NCLEX: Physiological Integrity: Nursing Care of the Adult Client

Physiological Integrity: Nursing Care of the Adult Client: CARDIOVASCULAR SYSTEM

Focus topic: Physiological Integrity: Nursing Care of the Adult Client

VEIN LIGATION AND STRIPPING: surgical intervention for advancing varicosities, stasis ulcerations, and cosmetic needs of client. Procedure involves ligation of the saphenous vein at the groin, where it joins the femoral vein; saphenous stripping from the groin to the ankle; legs are wrapped with a pressure bandage. Frequently done as outpatient surgery.

Focus topic: Physiological Integrity: Nursing Care of the Adult Client

A. See preceding section on varicose veins for assessment data and nursing diagnosis of the client requiring surgery.

Focus topic: Physiological Integrity: Nursing Care of the Adult Client

B. Nursing care plan/implementation:

  • Goal: prevent complications after discharge.

a. Position: elevate legs as instructed.

b. Activity: No chair sitting to prevent venous pooling, thrombus formation. Avoid standing in one place.

c. Bleeding: report to physician.

  • Goal: health teaching to prevent recurrence.

a. Weight reduction.

b. Avoid constricting garments.

c. Change positions frequently.

d. Wear support hose/stockings to enhance venous return.

e. No crossing legs at knees.

C. Evaluation/outcome criteria:

  • No complications—hemorrhage, infection, nerve damage, deep vein thrombosis.
  • No recurrence of varicosities.
  • Adequate circulation to legs: strong pedal pulses.
  • Resumes daily activities; free of pain.

DEEP VEIN THROMBOSIS (THROMBOPHLEBITIS): formation of a blood clot in an inflamed vein, secondary to phlebitis or partial obstruction; may lead to venous insufficiency and pulmonary embolism. Deep vein thrombosis (DVT) is most serious form.

Focus topic: Physiological Integrity: Nursing Care of the Adult Client

A. Pathophysiology: endothelial inflammation → formation of platelet plug (blood clot) → slowing of blood flow → increase in procoagulants in local area → initiation of clotting mechanisms.

Focus topic: Physiological Integrity: Nursing Care of the Adult Client

B. Risk factors:

  • Immobility/stasis—prolonged sitting, bedrest, obesity, pregnancy.
  • Venous disease; history DVT.
  • Age—increased incidence in elderly.
  • Gender—more often women.
  • Hypercoagulability of blood.
  • Intimal damage—IVs, drug abuse.
  • Fractures.
  • Oral contraceptives (related to estrogen content).

C. Assessment:

  • Subjective data:

a. Calf stiffness, soreness.

b. Severe pain: walking, dorsiflexion of foot (Homans’ sign—may be unreliable).

  • Objective data:

a. Vein: redness, heat, hardness, threadiness.

b. Limb: swollen, pale, cold.

c. Vital signs: low-grade fever.

d. Diagnostic tests: venogram, impedance plethysmography (electrical resistance to blood flow), ultrasonography.

D. Analysis/nursing diagnosis:

  • Altered peripheral tissue perfusion related to venous stasis.
  • Pain related to inflammation.
  • Activity intolerance related to leg pain.
  • Risk for injury related to potential pulmonary emboli.

E. Nursing care plan/implementation:

  • Goal: provide rest, comfort, and relief from pain.

a. Bedrest until therapeutic level of heparin reached (5 to 7 days with traditional heparin; after 24 hours with low-molecular-weight heparin).

b. Position: as ordered; usually extremity elevated; watch for pressure points.

c. Apply warm, moist heat to affected area as prescribed (cold may also be ordered).

d. Assess progress of affected area: swelling, pain, soreness, temperature, color.

e. Administer analgesics as ordered.

  • Goal: prevent complications.

a. Observe for signs of embolism (pain at site of embolism); allergic reaction (anaphylactic shock) with streptokinase.

b. Precautions: no rubbing or massage of limb.

c. Medications: anticoagulants (sodium heparin, enoxaparin, warfarin [Coumadin]); streptokinase (Varidase), tissue plasminogen activator (Nursing Responsibilities with Anticoagulant Therapy).

d. Bleeding: hematuria, epistaxis, ecchymosis. Check INR levels.

e. Skin care, to relieve increased redness/ maceration from hot or cold applications.

f. ROM: unaffected limb.

