INTRODUCTION

The liver is one of the largest and most complex organs in the body. It stores vital energy and
nutrients, manufactures proteins and enzymes necessary for good health,
protects the body from disease, and breaks down (or metabolizes) and helps remove harmful
toxins, like alcohol, from the body. It is one of the most important organs in the
body since it has many significant functions. A lack or failure to provide proper care of it may lead to an
abnormality or disorder. One of the severe forms that may happen is liver cirrhosis

Liver Cirrhosis is derived from Greek word kirrhos, meaning "tawny" (the orange-yellow colour
of the diseased liver).It 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. Cirrhosis is most commonly caused by alcoholism, hepatitis
B and C and fatty liver disease but has many other possible causes. Some cases are idiopathic,
i.e., of unknown cause. It may be classified by the structural changes that take place or by the
cause of the disorder.

Internationally, liver cirrhosis is the 8th th most common cause of death. It is most common among
people ages 45 – 75, killing more than 25,000 people each year, 50% are alcohol related. In the
Philippines and other underdeveloped countries , however, the incidence of liver cancer is rather
high. Liver cancer is relatively common in our country primarily because many Filipinos suffer
from cirrhosis of the liver, a major risk factor for liver cancer. Cirrhosis of the liver precedes 80
percent of all liver cancers; thus, any condition that predisposes to cirrhosis indirectly causes
liver cancer. The usual cause of liver cirrhosis among Filipinos is chronic hepatitis B, a major
public health
 problem in the country. Chronic hepatitis B afflicts between 10 and 12 percent of all Filipinos
(i.e., more than 8 million Filipinos). Other less significant causes of cirrhosis are hepatitis C
infection and alcoholism. The latest DOH advisory shows that liver cancer is the third most
common form of cancer among Filipinos—in men, it is the second most common, while in
women, it is the ninth most common.

PATIENT DATA

NAME: J. Dela Cruz

AGE: 50
SEX: Male
DATE OF BIRTH: May 23, 1971
PLACE OF BIRTH: Davao City
OCCUPATION: Farmer
NATIONALITY: Filipino
RELIGION: Roman Catholic
CIVIL STATUS: Married

CLINICAL DATA

DATE OF ADMISSION: March 30, 2021

TIME OF ADMISSION: 04:10 PM
MODE OF ADMISSION: Ambulatory
CHIEF COMPLAINT: Malaise, Loss of appetite, nausea and black tarry tool
VITAL SIGNS UPON ADMISSION:
T: 36.6 C
BP: 90/60 mmHG
PR: 65bpm
RR: 28cpm
FINAL DIAGNOSIS: CAP MR Ascites 2’ Liver Cirrhosis
FAMILY BACKFROUND AND HEALTH HISTORY

FAMILY HISTORY
No one on the family had any of the sickness that Mr. J has, namely Liver Cirrhosis and Community
Acquired Pneumonia.
Mr.J is a married man with three children. He is tha main decision maker in the family as evidenced
by her wife verbalizing “siya man gyud ng gabuot ug unsay mayo para sa amoa”. In regards to their health,
several members of their family specifically the patient, his wife and his daughter has hypertension which
was diagnosed (August 2020) by the physician whom they usually consult in Polyclinic Health Center
where their neighbor works as a nurse. In reference to their diagnosis, they were given maintenance
hypertensive medication, however they only used the said medication for about two weeks, finances were
a factor since they were not able to comply the medication prescribed.
The family does not seek medical advice until the condition they have worsens as stated by Mr. J
wife. All of them had experienced fever, flu, cough colds, stomach pains etc. and only took over-the-
counter drugs for intervention.

LIFESTYLE
The patient’s wife verbalized that during his young age, he was just a typical adolescent guy who
goes with his friends and often explores things around. He was curious at all things because of that he was
inclined to a number of vices which may actually have affected his health status. He was smoking badly as
he was able to consume 1-2 packs of cigarette per day and drinks enormously as he was able to drink one
1 long neck of Tanduay on his own. At times, he goes beyond that and even drink half a gallon of Tuba
when he is not yet drunk. As stated by his wife, his husband does not stop drinking unless he becomes
drunk. As the normal things go, the Mr. J. and his drinking colleagues use the same glass whenever they
drink.
During his adulthood, he worked as a farmer and still continued to drink and smoke whenever he
has time. He often sleeps at 10PM and wakes up at 5AM then takes his breakfast and goes to work. He
had a vigorous job and was accustomed to it as he grew older. He then had to stop working when he was
diagnosed with hypertension because he was advised to rest. He then eventually realized that his vices
were responsible to his health and lessen his cigarettes to 2-4 stick per day.

