Cirrhosis
John Richards, 45 years old
Primary Concept
Nutrition
Interrelated Concepts (In order of emphasis)
1. Fluid and Electrolyte Balance
2. Perfusion
3. Cognition
4. Addiction
5. Clinical Judgment
6. Patient Education
7. Communication
8. Collaboration
UNFOLDING Reasoning Case Study: STUDENT
© 2016 Keith Rischer/www.KeithRN.com
, Cirrhosis History
of Present Problem:
John Richards is a 45-year-old male who presents to the emergency department (ED) with abdominal pain and worsening
nausea and vomiting the past three days that have not resolved. He is feeling more fatigued and has had a poor appetite the
past month. He denies any ETOH (alcohol) intake the past week, but admits to episodic binge drinking on most weekends.
John weighs 150 pounds (68.2 kg) and is 6'0" (BMI 17.6). You are the nurse responsible for his care.
Personal/Social History:
John is single, has never married, and lives alone in his own apartment. He has struggled with heroin use/abuse in the past,
but has not used in the past two years. John is currently unemployed and has no health insurance. He was diagnosed with
hepatitis C ten years ago but has had minimal follow-up medical care since.
What data from the histories are RELEVANT and have clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
Abdominal pain and worsening N/V Should be monitored, could be a S&S of something serious.
the past three days that have not
resolved. Could be fatigued d/t N/V or an underlying condition. The
He is feeling more fatigued and has patient will need a medical history for clues as to what is
had a poor appetite. happening.
He denies any ETOH intake the past Could indicate alcoholism or alcohol abuse
week but admits to episodic binge
drinking on most weekends.
RELEVANT Data from Social History: Clinical Significance:
He has struggled with heroin IV drug use is a risk factor for many serious
use/abuse in the past but has not conditions/diseases.
used in the past two years.
John is currently unemployed and
has no health insurance. John will need assistance and resources to pay for his medical
Diagnosed with hepatitis C ten years care.
ago but has had minimal follow-up Hepatitis C needs regular medical intervention/monitoring.
medical care since. Alcohol binging will worsen his Hep C S&S
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect.)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
*Hepatitis C–past history of Ibuprofen 600 mg PO prn NSAID Relief of pain and
IV drug abuse for headache inflammation
*ETOH abuse x 25 years
One disease process often influences the development of other illnesses. Based on your knowledge of
pathophysiology, (if applicable), which disease likely developed FIRST that created a “domino effect” in his/her life?
• Circle the PMH problem that likely started FIRST.
• Underline the PMH problem(s) FOLLOWED as domino(s).
Patient Care Begins:
© 2016 Keith Rischer/www.KeithRN.com
John Richards, 45 years old
Primary Concept
Nutrition
Interrelated Concepts (In order of emphasis)
1. Fluid and Electrolyte Balance
2. Perfusion
3. Cognition
4. Addiction
5. Clinical Judgment
6. Patient Education
7. Communication
8. Collaboration
UNFOLDING Reasoning Case Study: STUDENT
© 2016 Keith Rischer/www.KeithRN.com
, Cirrhosis History
of Present Problem:
John Richards is a 45-year-old male who presents to the emergency department (ED) with abdominal pain and worsening
nausea and vomiting the past three days that have not resolved. He is feeling more fatigued and has had a poor appetite the
past month. He denies any ETOH (alcohol) intake the past week, but admits to episodic binge drinking on most weekends.
John weighs 150 pounds (68.2 kg) and is 6'0" (BMI 17.6). You are the nurse responsible for his care.
Personal/Social History:
John is single, has never married, and lives alone in his own apartment. He has struggled with heroin use/abuse in the past,
but has not used in the past two years. John is currently unemployed and has no health insurance. He was diagnosed with
hepatitis C ten years ago but has had minimal follow-up medical care since.
What data from the histories are RELEVANT and have clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
Abdominal pain and worsening N/V Should be monitored, could be a S&S of something serious.
the past three days that have not
resolved. Could be fatigued d/t N/V or an underlying condition. The
He is feeling more fatigued and has patient will need a medical history for clues as to what is
had a poor appetite. happening.
He denies any ETOH intake the past Could indicate alcoholism or alcohol abuse
week but admits to episodic binge
drinking on most weekends.
RELEVANT Data from Social History: Clinical Significance:
He has struggled with heroin IV drug use is a risk factor for many serious
use/abuse in the past but has not conditions/diseases.
used in the past two years.
John is currently unemployed and
has no health insurance. John will need assistance and resources to pay for his medical
Diagnosed with hepatitis C ten years care.
ago but has had minimal follow-up Hepatitis C needs regular medical intervention/monitoring.
medical care since. Alcohol binging will worsen his Hep C S&S
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medication treats which condition? Draw lines to connect.)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
*Hepatitis C–past history of Ibuprofen 600 mg PO prn NSAID Relief of pain and
IV drug abuse for headache inflammation
*ETOH abuse x 25 years
One disease process often influences the development of other illnesses. Based on your knowledge of
pathophysiology, (if applicable), which disease likely developed FIRST that created a “domino effect” in his/her life?
• Circle the PMH problem that likely started FIRST.
• Underline the PMH problem(s) FOLLOWED as domino(s).
Patient Care Begins:
© 2016 Keith Rischer/www.KeithRN.com