  • Goal: health teaching.

a. Precautions: tight garters, girdles; sitting with legs crossed; oral contraceptives.

b. Preventive measures: walking daily, swimming several times weekly if possible, wading, rest periods with legs elevated, elastic stockings (may remove at bedtime).

c. Medication side effects: anticoagulants—pink toothbrush, hematuria, easily bruised.

(1) Carry Medic Alert card/bracelet.
(2) Contraindicated drugs—aspirin, glutethimide (Doriden), chloramphenicol (Chloromycetin), neomycin, phenylbutazone (Butazolidin), barbiturates.

d. Prepare for surgery (thrombectomy, vein ligation).

F. Evaluation/outcome criteria:

  • No complications (e.g., embolism).
  • No recurrence of symptoms.
  • Free of pain—ambulates without discomfort.

 

Physiological Integrity: Nursing Care of the Adult Client

 

PERIPHERAL EMBOLISM: fragments of thrombi, globules of fat, clumps of tissue, calcified plaques, or air moves in the circulation and lodges in vessel, obstructing blood flow; thrombic emboli most common; may be venous or arterial.

Physiological Integrity: Nursing Care of the Adult Client: GASTROINTESTINAL SYSTEM

Focus topic: Physiological Integrity: Nursing Care of the Adult Client

GENERAL NUTRITIONAL DEFICIENCIES

Focus topic: Physiological Integrity: Nursing Care of the Adult Client

A. Assessment:

  • Subjective data:

a. Mental irritability or confusion.

b. History of poor dietary intake.

c. History of lack of adequate resources to provide adequate nutrition.

d. Lack of knowledge about proper diet, food selection, or preparation.

e. History of eating disorders.

f. Paresthesia (burning and tingling): hands and feet.

  • Objective data:

a. Appearance: listless; posture: sagging shoulders, sunken chest, poor gait.

b. Muscle: weakness, fatigue, wasted appearance.

c. GI: indigestion, vomiting, enlarged liver, spleen.

d. Cardiovascular: tachycardia on minimal exertion; bradycardia at rest; enlarged heart, elevated BP.

e. Hair: brittle, dry, thin, sparse; lack of natural shine; color changes; can be easily plucked out.

f. Skin: dryness (xerosis), scaly, dyspigmentation, petechiae, lack of fat under skin.

g. Mouth:

(1) Teeth: missing, abnormally placed, caries.
(2) Gums: bleed easily, receding.
(3) Tongue: swollen, sore.
(4) Lips: red, swollen, angular fissures at corners.

h. Eyes: pale conjunctivae, corneal changes.

i. Nails: brittle, ridged.

j. Nervous system: abnormal reflexes.

k. Laboratory data: blood—decreased albumin, iron-binding capacity, lymphocyte, hemoglobin, and hematocrit.

l. Anthropometric measurements document nutritional deficiencies.

B. Analysis/nursing diagnosis:

  • Altered nutrition, less than body requirements, related to poor dietary intake.
  • Knowledge deficit (learning need) related to nutritional requirements.
  • Altered health maintenance related to inability to provide own nutritional care.
  • Ineffective individual coping related to eating disorders.
  • Ineffective family coping, disabling, related to inadequate resources or knowledge to provide appropriate family nutrition.

C. Nursing care plan/implementation:

  • Goal: prevent complications of specific deficiency.

a. Identify etiology of nutritional deficiency.

b. Recognize signs of nutritional deficiencies

c. Identify foods high in deficient nutrient

d. Evaluate economic resources to purchase appropriate foods.

e. Identify community resources for assistance.

f. Monitor progress for potential additional illnesses.

  • Goal: health teaching.

a. Effects of nutritional deficiencies on health.

b. Foods to include in diet to avoid deficits.

D. Evaluation/outcome criteria:

  • Complications do not occur.
  • Client gains weight.
  • Client selects appropriate foods to alleviate deficiency.

CELIAC DISEASE (gluten enteropathy, nontropical sprue): immune to gluten, causing impaired absorption and digestion of nutrients through the small bowel. Affects adults and children and is characterized by inability to digest and use sugars, starches, and fats.

Focus topic: Physiological Integrity: Nursing Care of the Adult Client

A. Pathophysiology: intolerance to the gliadin fraction of grains causing degeneration of the epithelial surface of the intestine, atrophy of the intestinal villi, and impaired absorption of essential nutrients.