DIET
The patients diet had not been very healthy either. He like eating fatty and salty foods and his
favorite viands include “taba ng baboy” and dried fish with ginamos. They also often eat canned goods. As
the patients wife verbalized “dong ana man gyud na sa pobre”. Moreover, drinking coffee every morning
and afternoon had always been his husband routine.

PAST HEALTH HISTORY

Other than ordinary fever, cough, and flu, which they treat only through over-the- counter drugs and
no consultations, the patient didn’t have any serious illness. This was the case, however, until he reached
the old age when different signs and symptom started to manifest, increased blood pressure arise. He then
sought medical advice since there were other manifestations of hypertension such as dizziness, nausea
and pain on his nape. Then he found out that he has hypertension as diagnosed. Only through daily BP
taking at Santo Tomas Clinic, a clinic just around the area, did they found out about this gradual increase
in blood pressure. It was treated and taken cared of through unrecalled medications that were prescribed
to him by the said clinic

PRESENT HELATH HISTORY

For the past years, the patient did not have any serious illness related to his present condition. But
on March 16, 2021, 2 weeks prior to the patient’s admission, he had headache, chest pain, dull abdominal
pain, felt nauseated and dizzy. The patient and even his wife had never thought that it was a manifestation
of an underlying problem and so they did not take it seriously. They did not seek medical attention; instead
his wife gave him over-the-counter medication such as Paracetamol for his headache which he took four
times during that day and one Diatabs for his stomach pain which is actually not appropriate since the
medication itself was wrong and that the underlying condition was not taken into consideration. The
condition however did not last long since it was relieved one day after it occurred.

The patient and his wife were relieved and thought that it was just a “Panuhot and Kabuhi”.
One week prior to patient’s admission to the hospital, his wife noticed that his husband had abdominal
distention which she abruptly noticed.
On the 26th day of March, 2021 four days prior to admission to the hospital the patient sought
consultation at the Emergency Room since the patient felt loss of appetite, stomach pain which radiated to
the patient’s back and prandial vomiting. Despite the manifestations seen on the client, he was discharged
and was requested to have an ultrasound of the abdomen. Aside from that, it was again diagnosed that he
has hypertension so antihypertensive medications were prescribed. Days had gone and on the 30 th day of
March. 2021, the patient experienced body malaise, loss of appetite, nausea, and black tarry stool which
were his chief complaint that resulted to his admission to Davao Medical Center.

PHYSICAL ASSESSMENT
Skin
The patient had jaundice with uniform skin color all throughout the body except under his axillae, which is
darker. His skin folds and axillae were moist. Skin temperature was uniform in all extremities when
touched. Senile skin was noted.

Hair
Upon inspection, hair was short and white in color. His hair was thin and evenly distributed as evidenced
by the absence of areas of alopecia along the scalp. No infection
or infestations were noted upon inspection and palpation of the patient’s hairline and scalp. Dandruff was
noted on patient’s scalp however there were no lesions, lumps, or 
masses upon palpation.

Nails
Clubbing of nails was noted on patient. Upon palpation, nail base was firm and fingernails had a rough
texture. Epidermis surrounding the nails was intact and no lesions were noted. Nails were long, dirty and
untrimmed. Toenail surface was slightly curved and rough.

Skull and Face

Skull was rounded and normocephalic. Symmetry in anatomy of face was noted.

Eyes and Vision

Hair of eyebrows was evenly distributed and periorbital skin was intact without swelling or inflammation.
Eyebrows were symmetrically aligned. Upon inspection, skin of eyelids was intact and no discharges and
discolorations were present. Icteric sclera was noted. Iris were black in color, and had a round, smooth
border. Pupillary response to illumination was sluggish and equal on both eyes as evidenced by
constricting of both illuminated and non-illuminated pupils upon illumination. Patient does not wear
glasses: visual acuity when he was still conscious and awake was grossly normal as stated by his wife.

