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cirrhosis of the liver
A 65-year-old man is admitted to the hospital with the diagnosis of cirrhosis of the liver. During the admission assessment, the nurse collects the following data: The patient has been unable to eat secondary to nausea and vomiting for the past 3 days: he has seen moderate amounts of blood twice in the past 24 hours when he vomited:he has noted a slight yellow color to his skin and has had increased itching of the skin for the past 3 weeks, PMH of increased alcohol intake for 20 years. On exam, the following were noted: BP 90/60, p. 110. r. 20 Skin: moderate jaundice with drying and decrease tugor HEENT:cirrhosis of the liver sclera is yellow Lungs: clear to auscultation ABD: distended with increased venous markings. BS present. Liver palpable 1 cm below the costal margin EXT: thin, pulses 1+ present and bilateral, capillary refill decreased 1. How does the cirrhosis of the liver cause the jaundice seen in this patient? Explain physiologically relating to normal bile production and bilirubin metabolism. 2. On physical examination, the nurse noted abdominal distention. If on exam the distension was found to be fluid in the peritoneal cavity, how could you physiologically explain the relationship between the ascites (fluid in the peritoneal cavity) and his cirrhosis? 3.cirrhosis of the liver On the third day of hospitalization, the laboratory calls to tell the nurse the patient has a very high serum ammonia. Knowing how proteins are normally metabolized by the liver, explain why the elevated serum ammonia is concerning.