Focus topic: Physiological Integrity: Nursing Care of the Adult Client

B. Risk factors:

  • Possible genetic or familial factors.
  • Hypersensitivity response.
  • History of childhood celiac disease.

C. Assessment:

  • Subjective data: family history.
  • Objective data:

a. Loss: weight, fat deposits, musculature.

b. Anemia.

c. Vitamin deficiencies.

d. Abdomen distended with flatus.

e. Stools: diarrhea, foul smelling, bulky, fatty, float in commode.

f. Skin condition known as dermatitis herpetiformis.

g. History of acute attacks of fluid and electrolyte imbalances.

h. Diagnostic tests: stool for fat; barium enema; antibody tests, including endomysial antibody (EMA); blood studies of: iron, folate, proteins, minerals, and clotting factors; small bowel biopsy.

i. Gluten-free diet leads to remission of symptoms.

D. Analysis/nursing diagnosis:

  • Altered nutrition, less than body requirements, related to inability to digest and use sugars, starches, and fats.
  • Diarrhea related to intestinal response to gluten in diet.
  • Fluid volume deficit related to loss through excessive diarrhea.
  • Knowledge deficit (learning need) related to dietary restrictions to control symptoms.

E. Nursing care plan/implementation:

  • Goal: prevent weight loss.

a. Diet: high in calories, protein, vitamins, and minerals, and gluten free.

(1) Avoid: wheat, rye, oats, barley.
(2) All other foods permitted.

b. Daily weights to monitor weight changes.

  • Goal: health teaching.

a. Nature of disease.

b. Dietary restrictions and allowances.

c. Complications of noncompliance.

F. Evaluation/outcome criteria:

  • No further weight loss.
  • Normal stools.
  • Fluid/electrolyte balance obtained and maintained.

HEPATITIS: inflammation of the liver.

Focus topic: Physiological Integrity: Nursing Care of the Adult Client

A. Pathophysiology:

  • Infection with hepatitis A (formerly called infectious hepatitis), hepatitis B (formerly called serum hepatitis), hepatitis C (single-stranded RNA virus of the Flaviviridae family; usually asymptomatic), delta hepatitis (infection caused by a defective RNA virus that requires hepatitis B virus to multiply), or hepatitis E (major etiological agent of the enterically transmitted non-A, non-B hepatitis worldwide) → inflammation, necrosis, and regeneration of liver parenchyma. Hepatocellular injury impairs clearance of urobilinogen→ elevated urinary urobilinogen; and, as injury increases → conjugated bilirubin not reaching the intestines → decreased urine and fecal urobilinogen → increased serum bilirubin→ jaundice.
  • Failure of liver to detoxify products → increased toxic products of protein metabolism → gastritis and duodenitis.

B. Risk factors:

  • Exposure to virus.
  • Exposure to carriers of virus.
  • Exposure to hepatotoxins such as dry-cleaning agents.
  • Nonimmunized.

C. Assessment:

  • Subjective data:

a. Anorexia, nausea.

b. Malaise, dull ache in right upper quadrant, abdominal pain.

c. Repugnance to: food, cigarette smoke, strong odors, alcohol.

d. Headache.

  • Objective data:

a. Fever.

b. Liver: enlarged (hepatomegaly), tender, smooth.

c. Skin: icterus in sclerae of eyes, jaundice; rash; pruritus; petechiae, bruises.

d. Urine: normal, dark.

e. Stool: normal, clay colored, loose.

f. Vomiting, weight loss.

g. Lymph nodes: enlarged.

h. Laboratory data:

(1) Blood—leukocytosis.
(2) Increased AST (SGOT), alanine aminotransferase (ALT, or serum glutamic-pyruvic transaminase [SGPT]), and bilirubin levels, alkaline phosphatase.
(3) Urine—increased urobilinogen.

i. Etiology, Incidence, and Epidemiological and Clinical Comparison of Hepatitis A, Hepatitis B, Hepatitis C, and Delta Hepatitis for comparison of hepatitis A, B, C, and D.

Physiological Integrity: Nursing Care of the Adult Client

D. Analysis/nursing diagnosis:

  • Pain related to inflammation of liver.
  • Impaired skin integrity related to pruritus.
  • Activity intolerance related to fatigue.
  • Risk for infection to others related to incubation/infectious period.
  • Altered nutrition, less than body requirements, related to repugnance of food.
  • Social isolation related to isolation precautions.