Ears and Hearing

Upon inspection, auricles were of the same color with facial skin, were symmetrically aligned with each
other, and were aligned with the outer canthus of each eye. Cerumen was present but was not impacted or
excessive in amount. Upon palpation, auricles were firm, and not tender as evidenced by the auricle being
pulled upward, downward, and backward without resistance, and the pinna being folded forward without
resistance and recoiling after folding. Patient was unresponsive since he is in comatose.

Nose
Upon inspection, external nose was symmetrical. No abnormal discharges or flaring were noted. Also, the
nose was with uniform color with facial skin. Nasal Septum was intact and in midline. Patient was with
NGT on his right nares.

Mouth
Upon inspection, endotracheal tube with O2 at 5-7 L/min connected to bag valve was noted. Outer lips
were brownish pink and were dry. Teeth were shiny and yellow in color.

Neck 
Upon inspection, neck veins were not distended or visible. Shoulder muscles were of anatomically
symmetrical.

Thorax and Lungs

The skin over the posterior thorax was intact and uniform in color with the rest of the body. Also, chest
expansion was symmetrical when air is administered through the endotracheal tube with O2 at 5-7 L/min
connected to a bag valve. Crackles were noted upon auscultation.
Cardiovascular and Peripheral Vascular
Peripheral pulses were regular and present on all four extremities. Slow capillary refill time of 4-5 seconds
gathered upon three checks was noted.

Chest
No masses, lesions or any unusuality noted on patient’s chest.

Abdomen
Upon inspection, distended abdomen and ascites was noted. Abdomen was supple when palpated. Size of
abdomen was observed to be not appropriate for patient’s body. Abdominal girth of 39 inches was taken.
Caput medusae noted on the skin of the abdomen

Genito-urinary
Upon inspection, no swelling, lesion or mass noted on the genitals of the patient. Patient is with Foley
catheter which is connected to a Urobag draining 100 cc of dark yellow colored urine.

Back and Extremities

Patient was not able to manifest movements on the upper body and lower body since the patient was not
conscious during the assessment. Bones appear to have no deformities. Elbows have no deformities.
However, a grade 1 pitting edema was noted on all four extremities as skin does not immediately
(approximately 4 seconds) go back to its
normal state when pressure is applied.

ETIOLOGY
Basic Etiology Present/ Absent Rationale Actual
Predisposing factor
Male  Liver cirrhosis occurs mostly in men The patient is male

Ages 45-75  Liver cirrhosis is most common among The patient is 50 y/o
people aged 45-75
Race: Asian  In Asia and Africa, cirrhosis The patient is an Asian
is also common but more likely to be since he was born from
associated with Filipino parents, and he
hepatitis was born in IGACOS,
Davao City, and currently
resides here in Buhangin,
Davao City

Biliary atresia X Infants can be born without The patient has no record
 bile ducts ( biliary atresia) and or history of Biliary atresia.
ultimately develop cirrhosis. The bile
ducts carry bile formed in the liver to
the intestines, where the bile helps in
the digestion of fat. So, when the bile
ducts are blocked,
 bile is trapped in the liver,
Chronic alcoholism  Chronic high levels of alcohol As stated by the
consumption injure liver cells. Alcohol  patient’s wife, the
seems to injure the liver  patient at his young age
by blocking the normal was able to drink 1 long
metabolism of protein, fats, and neck (750 ml) of 
carbohydrates. Alcohol can poison all Tanduay on his own. At
living cells, causing liver cells to times, he goes beyond 1
become inflamed and die. Thirty long neck and even drinks
percent of individuals who drink half a gallon of “Tuba”
daily at least eight to sixteen ounces when he is not yet
of hard liquor or the equivalent drunk. As stated by his
for fifteen or more years will develop wife, his husband does not
cirrhosis. stop drinking
unless he becomes drunk.
When he reached his
adulthood, he continues to
drink and smoke when he
finds time to do them

