Liver Failure Case Studies

There is insufficient medical record documentation to determine whether Novolog is medically necessary for the treatment of this member’s

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

2/10/2016, 1600, Vital Signs: BP 140/85 P132 RR32 Temp 102.2 SpO2 85% on 2 liter by nasal cannula. Jacquline Catanzaro is 45 years old female on disability admitted to Medical Unit Hospital. Sister with patient. Reason to admit is can’t breathe. Diagnosis is 30 year of asthma exacerbation, psychiatric schizophrenia, obesity, pneumonia and herniated disc. Smokes 40 packs year. Drinks 2 pots of coffee a day. Drinks 3 beers each day. Frequency ED visits and hospitalization dependence on rescue inhaler. Patient refuses wear nasal cannula because of worry that it contains poison. Patient has a long history of stopping taking psychiatric medication and asthma medications. Patient has isolated herself from others. Sister is only caregiver. Neuro

He was diagnosed with liver disease a few years ago. He had a history of positive hepatitis C virus antibody. His hepatitis C virus PCR was checked on two different occasions and has been negative. He was evaluated by hepatology, Christopher Albers, MD at Tampa General Hospital for his liver disease. He had a liver biopsy done showing evidence of liver cirrhosis. Per patient's report, he was told that he is not a candidate for a liver transplant at his point. No evidence of abnormal liver function tests in the records and his coagulations were in normal range. He has chronic thrombocytopenia that has been attributed to alcohol use and liver disease. No history of hematemesis. He reports that he had endoscopy as part of the work up at Tampa General Hospital but he does not recall the results. His last colonoscopy was done this year at Tampa General Hospital. No reported malignancy, per patient's report. He also has imaging for his abdomen and pelvis but we do not have the results at this time.

History of Present Illness: The patient is a 27-year-old male complaining of right lower-quadrant abdominal pain, nausea, and

JS is geriatric female patient comes for a cleaning. She is in a wheelchair and prefers to be treated in the wheelchair because transferring to the dental chair makes her very anxious. Medical history was reviewed, patient is takin several medications daily, but none of her medical conditions represent a contraindication to treatment (list of medications and conditions were reviewed, but I did not copied it).

Mr. Wilson is a 47 year old man being evaluated for complaints of fatigue, anorexia and abdominal distention. On examination, it is noted that the skin is jaundiced and the liver enlarged. D.W. denies significant alcohol or drug use. He denies any known exposure to hepatitis and has never been vaccinated for hepatitis. He is taking no medication. Laboratory tests reveal the following and a diagnosis of acute hepatitis B is made:

Last, hospital visit was to the emergency room. Last year she had an episode of SOB, and she was prescribed an albuterol inhaler. GL has been treated for hypertension for the past 13 years, her current medications are propranolol 40 mg twice daily and hydrochlorothiazide 15 mg daily. GL’s physical assessment and vitals are as followed; HR: 60 bpm, RR: 30 bpm, and B/P 152/85 mm Hg. Upon auscultation of her lungs, revealed an expanded chest, with diminished breath sounds and faint wheezes. Heart sounds were normal. The diagnosis includes COPD and asthma. Physician had ordered albuterol inhaler 1 unit does x 3 times a day and fluticasone provide anti-inflammatory, decreasing edema of airways 40 mg x 3 times a day, and oxygen 2L/NC PRN. With GL’s increasing fatigue fall precaution should be initiated and while ambulating CNA should monitor patient. Educate GL about using call light when needed and not to try and get up alone. She should also be educated daily on cessation of smoking and how to prioritize her days. Physician wants to admit

D/A: Mr. Brown had two appointments this week. On 02/06/17, Mr. Brown was transported to his appointment with Dr. Chua. According per Nurse Note, assessment states shortness of breath, coughing and tiredness. Consumer complained of pain, headache, back pain and arm pain. Consumer was assisted to his appointment with Dr. Redelcovecui in Dover at 2:42 p.m. On 02/08/17, according to the Nurse note, consumer was seen by Christiana Care Vising Nurse Associates for physical therapist evaluation. The Visiting Nurse stated that “consumer tolerated treatment well today.” Consumer met with his psychiatrist Dr. Capiro on02/06/17. Dr. Capiro provided consumer a comprehensive, psychiatric & medication review and an assessment of his needs. Consumer was

Patient is 52 year male with diagnosed with Schizoaffective disorder, Type 2 diabetes mellitus, Generalized anxiety, Gastro-esophageal reflux Constipation, Alert orient X 3, was and cooperative during SN visit. Denied SI, HI, V/H, A/H, self harm behavior and contracted for safety. Mood/affect flat. pt has poor family dynamic , a family that have not been supporting him. pt has been under CHD for financial managements. and A better life home care with his which provide him with daily skilled visit in provided daily assessments of patient vital signs, medication administration/management (assessing compliance of pre-poured medication), assessing patient’s mood, mental status, coping skills as well as safety which has in turn kept the patient out of any possible hospitalization this period. Patient continue on clozaril which requires to be carefully administered and monitored if any side effect.patient is also continue on Vistaril Oral 25 MG 1 Cap(s) by mouth twice daily AM & PM as needed for anxiety which he requires daily d/t being

At today’s visit he is accompanied by his daughter. The patient is awake, alert but unable to express his needs. I am her to follow up per the family request due to the patient having an elevated temperature. The daughter reports that on Sunday the patient had a temperature of 99. She gave him Tylenol via his PEG and his elevated temperature resolved. She reports that he has a chronic cough, which has not worsened. The patient has pressure ulcer to his buttock which is care for by his family. The patient is unable to clear his secretion; the family suctions him throughout the day. The patient is at risk for aspiration pneumonia and increased skin breakdown due to his decrease

In the presented case scenario, we have Mr. Gil Martin who is a 55-year-old Hispanic male. He comes in to the clinic today with complaints of weakness, fatigue, and loss of appetite. A student nurse will be precepting your assessment of Mr. Martin and when collecting subjective and objective data it is important to pay close detail to all findings. Ultimately this patient was diagnosis with cirrhosis, which is an abnormal liver condition that leads to irreversible scarring of the liver (National Institute of Health [NIH], 2017), so during assessment we should pay attention to details leading to this diagnosis.

Neurological system. Upon inspection, Mr. Fedora has a high level of consciousness, as he was awake, and alert. He has a strong cough that is producing yellow sputum. His gag reflex is present and reports feeling nauseous. The pt. has been dry heaving, but not actively vomiting. Mr. Fedora’s motor function is adequate. Pt. reports pain to his chest and abdomen.

An acute liver failure happens when the normal function of the liver stops. This happens to people that never before had liver problems. And it happens in a short time of period like a couple of weeks and even days. So it can happen fast and it also causes complications that can be very bad. It causes strong pain on the brain and intense bleeding.

There are many different causes for liver damage and disease, and mild cases may not exhibit any symptoms or warning signals until months of damage has been done. As the liver damage or disease progresses, some indicators become more obvious. Your liver can be damaged by habits such as drinking alcoholic beverages all too often, or from taking medications that contain acetaminophen for many years. It depends on how sensitive your liver and internal system are and how long you have been possibly putting substances in your body that just don’t mesh well with the liver.