E. Nursing care plan/implementation:

  • Goal: prevent spread of infection to others.

a. Isolation according to type

(1) Hepatitis A:

(a) Contact precautions
(b) Private room preferred.
(c) Gown/gloves for direct contact with feces.
(d) Hand washing when in direct contact with feces.

(2) Hepatitis B: blood and body fluid precautions.

(a) Needle/dressing precautions.
(b) Private room not necessary.
(c) Gown: only if enteric precautions also necessary.
(d) Hand washing: use gloves when in direct contact with blood.

(3) Hepatitis C: blood and body fluid precautions—same as hepatitis B, except when in countries with fecal-oral form, then use hepatitis A precautions also.

(4) Delta: same as hepatitis B.

b. Passive immunity for contacts.

(1) Hepatitis A: hepatitis A vaccine (Havrix, VAQTA), immune serum globulin (ISG), administered before and after exposure.

(2) Hepatitis B: hepatitis B immune globulin (HBIG) (Recombivax HB, Energix-B) or ISG.

(3) Hepatitis C: prophylaxis not as effective; ISG may be given.

(4) Delta: same as for hepatitis B.

  • Goal: promote healing.

a. Diet as tolerated:

(1) NPO with parenteral infusions, when in acute stage.
(2) High protein, high carbohydrate, low fat, offered in frequent small meals.
(3) Push fluids, if not contraindicated; I&O.

b. Medications:

(1) Antiviral for clients with persistently elevated ALT levels.
(2) Interferon for initial treatment of hepatitis C.

  • Goal: monitor for worsening of disease process, failure to respond to prescribed treatment.

a. Observe urine—dark due to presence of bile and stool, clay colored.

b. Observe sclerae, laboratory tests for increasing jaundice.

c. Mental confusion, unusual somnolence may indicate decreased liver function.

d. Weigh daily—increase indicates fluid retention and possible ascites.

  • Goal: health teaching.

a. Diet and fluid intake to promote liver regeneration.

b. Importance of rest and limited activity to reduce metabolic workload of liver.

c. Personal hygiene practices to prevent contamination.

d. Avoid: alcohol, blood donations, and contact with communicable infections.

e. Follow-up case referral; may take 6 months for full recovery.

f. Teach contacts about available immunizations.

  • Goal: promote comfort.

a. Bedrest to combat fatigue and reduce metabolic needs until hepatomegaly subsides; semi-Fowler’s or supine positioning.

b. Oral hygiene q1–2h to decrease nausea.

c. ROM exercises to maintain muscle strength.

d. Measures to reduce pruritus:

(1) Mild, oil-based lotion to reduce itching.
(2) Nails cut short, cotton gloves, long-sleeved clothing to prevent skin injury from scratching.
(3) Environment: cool and dry.
(4) Cool wet soaks to skin.
(5) Diversional activities.
(6) Medications as ordered:

(a) Emollients to relieve dry skin.
(b) Topical corticosteroids to reduce inflammation.
(c) Antihistamines to reduce itch.
(d) Tranquilizers and sedatives to allow rest and prevent exhaustion.

F. Evaluation/outcome criteria:

  • Tolerates food; nausea and vomiting decreased.
  • Signs of infection/inflammation absent.
  • No complications, hemorrhage, liver damage, ascites.
  • No jaundice noted.

PANCREATITIS: inflammatory disease of the pancreas that may result in autodigestion of the pancreas by its own enzymes.

Focus topic: Physiological Integrity: Nursing Care of the Adult Client

A. Pathophysiology: proteolytic enzymes within the pancreas are activated by endotoxins, exotoxins, ischemia, anoxia, or trauma. Pancreatic enzymes begin process of autodigestion of pancreas and surrounding tissues; also activate other enzymes that digest cellular membranes. Autodigestion leads to: edema, hemorrhage, vascular damage, coagulation necrosis, and fat necrosis.

Focus topic: Physiological Integrity: Nursing Care of the Adult Client

B. Risk factors:

  • Obesity.
  • Alcoholism, alcohol consumption.
  • Biliary tract disease.
  • Abdominal trauma.
  • Surgery.
  • Drugs.
  • Metabolic disease.
  • Intestinal disease.
  • Obstruction of the pancreatic ducts.
  • Infections.
  • Carcinoma.
  • Adenoma.
  • Hypercalcemia.