Chronic viral hepatitis (types X Condition where hepatitis B or hepatitis The patient had no medical
B, C, and D). C virus infects the liver for years. some record of acquiring hepatitis
patients infected with hepatitis B virus B, C, or D.
and most
 patients infected with hepatitis C virus
develop chronic hepatitis, which, in
turn, causes progressive liver damage
and leads to cirrhosis, and, sometimes,
liver cancers

Hepatitis B causes liver 

inflammation and injury that
over several decades can lead to
cirrhosis. Hepatitis D is
dependant on the presence of hepatitis
B, but accelerates
cirrhosis in co-infection The hepatitis C
virus ranks with
alcohol as a major cause of chronic liver
disease and cirrhosis. Infection with
this virus causes inflammation of and
low
grade damage to the liver that over
several decades can lead to
cirrhosis.
Smoking  Research reveals that smoking The patient smokes 1-2
damages the liver. Smoking activates  packs of cigarette a day,
chemical materials within the body. and he started smoking
These chemicals that are manufactured when he was a teenager.
by smoking also provoke oxidative At the same time, he also
stress which is linked with lipid drinks Tanduay (750mL) 2-
peroxidation. When this occurs, the 3 times a week since he
condition fibrosis is developed. Smoking was a teenager. He only
increases the manufacturing of pro- stopped smoking when
inflammatory cytokines which is related he was diagnosed with
to liver cell damage. hypertension last 2020
Smoking also contributes the continued
succession of chronic alcoholic-hepatitis
as well as to the progression of cirrhosis
Malnutrition, especially high  Fat builds up in the liver and eventually There is no scientific
fat intake causes cirrhosis.  basis that the patient has
an increase fat in the
 blood or increased level of
cholesterol in the
 blood (LDL-bad
cholesterol)

SYMPTOMATOLOGY

SYMPTOMS Present/ Absent Rationale Actual

Anorexia  Increased brain tryptophan (TRP) This is present with the

availability for serotonin synthesis patient, since this is one of
play a role in the pathogenesis of the reasons he consulted
anorexia. Since in chronic liver failure, the emergency room.
increased plasma and cerebrospinal The wife stated that the
fluid TRP concentrations are patient had no appetite to
characteristically reported, that also in eat
liver cirrhosis, increased brain TRP
availability constitute the pathogenic
mechanism of anorexia.
Nausea and vomiting  The malabsorption of fats may lead to Two weeks prior to
deficit of fat-soluble vitamins, admission, the
hemorrhoids, intolerance to fatty foods,  patient started feeling
nausea and vomiting attacks, and nauseous, and four days
abdominal bloating. Since the liver has  prior to admission, he had
already decreased in function, its  prandial vomiting which is
function to produce bile which one of the reasons he
emulsifies fats is also decreased, thus sought consultation at the
these symptoms emergency room
persists.
Body malaise  This is due to the decreased in liver The patient experienced
function of the liver because of the body malaise, and was one
hepatic fibrosis. Therefore, the of his chief complaint that
patient has also decreased resulted to his admission at
erythropoietin which then results to the DMC
decrease of red blood cells circulating
in the blood, and there will be
decreased hemoglobin. All of 
this in return will cause the patient to
have body malaise.
Bleeding tendencies  Bleeding tendencies such as The patient had
nosebleeds, easy bruising, and  bleeding as evidenced by
bleeding gums may result from him having black stools,
thrombocytopenia secondary to which is also known
splenomegaly, decreased vitamin K as melena, indicative of
absorption and decreased production bleeding in the
of coagulation factors and regurgitation upper gastrointestinal
of blood to the spleen and tract.
gastrointestinal tract.
Portal hypertension  Portal hypertension occurs because of The patient has ascites
the obstruction of portal circulation which is a complication of 
 brought about by the portal obstruction  portal hypertension. This
caused by the hepatic scarring is an evidence that he
indeed has portal
hypertension. In addition,
the patient was diagnosed
to have hypertension on
the year 2020
Ascites  This happened because of the The patient has ascites as
decrease of albumin in the blood evidenced by his
plasma. Albumin is responsible for distended abdominal cavity

