standard assessment of cirrhosis
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Does anyone have any suggestions for me? I know all about cirrhosis, hepatitis... But for someone with these disorders/diseases, what would a standard assessment be.
Jun 2, '08I'm not quite sure what you are meaning by a "standard assessment". To me a standard assessment is either a head to toe or body systems physical exam. However, I have a feeling that what you are meaning is what you want to specifically look for what is abnormal in the patient with cirrhosis or hepatitis, right?
One of the nicest care plan books that I have that does this is
Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span, 7th edition, by Marilynn E. Doenges, Mary Frances Moorhouse and Alice C. Murr. Both conditions are listed in it. I will quote you what is in the book about assessment only for cirrhosis and hepatitis. I am not including the abnormal lab and test information because I am getting tired:
"CIRRHOSIS (pages 453-454)
Data depends on the underlying cause of the condition.
ACTIVITY/REST"HEPATITIS (pages 443-444)
May report: Weakness, fatigue, exhaustionCIRCULATION
May exhibit: Lethargy
Decreased muscle mass/tone
May report: History of/recent onset of heart failure, pericarditis, rheumatic heart disease, or cancer (causing liver impairment leading to failure)ELIMINATION
Easy bruising, nosebleeds, bleeding gums
May exhibit: Hypertension or hypertension (fluid shifts)
Dysrhythmias, extra heart sounds (S3, S4)
Jugular venous distension (JVD), distended abdominal veins, spider angiomas/collateral circulation
Ecchymosis, petechiae
anemia, leukopenia, thrombocytopenia, coagulation disorders, splenomegaly
May report: FlatulenceFOOD/FLUID
Diarrhea or constipation; gradual abdominal enlargement
May exhibit: Abdominal distension (hepatomegaly, splenomegaly, ascites)
Decreased/absent bowel sounds
Clay-colored stools, melena
Hemorrhoidal varices
Dark, concentrated urine; oliguria (hepatorenal syndrome/failure)
May report: Anorexia, food intolerance/indigestionNEUROSENSORY
Nausea/vomiting, hematemesis
May exhibit: Weight loss or gain (fluid)
Tissue wasting, delayed wound healing
Edema generalized in tissues
Dry skin, poor turgor
Halitosis/fetor hepaticus. bleeding gums
Hypoalbuminemia
May report: Significant other(s) may report personality changes, depressed mentationPAIN/DISCOMFORT
May exhibit: Changes in mentation, confusion, hallucinations, coma
Slowed/slurred speech
Asterixis (involuntary jerking movements of hands/tongue/feet associated with hepatic encephalopathy)
May report: Abdominal tenderness/RUQ painRESPIRATION
Severe itching
Pins/needles sensation, burning pain in extremities (peripheral neuropathy)
May exhibit: Guarding/distraction behaviors
Self-focus
May report: DyspneaSAFETY
May exhibit: Tachypnea, shallow respiration, adventitious breath sounds
Limited thoracic expansion (ascites)
Hypoxia
May report: Itching/dryness of skinSEXUALITY
May exhibit: Fever (more common in alcoholic cirrhosis)
Jaundiced skin and sclera, pruritis
Spider angiomas, telangiectasis, palmar erythema
Confusion progressing to delirium and coma (hepatic encephalopathy)
Unsteady or shaky/jerking movements
May report: Menstrual disorders (women), impotence (men)TEACHING/LEARNING
May exhibit: Testicular atrophy, gynecomastia, loss of hair (chest, underarm, pubic)
May report: History of long-term alcohol or IV drug use/abuse, alcoholic liver disease. use of drugs affecting liver function
History of biliary disease, hepatitis, exposure to toxins, liver trauma, complications of portal hypertension (e.g. episodes of bleeding esophageal varices and hepatorenal syndrome)"
Data depends on the cause (type of hepatitis) and severity of liver involvement/damage.
ACTIVITY/REST
May report: Fatigue, weakness, general malaise, muscle achesCIRCULATION
May exhibit: Bradycardia (severe hyperbilirubinemia)ELIMINATION
Jaundiced sclera, skin, mucous membranes
May report: Dark urineFOOD/FLUID
Diarrhea/constipation, clay-colored stools
current/recent hemodialysis
May report: Loss of appetite (anorexia), weight loss or gain (edema)NEUROSENSORY
Nausea/vomiting
May exhibit: Ascites
PAIN/COMFORT
May exhibit: Irritability, drowsiness, lethargy, asterixis, headache
May report: Abdominal cramping, right upper quadrant (RUQ) tendernessRESPIRATION
Myalgias, arthalgias; headache
Itching (pruritis)
May exhibit: Muscle guarding, restlessness
May report: Distaste for/aversion to cigarettes (smokers)SAFETY
Recent flu-like URI signs and symptoms
May report: Transfusion of blood/blood products in the pastSEXUALITY
May exhibit: Fever
Urticaria, maculopapular lesions, irregular patches of erythema
Exacerbation of acne
Spider angiomas, palmar erythema, gynecomastia in men (sometimes present in alcoholic hepatitis)
Splenomegaly, posterior cervical node enlargement
May report: Lifestyle/behaviors increasing risk of exposure (e.g. sexual promiscuity, sexually active homosexual/bisexual male)TEACHING/LEARNING
May report: History of known/possible exposure to virus, bacteria, or toxins (contaminated food, water, needles, surgical equipment or blood), carriers (symptomatic or asymptomatic), recent surgical procedure with halothane anesthesia, exposure to toxic chemicals (e.g. carbon tetrachloride, vinyl chloride)
History of known/possible exposure to hepatotoxic prescription (e.g. sulfonamides, phenothiazides, isoniazid) or OTC drug use (e.g. acetaminophen)
Use of herbal supplements associated with hepatotoxicity, (e.g. chaparral, JinBuHuan, germander, comfrey, mistletoe, skullcap, margosa oil, pennyroral)
Use of street injection drugs or alcohol
Travel to/immigration from China, Africa, Southeast Asia, Middle East (hepatitis B [HBV] and C [HBC] are endemic in these areas)
Concurrent diabetes, heart failure, malignancy, or renal disease"
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