C. Assessment:

  • Subjective data:

a. Pain:

(1) Sudden onset; severe, widespread, constant, and incapacitating.
(2) Location—epigastrium, right upper quadrant (RUQ) and left upper quadrant (LUQ) of abdomen; radiates to back, flanks, and substernal area.

b. Nausea.

c. History of risk factors.

d. Dyspnea.

  • Objective data:

a. Elevated: temperature, pulse, respirations, BP (unless in shock).

b. Decreased breath sounds related to atelectasis/pleural effusion.

c. Increased crackles, cyanosis.

d. Hemorrhage, shock.

e. Vomiting.

f. Fluid and electrolyte imbalances, dehydration.

g. Decreased bowel sounds; abdominal tenderness with guarding.

h. Stools: bulky, pale, foul smelling, steatorrhea (excessive fat in stools).

i. Skin: pale, moist, cold; may be jaundiced.

j.Muscle rigidity.

k. Supine position leads to increased pain.

l. Fluid accumulation in the abdomen.

m. Laboratory data:

(1) Elevated:

(a) Amylase, serum, and urine.
(b) Serum lipase, AST (SGOT).
(c) Alkaline phosphatase.
(d) Bilirubin, glucose; serum and urine.
(e) Urine protein, WBC count.
(f) Leukocytes.
(g) BUN.
(h) LDH (liver function).

(2) Decreased:

(a) Serum calcium.
(b) Protein.

n. Ultrasound for gallstones, CT scan.

D. Analysis/nursing diagnosis:

  • Altered nutrition, less than body requirements, related to nausea and vomiting.
  • Pain related to inflammatory and autodigestive processes of pancreas.
  • Fluid volume deficit related to inflammation, decreased intake, and vomiting.
  • Ineffective breathing pattern related to pain and pleural effusion.
  • Knowledge deficit (learning need) related to risk factors and disease management.

E. Nursing care plan/implementation:

  • Goal: control pain.

a. Medications: analgesics—meperidine (not morphine or codeine due to spasmodic effect).

b. Position: sitting with knees flexed.

  • Goal: rest injured pancreas.

a. NPO.

b. Nasogastric (NG) tube to low suction.

c. Medications:

(1) Antiulcers.
(2) Antibiotics.
(3) Antiemetics.
(4) Antispasmodics.
(5) Anticholinergics.
(6) Histamine2 receptors (cimetidine).

  • Goal: prevent fluid and electrolyte imbalance.

a. Monitor: vitals, CVP.

b. IVs, fluids, blood, albumin, plasma.

  • Goal: prevent respiratory and metabolic complications.

a. Cough, deep breathe, change position.

b. Monitor: blood sugar as ordered.

c. Monitor calcium levels: Chvostek’s and Trousseau’s signs positive when calcium deficit exists for description of tests.

  • Goal: provide adequate nutrition.

a. Low-fat diet.

b. Bland, small, frequent meals.

c. Vitamin supplements.

d. Avoid alcohol.

6. Goal: prevent complications.

a. Monitor for signs of:

(1) Peritonitis.
(2) Perforation.
(3) Respiratory complications.
(4) Hypotension, shock.
(5) DIC.
(6) ARDS.
(7) Hemorrhage from ulcers, varices.
(8) Anemia.
(9) Encephalopathy.

  • Goal: health teaching.

a. Food selections for low-fat, bland diet.

b. Necessity of vitamin therapy.

c. Importance of avoiding alcohol.

d. Signs and symptoms of recurrence.

e. Importance of rest, to prevent relapse.

f. Desired effects and side effects of prescribed medications:

(1) Narcotics for pain.
(2) Antiemetics for nausea and vomiting.
(3) Pancreatic hormone and enzymes to replace enzymes not reaching duodenum.

F. Evaluation/outcome criteria:

  • Pain is relieved.
  • No complications (e.g., peritonitis, respiratory).
  • States dietary allowances and restrictions.
  • Takes medications as ordered; states purposes, side effects.
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CIRRHOSIS: chronic inflammation and fibrosis (irreversible scarring) of the liver in which some liver cells (hepatocytes) undergo necrosis and others undergo proliferative regeneration.

Focus topic: Physiological Integrity: Nursing Care of the Adult Client

A. Pathophysiology: progressive destruction of hepatic cells → loss of normal metabolic function of the liver and formation of scar tissue. Regeneration and proliferation of fibrous tissue → obstruction of the portal vein → increased portal hypertension, ascites, liver failure, and eventual death.