maintaining the oncotic pressure in the

blood volume. A decrease in
albumin will mean a decrease in oncotic
pressure, which will result to a more
permeable membrane which results to
fluid leaking through the vasculature
into the abdominal cavity.
Jaundice  Jaundice is the buildup of bile The patient was noted to
pigment that is passed by the liver into have yellowish skin color on
the intestine. Due to the portal all four extremities including
obstruction, the bile going to the GI tract the
will have a backflow to the liver. The  palms. The patient also
bile then goes to the blood stream, and had icteric sclera when
this causes the yellowing of the skin, inspected
due to the presence of bile.
Edema on the extremities  Plasma amount, leading to edema. One week prior to
admission, the wife of the
patient noticed the obvious
abdominal
distention of the
 patient’s abdomen. Upon
 physical assessment, the
 patient was noted to have
ascites and edema on all
four extremities
Caput medusae  Portal hypertension results from the The patient was noted to
abnormal blood flow pattern in liver have large, dilated, and
created by cirrhosis. The increased distended veins on the
pressure is transmitted to collateral abdomen area when
venous channels. Sometimes these inspected
venous collaterals are dilated. Caput
medusa consists of dilated veins seen
on the abdomen of a patient with
cirrhosis of the liver
Coma  This is a progressive symptom, The patient is on a
secondary to the loss of ammonia to comatose state.
urea conversion and consequent
delivery of toxic ammonia to the
brain.
Deterioration of mental function from
Lethargy to coma and eventual death.
DIAGNOSTIC EXAMS

ARTERIAL BLOOD GAS

Test Normal Range Value Clinical Significance

pH 7.35-7.45 mmHg 7.510 Increase in pH is brought about by the increase in bilirubin in the blood
which is alkalinic.

pC02 35-45 mmHg 21.3 Decreased pC02 is caused by hypoxia due to the accumulated fluid in
the abdominal cavity creating pressure in the diaphragm. Thus,
affecting the respiratory status of the patient
PO2 80-1000 mmHg 82 PO2 l evel i s a t n ormal r ange.

HC03 22.0-27.0 mmol\L 16.6 When bicarbonate levels are lower than normal, it suggests that the
body is having trouble maintaining its acid-base balance. Bicarbonate
concentrations in the serum may fall due to consumption by combining
with protons (H+) from acids such as lactic acid, keto-acids etc; or by
loss from the body from gastro-intestinal or renal sources. Renal loss
of bicarbonate may be due to compensatory mechanisms for a
respiratory alkalosis
02Sat 80-100 % 97.2% 02 S aturation i s a t n ormal r ange
Partially Compensated Respiratory alkalosis

Respiratory alkalosis is a medical condition in which increased respiration (hyperventilation) elevates the blood pH (a
condition generally called alkalosis). Respiratory alkalosis is due to the dyspnea caused by the pressure exerted by the
ascites to the diaphragm, leading to respiratory rate which is lower than normal. Moreover, respiratory alkalosis could
result from a ventilatory rate or tidal volume that is too high or from the patient triggering excessive additional breaths

HEMATOLOGY
Test Normal Range Result N\L\H Clinical Significance

CBC + PLT
Hgb 115-175 g/L 104 L Low Hgb is referred to as anemia which may by the
decreased erythropoietin caused by cirrhosis of the liver.
Hct 0.36-0.52 0.29 L Because of the decrease in RBC in the blood hematocrit as
well decreases.
RBC 4.20-6.1 2.94 L A decreased number of RBC results from the decreas
erythropoietin production of the liver.
WBC 5.0-10.0 9.65 N WBC is in n ormal range.
Differential count
Neutrophils 55-75 % 71% N Within normal range

