ( "g ( /he patient was am$ulatory and was a$le to

perform independent activities of daily living(

IA+NOSTIC AN LABORATOR, FIN IN+S

Pro!edure Normal -alues

A!tual Findings:

Im'li!ations.:/0 P&01"2."2/

Red BloodCell +(&' H &(&' * %' %2 6

+(%3 =ecreased

(emato!rit '(3 H '(+ 6 '(3) =ecreased

(emoglo3in %%'('' H %&'('' g l 4) =ecreased(

4hite Blood!elles +(&' H %'('' * %' 4 6

+() normal

Pro!edure Normal -alues

A!tualFindings:

Im'li!a2:55 A&01"2."2/


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Blood $rea Nitrogen '(2- '(+ g 6 '(2+2 g l normal

Creatinine )-%2 mg 6 %2('4 mg l Increased

Ioni)ed Cal!ium %('& H %(2& mmol 6 %(%% mmol l normal

Potassium 3(& H &(% mmol 6 +(% normal(

ALT3 H 3) 6 60 Increased

AST ' H 3& 6 78 Increased

epatic serology was negative?one $iopsy under C/ scan and scintigraphy: $one metastases of poorly differentiated carcinoma

Immunola$eling:Anti$ody anti-C5 : negativeAnti$ody Anti-. : positiveAnti$ody Anti hercept : score 2 > inviting a control for in situ hy$ridi ation


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CLINICAL FIN IN+S

SI+NIFICANT SI+NS AN S,&PTO&S:

Liver metastases

J0ain in the upper a$domen on the right sideK it e*tends to the $ac" and shoulder

J!wollen a$domen 9$loating

JLeight loss

J6oss of appetite and feelings of fullness

JLea"ness or feeling very tired JNausea and vomiting

J;ellow s"in and eyes, and dar" urine from @aundice

JEever

PROBLE& LIST AN PRIORITI9ATION

ACT$AL PROBLE&

RAN

PROBLE& C$ES ;$STIFICATION

2 Im$alanced Nutrition less than $ody re7uirements

Light + ( "g6oss of appetiteLea"ness

Jto identify deficits in

nutritional inta"e and ade7uacy


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Nausea and vomiting of nutritional state

Jprovides calories for energy,

sparing protein for healing

Jto prevent edema and ascites

formation

Jdecrease feeling of fullness,

$loating

Jreduce discomfort from

a$dominal distension and

decrease sense of fullness

produced $y pressure of

a$dominal contents and ascites

on the stomach5 Activity intolerance

related to fatigue

and wea"ness

- Lea"ness- emoglo$in count of 4)

g 6- 6ac" of energy- Anemia with and .?C

count of +(%3

Jprovide $aseline for further

assessment and criteria forassessment of effectiveness

of interventions

Jpromotes e*ercise and

hygiene within patient s level

of tolerance

Jstimulates patient s interest in

selected activities

Jconserve energy

Jprovides calories for energy


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and protein for healing

-

7 =istur$ed ?odyImage !elf- steem

6eft mastectomy6oss of hair

0atient is very sensitive to $odychanges and may e*periencefeelings of guilt when cause isrelated to $ody emage(

POTENTIAL PROBLE&

RAN

PROBLE& C$ES ;$STIFICATION

2.is" for infective

$irthing patternRis< %a!tors ma# in!lude

-Intra-a$dominal fluidcollection 9ascites

-=ecreased lung e*pansion,accumulated secretions

-=ecreased energy, fatigue

( In order to prevent theris" for infective $irthing

pattern, we must monitorrespiratory rate, depth, andeffort(

5 .is" for acute

confusion • Ina$ility of liver to

deto*ify certain

en ymes drugs

- Adverse drug reactions orinteractions 9e(g(, cimetidine

plus antacids may potentiateand or e*acer$ate confusion


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N$RSIN+ CARE PLANS

ASSES&ENT

C$ES

N$RSIN+

IA+NOSIS

PLANNIN+ =

O$TCO&E

N$RSIN+

INTER-ENTIONS

RA

Su3>e!tive: I can t eat

$ecause of loss of

appetite,G stated the

pt(

O3>e!tive:9> weight loss9> /he patient ate

'F of her $rea"fast-

Im$alanced

Nutrition less than

$ody re7uirements

related to anore*ia,

nausea and

vomiting evidenced

$y weight loss

Short term:

After hours of nursinginterventions, the ptwill ver$ali eunderstanding anddemonstrate $ehaviorsto maintain appropriatenutrition(

Long term: =emonstrate

progressive weight gaintoward goal with

patient-appropriatenormali ation ofla$oratory values(

*perience no furthersigns of malnutrition(

Inde'endent:

- sta$lished rapport

with client and

family(

- Monitored D!(

- Measure dietary inta"e

$y calorie count(

- ncourage patient to

eatK e*plain reasons for

the types of diet( Eeed

patient if tiring easily,

or have !< assist

patient( Include patientin meal planning to

consider his her

preferences in food

choices(

e'endent:

- Administered

medications as

prescri$ed $y =octor(

- To gain

cooper

- For ba

observ

distress- 0rovide

informa

needs a- Improv

diet is v

0atient

family i

preferre

include

possi$le

- For the

pharm

manag

sympto


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ASSES&ENT

C$ES

N$RSIN+

IA+NOSIS

PLANNIN+ =

O$TCO&E

N$RSIN+

INTER-ENTIONS

RA

INEFFECTI-E AIR4A, CLEARANC

ASSES&ENT C$ES N$RSIN+

IA+NOSIS

PLANNIN+ =

O$TCO&E

N$RSIN+

INTER-ENTIONS

R

Su3>e!tive:MCA stated that she

has cramps(0ain scale of &O3>e!tive:!he gets out of $ed

rarely!he is frail with

general wea"ness

emoglo$in count of

4) g 6

6ac" of energy

Anemia with and .?C

count of +(%3

Activity intolerance

related to fatigue and

wea"ness as

evidenced $y rare

movements

Short term:

After hours of

nursing interventions,

the pt will report

improved sense of

energy O perform

A=6 s

Long term:

After % day of nursing

interventions done,

patient will $e a$le to

apply energy

conservation

techni7ues(

Inde'endent:- sta$lished rapport

with pt and relatives(- Monitored D!(

ncouraged ade7uate and

fre7uent $ed restMinimi ed environmental

stimuli, dim lighting and

ensure 7uiet environment

.- To ga

coope- For b

asses

distre- To pr

conse

- To fa

prom

conse

RIS FOR INFECTION

RIS FOR ALTERE N$TN$TRITION: LESS T(AN BO , RE?$IRE&ENTS

ASSES&ENT C$ES N$RSIN+

IA+NOSIS

PLANNIN+ =

O$TCO&E

N$RSIN+

INTER-ENTIONS

R


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Su3>e!tive: I have lost my

appetiteGAs ver$ali ed $y pt(

O3>e!tive:9> Anore*ia9> N D

Ris< %or altered

nutrition: less than

3od# re@uirements

Inde'endent:- =etermine pts a$ility

to chew, swallow and

taste food(

- Assess understanding

of individuals

nutritional needs(

- =iscuss food

preferences O

intolerances(

- ncourage pt to

choose foods

appropriate for her

prescri$ed diet(- Administer anti-

emetics as prescri$ed(

.- Thes

can a

and/

nutri

- . to d

infor

of pt.

- To a

clien

- To st

- To co

and v

great

appe

R$+ST$ ,

R$+A&E

ACTION IN ICATION

CONTRAIN ICATION

A -ERSEREACTION

N$RSIN+RESPONSIBIL

ITIES

nericmo*if

sage

$lette

uteal

e7uen

- is an anti-estrogenthat

prevents theeffects ofestrogenson tissues(/he precisemechanismof its a!tionis un"nown,

$ut one possi$ilityis that it

$inds and $loc"sestrogenreceptors onthe surfaceof cells,

preventingestrogensfrom

$inding andactivatingthe cell(

- Lomenta"ing

Nolvade* todecrease theris" ofdeveloping

$reastcancerhavedevelopedcancerof theuterus,stro"e,and

$loodclots inthelung(

=o N


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R$+NA&E ACTION IN ICATION CONTRAIN ICATION A -ERSEREACTI

ON

N$RSIN+RESPONSIBILITIES

enerictramadol

?randtramal

=osage%/a$ H&''mg

.oute


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after ta"ing

medication(

- Instruct patient

to immediately

report any

adverse

reactions(

R$+NA&E

ACTION IN ICATION

CONTRAIN ICATION

A -ERSE

REACTION

N$RSIN+RESPONSIBILI

TIES

eneric0rednisone

=osage&mg

.oute


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Caltrate0lus

=osage

% /a$

.oute


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R$+NA&E

ACTION IN ICATION

CONTRAIN ICATION

A -ERSE

REACTION

N$RSIN+RESPONSIBILI

TIES

eneric!evelamer

=osage8'' mg

.oute


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Classification- 0hosphate?inders