Focus topic: Physiological Integrity: Nursing Care of the Adult Client

B. Risk factors:

  • Alcohol abuse most common cause.
  • Nutritional deficiency with decreased protein intake.
  • Hepatotoxins.
  • Virus.
  • Hepatitis B and C.

C. Assessment:

  • Subjective data:

a. Chronic feeling of malaise.

b. Anorexia, nausea.

c. Abdominal pain.

d. Pruritus.

  • Objective data:

a. GI:

(1) Malnutrition, weight loss.
(2) Vomiting.
(3) Flatulence.
(4) Ascites.
(5) Enlarged liver and spleen.
(6) Glossitis.
(7) Fetid breath (sweet, musty odor).

b. Blood—coagulation defects, possible esophageal varices, portal hypertension, bleeding from gums and injection sites.

c. Skin and hair—edema, jaundice, spider angioma (telangiectasias); palmar erythema, decreased pubic and axillary hair.

d. Reproductive—menstrual abnormalities, gynecomastia, testicular atrophy, impotence.

e. Neurological deficits—memory loss, hepatic coma, decreased level of consciousness: flapping tremor, grimacing.

f. Laboratory data:

(1) Decreased: albumin, potassium, magnesium, blood urea nitrogen (BUN).
(2) Elevated: prothrombin time, globulins, ammonia, AST (SGOT), bromsulphalein (BSP), alkaline phosphate, uric acid, blood sugar.

g. Diagnostic tests:

(1) Celiac angiography, hepatoportography.
(2) Liver biopsy.
(3) Paracentesis.

D. Analysis/nursing diagnosis:

  • Altered nutrition, less than body requirements, related to decreased intake, nausea, and vomiting.
  • Risk for injury related to decreased prothrombin production.
  • Activity intolerance related to fatigue.
  • Fatigue related to anorexia and nutritional deficiencies.
  • Self-esteem disturbance related to physical body changes.
  • Risk for impaired skin integrity related to pruritus.

E. Nursing care plan/implementation:

  • Goal: provide for special safety needs.

a. Monitor vitals (including neurological) frequently for hemorrhage from esophageal varices (may have Sengstaken-Blakemore or Linton tube inserted).

b. Prepare client for LeVeen shunt surgery for portal hypertension as needed.

c. Assist with paracentesis performed for ascites; monitor vitals to prevent shock during procedure.

  • Goal: relieve discomfort caused by complications.

a. Position: semi-Fowler’s or Fowler’s to decrease pressure on diaphragm due to ascites.

b. Deep breathing q2h to prevent respiratory complications.

c. Skin care, topical medications to relieve pruritus; nail care to decrease possibility of further skin injury.

d. Frequent oral hygiene related to nausea, vomiting, and fetid breath.

  • Goal: improve fluid and electrolyte balance.

a. IV fluids and vitamins.

b. I&O, hourly urines during acute attacks.

c. Daily: girths, weights to monitor fluid balance.

d. Diuretics as ordered to decrease edema.

e. May receive serum albumin to promote adequate vascular volume, prevent azotemia and encephalopathy, and promote diuresis (observe carefully, because albumin could escape quickly through cell walls and cause increase in ascites).

  • Goal: promote optimum nutrition within dietary restrictions.

a. NPO during acute episodes.

b. Small, frequent meals when able to eat.

c. Low protein (to decrease the amount of nitrogenous materials in the intestines) and sodium (to decrease fluid retention).

d. Moderate carbohydrate (to meet energy demands) and fat (to make diet more palatable to clients who are anorexic).

  • Goal: provide emotional support.

a. Quiet environment during acute episodes to decrease external stimuli.

b. Refer to community agencies for assistance for client (e.g., Alcoholics Anonymous; for family, Al-Anon/Alateen).

  • Goal: health teaching.

a. Avoid alcohol, exposure to infections.

b. Dietary allowances, restrictions Sodium-restricted diet, and purinerestricted diet,).

c. Drugs: names, purposes.

d. Signs, symptoms of disease; complications.

e. Stress-management techniques.

F. Evaluation/outcome criteria:

  • No complications.
  • Nutritional status improves; lists dietary restrictions.
  • No alcohol consumption.
  • Lists signs and symptoms of progression of disease and complications.
  • Complies with discharge plan, becomes involved with an alcohol treatment program.
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FURTHER READING/STUDY:

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