BLOOD CHEMISTRY
Test Normal Range Result N\L\H Clinical Significance
Total 63-82 g/L 59.40 L Low total protein levels can suggest a liver disorder. In
protein patients with liver problems, there is a decrease in total
protein levels because of the decrease in production of the
albumin, a protein which is exclusively produced in the liver.
Globulin 23-35 g/L 40.70 H An elevation in the level of serum globulin san indicate the
presence of cirrhosis of the liver and bacterial infection.
Albumin 35-50 g/L 18.70 L Ther is a decrease of albumin in the blood plasma because of
the decrease in its production due to problems in the liver.
A/G ratio 1.5-2.5 0.5 L A decrease in albumin globulin ratio is an indicative of a
problem in liver function.
SGPT 30.0-65.0 u/L 84.0 H An increase in SGPT level is due to impaired liver function
caused by liver cirrhosis. It can be caused by hepatic
inflammation (including infectious mononucleosis,
pancreatitis, alcohol, viral hepatitis)
SGOT 15.0-37.0 u/L 182 H An increase in SGOT level is due to impaired liver function
caused by liver cirrhosis. It can be caused by hepatic
inflammation. (including infectious mononucleosis,
pancreatitis, alcohol, viral hepatitis)

DRUG STUDY
Generic name: FUROSEMIDE
Brand name: Lasix, Furoside, Myrosemide, Uritol, Diumide-K
Classification: (functional) Loop diuretic, (chemical) Sulfonamide derivative
Action: Inhibits reabsorption of sodium and chloride at proximal and distal tubule and in the loop of Henle
Dosage Indication Contraindication Side/adverse effects Nursing
responsibilities
40mg tab OD Pulmonary edema, Hypersensitivity to CNS: headache, >assess for
hypertension, third sulfonamides, anuria, fatigue, weakness, drowsiness and
spacing hypovolemia, infants, vertigo restlessness for it
lactation and may indicate
electrolyte depletion CV: orthostatic metabolic alkalosis
hypotension, chest >monitor for signs of
pain, ECG changes hypokalemia; postural
circulatory collapse hypotension, malaise,
EENT: loss of hearing, fatigue, tachycardia,
ear pain, tinnitus and leg cramps and
blurred vision weakness
ELECT: hypokalemia, >observe hearing
hypochloremic problems including
alkalosis, tinnitus and hearing
hypocalcemia, loss
matabolic alkalosis
GI: nausea, diarrhea, >monitor I & O qd to
dry mouth, abdominal determine fluid loss.
cramps, gastric
irritaions GU: polyuria, >monitor vital signs;
renal failure, glycosuria rate, depth, and
HEMA: rhythm of respiration
thrombocytopenia, >administer in AM to
agranulocytosis, avoid interference
anemia with sleep if using
INTEG: rash, pruritus, drug as diuretic
purpura, diaphoresis
> Use sterile
equipment and apply
principles of asepsis.

> Ensure correct

identification of the
patient prior to the
procedure.

>Decontaminate
hands prior to the
procedure.
>The cannula
insertion site should
be inspected for
complications, i.e.
infiltration, infection.
>instruct patient to
increase fluid intake
2-3 L/day unless
contraindicated

>tell the patient to rise

slowly from lying or
sitting position
because orthostatic
hypotension may
occur 
>evaluate for
therapeutic response

Generic name: Omeprazole

Brand name: Zegerid, Losec, Prilosec
Classification: Gastric acid secretion, proton-pump inhibitor 
Action: Suppress gastric acid secretion by inhibiting the partial cell H+/K+ATP pump
Dosage Indication Contraindication Side/adverse effects Nursing
responsibilities
40mg IVTTq12 To prevent ulceration Known CNS: headache, >Ensure ten rights of
in patients under NPO hypersensitivity to dizziness, Neuro- medication
omeprazole muscular & Skeletal: administration
weakness, back pain
GI: nausea, diarrhea,
>Instruct patient not
vomiting, abdominal
to chew, crush or
pain, constipation,
open capsule
taste perversion
RESP: upper
respiratory infection, >Instruct patient to
cough take before eating,
capsule should be
swallowed whole
>Warn patients that
zegerid contains
461mg sodium
bicarbonate per dose.
Those following a
sodium-restricted diet
should be cautious.
> Tell patient to empty
contents of Zegerid
packet into a small
cup containing 2 tbsp
of water.
> Instruct patient to
take drugs 30 minutes
before meals.
> Caution patient to
avoid hazardous
activities if he gets
dizzy.
> Inform patient that
prilosec OTC may
take 1-4 days for full
effect.
Generic name: Spironolactone
Brand name: Aldactone
Classification: Electrolyte and water balance agent; potassium sparing diuretic