for the ne*t

dose(

- If there is

presence of

=


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-A/0ase

en ymesystem atthesecretorysurface ofthe gastric

parietal cell(Inhi$itionof $oth

$asal and

stimulatedgastricacidsecretion,irrespective of thestimulus(/he

$inding tothe 9 >,5 > -

A/0aseresults ina durationofantisecretory effectthat

persistslongerthan 2+hours forall dosestested

Classification- 0roton

pump

snee ingK

sore

throatK

stomach

painK gasK

N DK mild

diarrheaK

@oint painK

urinary

changes

oliguria or

polyuriaK

convulsio

ns

- =o not crush

or chew

swallow it

whole(

- /each pt a$out

the

medications

action and

possi$le

adverse

reactions(

- ncourage

ade7uate $ed

rest(

- Instruct to

report any

adverse

reactions(

http://www.rxlist.com/script/main/art.asp?articlekey=19488http://www.rxlist.com/script/main/art.asp?articlekey=19488


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inhi$itor

R$+NA&E

ACTION IN ICATION

CONTRAIN ICATION

A -ERSE

REACTION

N$RSIN+RESPONSIBILI

TIES

enericEurosemide

?rand

=osage+' mg

.oute


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ter, thus preventingthetransportof sodium

from thelumen ofthe loop of

enle intothe

$asolateralinterstitium(Conse7uently, thelumen

$ecomesmorehypertonicwhile theinterstitium

$ecomeslesshypertonic, which inturn

diminishestheosmoticgradientfor waterrea$sorptionthroughoutthenephron(?ecausethe thic"ascendinglim$ isresponsi$le for 2&Fof sodiumrea$sorption in the

loss of

appetiteK

@aundiceK

tinnitus

- Instruct to

immediately

report any

adverse

reactions(


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nephron,furosemide is a very

potentdiuretic(

Classification- 6oop=iuretic

R$+NA&E

ACTION IN ICATION

CONTRAIN ICATION

A -ERSE

REACTION

N$RSIN+RESPONSIBIL

ITIES

enericAcetylsalicylicAcidKA!A

=osage8' mg

.oute


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synthesis ofthe

prostaglandinintermediar

y( Inhi$itionof plateletaggregationisattri$uta$leto theinhi$ition of

plateletsynthesis ofthrom$o*ane A2, a

potentvasoconstrictor andinducer of

plateletaggregation(/his effectoccurs atlow dosesand lasts for the life of

the platelet98 days (igher

dosesinhi$it thesynthesis of

prostacyclin, a potentvasodilatorandinhi$itor of

plateletaggregation(

Classification- Analgesi

cs- Anti-

tarry

stoolsK

increased

$leeding

time

- Administer

with meal if

it causes I

distur$ances

in pt(

- If pt will

undergo

surgery, tell

surgeon

physician

that pt is

ta"ing

aspirin(

- .eport to

physician

mental

changes such

as confusion

andhallucination

s(

- If fever

persists

report to

physician(

- ncourage

ade7uate $ed

rest(

- Assist in

A=6 s

- Instruct pt to


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inflammatory

- 0lateletaggregation

inhi$itor s

immediately

report any

adverse

reactions(

R$+

NA&E

ACTION IN ICATI

ON

CONTRAIN ICAT

ION

A -ERS

EREACTI

ON

N$RSIN+

RESPONSIBILITIES

eneric/icagrelor

=osage4' mg

.oute


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n and plateletactivation(/icagrelorand its

activemeta$oliteareappro*imatelye7uipotent(

Classification- 0lateletinhi$itor

tarry

stoolsK

coughing

up $loodK

chest

painK

wea"nessK

pale s"inK

feverK

@aundiceK

!


