Case Study Question 1
The nurse is caring for a 67-yr-old male with history of alcohol use disorder and cirrhosis admitted to
the medical-surgical unit.
Nurses’ Notes
DAY 1 1000. Admitted with ascites and confusion; oriented to person only. Has 25-yr history of
alcohol use disorder, mild hypertension, and gastroesophageal reflux disease. Drowsy and dozing off
and on, mildly dyspneic, appears thin and malnourished; somewhat agitated answering questions.
States has not had a drink in a few weeks; sister who accompanied him notes recent drinking binge a
week ago. Placed on oxygen 2 L per nasal cannula. Bulging flanks and peripheral edema noted.
Bloodwork sent to lab. Admission weight 142 lbs (64.5 kg).
Vital Signs
Time Day1: 1000
Temp 98.4F/36.8C
P 85
RR 22
B/P 142/72
Pulse oximeter 92 on 2L NC
Glasgow Coma (3-15) 12
Abdominal girth 95 cm/37.5in
Medications
Medication Dosage/Frequency/ Route Time
metoprolol XL 50 mg daily 1000
Laboratory Report
Lab Results Reference range
BUN 22 mg/dL 10-20 mg/dL
Glucose (fasting) 70 mg/dL Normal < 99 mg/dL
Ammonia 94 mcg/dL 10-80 mcg/dL
Albumin 3.2 g/dL 3.4-5.4 g/dL
The nurse assesses the client upon admission to the unit.
➢ Which 2 findings are the most concerning?
Blood pressure
BUN
Neurologic assessment
Peripheral edema
Dyspnea
Albumin level
Glucose
, Case Study Question 2
The nurse is caring for a 67-yr-old male with history of alcohol use disorder and cirrhosis admitted to
the medical-surgical unit.
Nurses’ Notes
DAY 1 1000. Admitted with ascites and confusion; oriented to person only. Has 25-yr history of
alcohol use disorder, mild hypertension, and gastroesophageal reflux disease. Drowsy and dozing off
and on, mildly dyspneic, appears thin and malnourished; somewhat agitated answering questions.
States has not had a drink in a few weeks; sister who accompanied him notes recent drinking binge a
week ago. Placed on oxygen 2 L per nasal cannula. Bulging flanks and peripheral edema noted.
Bloodwork sent to lab. Admission weight 142 lbs (64.5 kg).
Vital Signs
Time Day1: 1000
Temp 98.4F/36.8C
P 85
RR 22
B/P 142/72
Pulse oximeter 92 on 2L
Glasgow Coma (3-15) 12
Abdominal girth 95 cm/37.5in
Medications
Medication Dosage/Frequency/ Route Time
metoprolol XL 50 mg daily 1000
Laboratory Report
Lab Results Reference range
BUN 22 mg/dL 10-20 mg/dL
Glucose (fasting) 70 mg/dL Normal < 99 mg/dL
Ammonia 94 mcg/dL 10-80 mcg/dL
Albumin 3.2 g/dL 3.4-5.4 g/dL
➢ For each finding, click to specify if the finding is most consistent with the condition of ascites or
elevated ammonia.
Assessment/Finding Ascites Elevated ammonia
Abdominal girth o o
Agitation o o
Bulging flanks o o
Dozing off and on o o
Dyspnea o o
Peripheral edema o o
Pulse oximetry o o
Serum albumin o o
The nurse is caring for a 67-yr-old male with history of alcohol use disorder and cirrhosis admitted to
the medical-surgical unit.
Nurses’ Notes
DAY 1 1000. Admitted with ascites and confusion; oriented to person only. Has 25-yr history of
alcohol use disorder, mild hypertension, and gastroesophageal reflux disease. Drowsy and dozing off
and on, mildly dyspneic, appears thin and malnourished; somewhat agitated answering questions.
States has not had a drink in a few weeks; sister who accompanied him notes recent drinking binge a
week ago. Placed on oxygen 2 L per nasal cannula. Bulging flanks and peripheral edema noted.
Bloodwork sent to lab. Admission weight 142 lbs (64.5 kg).
Vital Signs
Time Day1: 1000
Temp 98.4F/36.8C
P 85
RR 22
B/P 142/72
Pulse oximeter 92 on 2L NC
Glasgow Coma (3-15) 12
Abdominal girth 95 cm/37.5in
Medications
Medication Dosage/Frequency/ Route Time
metoprolol XL 50 mg daily 1000
Laboratory Report
Lab Results Reference range
BUN 22 mg/dL 10-20 mg/dL
Glucose (fasting) 70 mg/dL Normal < 99 mg/dL
Ammonia 94 mcg/dL 10-80 mcg/dL
Albumin 3.2 g/dL 3.4-5.4 g/dL
The nurse assesses the client upon admission to the unit.
➢ Which 2 findings are the most concerning?
Blood pressure
BUN
Neurologic assessment
Peripheral edema
Dyspnea
Albumin level
Glucose
, Case Study Question 2
The nurse is caring for a 67-yr-old male with history of alcohol use disorder and cirrhosis admitted to
the medical-surgical unit.
Nurses’ Notes
DAY 1 1000. Admitted with ascites and confusion; oriented to person only. Has 25-yr history of
alcohol use disorder, mild hypertension, and gastroesophageal reflux disease. Drowsy and dozing off
and on, mildly dyspneic, appears thin and malnourished; somewhat agitated answering questions.
States has not had a drink in a few weeks; sister who accompanied him notes recent drinking binge a
week ago. Placed on oxygen 2 L per nasal cannula. Bulging flanks and peripheral edema noted.
Bloodwork sent to lab. Admission weight 142 lbs (64.5 kg).
Vital Signs
Time Day1: 1000
Temp 98.4F/36.8C
P 85
RR 22
B/P 142/72
Pulse oximeter 92 on 2L
Glasgow Coma (3-15) 12
Abdominal girth 95 cm/37.5in
Medications
Medication Dosage/Frequency/ Route Time
metoprolol XL 50 mg daily 1000
Laboratory Report
Lab Results Reference range
BUN 22 mg/dL 10-20 mg/dL
Glucose (fasting) 70 mg/dL Normal < 99 mg/dL
Ammonia 94 mcg/dL 10-80 mcg/dL
Albumin 3.2 g/dL 3.4-5.4 g/dL
➢ For each finding, click to specify if the finding is most consistent with the condition of ascites or
elevated ammonia.
Assessment/Finding Ascites Elevated ammonia
Abdominal girth o o
Agitation o o
Bulging flanks o o
Dozing off and on o o
Dyspnea o o
Peripheral edema o o
Pulse oximetry o o
Serum albumin o o