Action: a potassium-sparing diuretic, a drug that promotes the output of urine (diuretic) while allowing the kidneys to hold
onto potassium.
Dosage Indication Contraindication Side/adverse effects Nursing
responsibilities
PO – (25, 50, 100) clinical conditions Patients with anuria,
mg tablets associated with acute renal
augmented insufficiency,
DOSING: Edema –
aldosterone significant impairment
25 – 200 mg/d in
of renal excretory
divided doses,  production, as in
function, or
continued for atleast essential
hyperkalemia
5 daysd hypertension,
refractory edema due
to CHF, hepatic
cirrhosis, nephritic
syndrome and
idiopathic edema

Generic name: Ceftriaxone

Brand name: Rocephin
Classification: cephalosporin antibiotic
Action: This antimicrobial agent inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding
proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls,
thus inhibiting cell wall biosynthesis
Dosage Indication Contraindication Side/adverse effects Nursing
responsibilities
1gm IVTTq12 Respiratory tract and Cephalosporin
intraabdominal hypersensitivity
infections
Generic name: metronidazole
Brand name: Flagyl
Classification: Anti-infectives, anti-protozoal, antiulcer agents

Action: Disrupts DNA and protein synthesis susceptible organisms. Therapeutic effects: Bactericidal, trichomonacidal or
amebicidal action. Spectrum: Most notable for activity against anaerobic including: Bacteroides, clostridium
Dosage Indication Contraindication Side/adverse effects Nursing
responsibilities
500mg 1 TAB q6 PO: Amebecide in the Hypersensitivity. CNS: Seizures,
management of dizziness, headache.
amebic dysentery,
amebic liver abscess
and trichomoniasis:
treatment of peptic
ulcer disease caused Use cautiously in:
by Helicobacter pylori history in blood
dyscrasias, History of
seizures or neurologic
problems and severe
hepatic impairement
Generic name: Lactulose
Brand name: Contulose
Classification: Laxative
Action: Produces osmotic effect in colon. Resulting distention promotes peristalsis. Decrease blood ammonia build- up
the causes hepatic encephalopathy, probably ass result of bacterial degradation which lowers pH of colon contents.
Relieves constipation, decreases ammonia concentration
Dosage Indication Contraindication Side/adverse effects Nursing
responsibilities
30cc @ bedtime >constipation Contraindicated in GI: belching, cramps,
patients on low- distention, flatulence,
>To prevent and treat
galactose diet diarrhea
hepatic
encephalopathy, ENDO: Hyperglycemia
including hepatic
precoma and coma I
patients with severe
hepatic disease.
>to restore bowel
movements after
hemorrhoidectomy
Generic name: Essentiale Forte
Brand name: Essentiale Forte
Classification: Cholagogues, Cholelitholytics & Hepatic Protectors
Action: Increase functional status of the liver, improvement in the lipids metabolism caused by accelerated synthesis of
lipoproteins in the liver, activation of the phospholipid-depending ferments, increased synthesis of glycogen in the liver,
decreased the fatty infiltration of the hepatocytes
Dosage Indication Contraindication Side/adverse effects Nursing
responsibilities
1 cap TID >cirrhosis >Contraindicated in In very rare cases it > Instruct patient on
patients can cause :abdominal proper use of the
>Hepatic steatosis drug
hypersensitive to drug pain, nausea, diarrhea
(also in cases of
and allergic
diabetes) >in newborn children
reaction(skin rash).
>Acute and chronic >in pregnant women
hepatitis
>Necrosis of the liver
cells
>Hepatic coma and
precoma
>Toxic liver damage
(including pregnancy
toxicosis)
Generic name:
Brand name:
Classification:
Action:
Dosage Indication Contraindication Side/adverse effects Nursing
responsibilities

Generic name:
Brand name:
Classification:
Action:
Dosage Indication Contraindication Side/adverse effects Nursing
responsibilities

NURSING CARE PLAN

 Ineffective airway clearance r/t accumulation of secretions secondary to CAP.

 Bleeding related to altered clotting mechanism: decreased prothrombin and thrombin production secondary to
liver cirrhosis.
.