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R$+NA&E

ACTION IN ICATION

CONTRAIN ICATION

A -ER SE

REACTION

N$RSIN+RESPONSIBILI

TIES

eneric=omperidone

?rand

=osage% /a$

.oute


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which -among others- regulatesnausea andvomiting(

Classification

- Anti-emetic

- =opaminergic

$loc"ingagent

l crampsK

constipati

onK

malaiseK

wea"ness

K dysuriaK

palpitatio

ns

environment,

place side

rails up,

ad@ust room

temp, 7uiet,

and dim lit(

- Assist in

A=6 s

- Instruct

relative to not

leave pt

unattended(

- Instruct pt toimmediatelyreport adversereactions(

ISC(AR+E PLANNIN+

&edi!ation

- !hould $e ta"en regularly as prescri$ed, strictly follow e*act dosage, time, O fre7uency,

ma"ing sure that the patient and relatives fully understand the importance of ta"ing

medications(

- Instruct patient and relatives to immediately report any side effects adverse reactions(

E er!ise


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- *ercise at least 3' minutes daily(

- !hould $e promoted in a way $y stretching all $ody parts every morning( 0atient should

$e encouraged to "eep active through light e*ercises(

- Maintain rest periods in $etween activities(

Treatment

- emodialysis /reatment should still $e followed( 2 * a wee"(

(ealth Tea!hing

- dhere to treatment regimen. Adherence to treatment regimen is essential in order to

prevent relapse( Most common cause of relapse is loss to compliance( Medications should

$e administered at proper times and with proper dosages(

- !est when you feel it is needed. !lowly start to do more each day( .eturn to your daily

activities as directed(

- "rotect your skin from #$ light. !unlight can ma"e your lupus symptoms worse( Avoid

the sun $etween %' am and + pm, when the rays are strongest( Apply sunscreen with a

!0E of 3' or more every 2 hours when you are outside( =o this even on cloudy days(

Lear pants and long sleeves to cover your $ody( A hat with a wide $rim can protect your

face, head, and nec"(

- %at healthy foods ( ealthy foods include fruits, vegeta$les, whole-grain $reads, low-fat

dairy products, $eans, lean meats, and fish(

- %xercise. /his will help decrease your symptoms and prevent depression( At least for 3'

minutes(

- aintain a healthy weight. As" your primary healthcare provider how much you should

weigh( As" him to help you create a weight loss plan if you are overweight(


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- 'o not smoke. If you smo"e, it is never too late to 7uit( As" for information a$out how to

stop smo"ing if you need help(

- anage your stress. !tress may slow healing and lead to illness( 6earn ways to control

stress, such as rela*ation, deep $reathing, and music( /al" to someone a$out things that

upset you(

Out Patient

- Eollow-up chec"-up as ordered $y the physician should $e greatly encouraged for the

patient to determine if his progression on treatment, and if he will have to continue on his

medications treatments which were ordered during hospitali ation(- Come $ac" 2* a wee" for hemodialysis(

iet

- Increase fluid water inta"e, should $e 8 glasses day(

- ealthy foods include fruits, vegeta$les, whole-grain $reads, low-fat dairy products,

$eans, lean meats, and fish(

S'iritual

- ncourage family and friends to pray and remain $y patients side(- ncourage client to $uild a strong faith and intimacy with od through prayers(- ncourage to attend mass and prayer sessions with family, for added emotional and

spiritual support(- Advise to continue spiritual practices(


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/he liver is located in the upper right-hand portion of the a$dominal cavity, $eneath the

diaphragm, and on top of the stomach, right "idney, and intestines( !haped li"e a cone, the

liver is a dar" reddish-$rown organ that weighs a$out 3 pounds( /here are two distinct sources

that supply $lood to the liver, including the following:Jo*ygenated $lood flows in from the

hepatic artery Jnutrient-rich $lood flows in from the hepatic portal vein /he liver consists of

two main lo$es, $oth of which are made up of thousands of lo$ules( /hese lo$ules are

connected to small ducts that connect with larger ducts to ultimately form the hepatic duct(

/he hepatic duct transports the $ile produced $y the liver cells to the gall$ladder and

duodenum 9the first part of the small intestine (

Cancer is uncontrolled replication of damaged cells( /his condition usually produces a mass

called a tumor( Cancer is a direct result of either a mutation of the cellular =NA or some sort

of damage to the cellular =NA( Eor the cancerous cells actually develop into tumor, it must $e

a$le to grow and to replicate itself (A cancerous cell that cannot grow or ma"e a copy of itself

will die or lic" dormant for an e*tended period(

S Carcinogenesis is a multistage process that $egins when a carcinogen causes a genetic

change or damages the =NA in a normal cell( /his ma"es the cell more vulnera$le to


34/38

other genetic changes( /his stage is called Tinitiation(T If the process ended here, and the

cancerous cell did not grow and replicate, no cancer would form( /he ne*t stage of

carcinogenesis is called Tpromotion(T /his occurs when the initiated cell is e*posed to an

agent that enhances its growth into a larger mass( Lhen a tumor actually forms, it has all of

the same $asic needs as a normal cell( ?ecause the tumor cells are genetically damaged, they

are inefficient and ro$ normal cells of important o*ygen and nutrients( In addition, a

malignant tumor grows uncontrolla$ly and can eventually interfere with the function of vital

organs, such as the liver(

Metastatic tumors form when large progressive tumors shed tumor cells( /hese tumor cells

must $e a$le to grow and function apart from the primary tumor JMove throughout the $ody,

usually through the circulatory system or the lymphatic system ( J


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9Male hormones used $y athletes to increase muscle can slightly increase liver cancer ris"

with long-term use J

?irth control pills

6iver Cancer !ymptoms

J6iver cancer is sometimes called a Tsilent diseaseT $ecause in an early stage it often does not

cause symptoms( owever, as the cancer grows, symptoms may include: J0ain in the upper

a$domen on the right sideK the pain may e*tend to the $ac" and shoulder J!wollen a$domen

9$loating JLeight loss J6oss of appetite and feelings of fullness JLea"ness or feeling very

tired JNausea and vomiting J;ellow s"in and eyes, and dar" urine from @aundice

JEever

Nursing Management

J Latch out for potential pro$lem related to cardiopulmonary involvement include vascular

complications and respiratory and liver dysfunction( J Careful attention to meta$olic

a$normalitiesJU 0atient undergo cryosurgery should monitored closely for: JS ypothermiaJS

hemorrhage or $ile lea"JS myoglo$inuria may occur as a result of tissue necrosis

J

(

Nursing diagnosis

JActivity intolerance related to fatigue and wea"ness

0lanning


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J0atient will report decrease in fatigue and increased a$ility to participate in activities

Intervention

JAssess level of activity tolerance and degree of fatigue and malaise

JAssist with activities and hygiene

JAssist with selection and pacing of desired activities and e*ercise

J ncourage rest when fatigued felt

JAdvice diet high in car$ohydrates with protein inta"e

.ationale

Jprovide $aseline for further assessment and criteria for assessment of effectiveness

of interventions

Jpromotes e*ercise and hygiene within patient s level of tolerance

Jstimulates patient s interest in selected activities

Jconserve energy

Jprovides calories for energy and protein for healing

valuation

Jimproved nutritional status $y increased weight without fluid retention

Jidentifies foods in car$ohydrates and within protein re7uirements

Jreport improved appetite

Nursing diagnosis

J Im$alanced Nutrition less than $ody re7uirements related to a$dominal distention and loss

of appetite

0lanning

Jto meet nutritional re7uirements


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Intervention

JAssess dietary inta"e and nutritional status through diet history

JAdvice diet high in car$ohydrates with protein inta"e

JAdvice patient of low sodium foods

J0rovide smaller, fre7uent meals

J levate the head of the $ed during meals

.ationale

Jto identify deficits in nutritional inta"e and ade7uacy of nutritional state

Jprovides calories for energy, sparing protein for healing

Jto prevent edema and ascites formation

Jdecrease feeling of fullness, $loating

Jreduce discomfort from a$dominal distension and decrease sense of fullness produced $y

pressure of a$dominal contents and ascites on the stomach

Nursing iagnosis

• =istur$ed ?ody Image !elf- steem

&a# 3e related to

• ?iophysical changes altered physical appearance

• ncertainty of prognosis, changes in role function

• 0ersonal vulnera$ility

• !elf-destructive $ehavior 9alcohol-induced disease

Possi3l# eviden!ed 3#

•

Der$ali ation of change restriction in lifestyle


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• Eear of re@ection or reaction $y others

• Negative feelings a$out $ody a$ilities

• Eeelings of helplessness, hopelessness, or powerlessness

esired Out!omes

• Der$ali e understanding of changes and acceptance of self in the present situation(

• Identify feelings and methods for coping with negative perception of self(

Nursing iagnosis

• .is" for acute confusion

Ris< %a!tors ma# in!lude

• Alcohol a$use

• Ina$ility of liver to deto*ify certain en ymes drugs

esired Out!omes• Maintain usual level of mentation reality orientation(

• Initiate $ehaviors lifestyle changes to prevent or minimi e recurrence of pro$lem(

Documents

Liver Cancer Case Study