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This Concept Map, created with IHMC CmapTools, has information related to: Chronic Conditions, Patient ID: J. H., 58 y/o, Male History of ETOH abuse. Medical Dx: Alcoholic Cirrhosis "Cirrhosis is a chronic progressive disease of the liver characterized by extensive degeneration and destruction of the liver parenchymal cells" (Lewis, Heitkemper, & Dirksen, 2000, p. 1203). chronically has Problem: Pain ND: Pain Data: peripheral neuropathy, subjective pain reports. Meds: Neurontin, Morphine, B Vitamin supplements. Interventions: Reposition for comfort, scheduled pain medication regimen, encourage use of prn pain medication., Problem: Social Isolation ND: Loneliness, risk for Data: Stays home at all times, unable to leave home. Meds: None Interventions: Evaluate social support system. may contribute to Problem: Alcohol Dependence ND: Ineffective coping mechanisms Data: Subjective reports of decades of heavy drinking from patient and wife. Lab results. Meds: None Interventions: Encourage use of social support systems (Falvo, 2009). Referral to self-help program, such as Alcoholics Anonymous (AA) if able to leave house (Falvo, 2009). Encourage abstinence from alcohol., Problem: Alcohol Dependence ND: Ineffective coping mechanisms Data: Subjective reports of decades of heavy drinking from patient and wife. Lab results. Meds: None Interventions: Encourage use of social support systems (Falvo, 2009). Referral to self-help program, such as Alcoholics Anonymous (AA) if able to leave house (Falvo, 2009). Encourage abstinence from alcohol. may lead to Patient ID: J. H., 58 y/o, Male History of ETOH abuse. Medical Dx: Alcoholic Cirrhosis "Cirrhosis is a chronic progressive disease of the liver characterized by extensive degeneration and destruction of the liver parenchymal cells" (Lewis, Heitkemper, & Dirksen, 2000, p. 1203)., Patient ID: J. H., 58 y/o, Male History of ETOH abuse. Medical Dx: Alcoholic Cirrhosis "Cirrhosis is a chronic progressive disease of the liver characterized by extensive degeneration and destruction of the liver parenchymal cells" (Lewis, Heitkemper, & Dirksen, 2000, p. 1203). may contribute to Problem: Pruritis Pruritis occurs when bile salts accumulate under the skin as a result of obstructive jaundice (Lewis, Heitkemper, & Dirksen, 2000). ND: Impaired skin integrity, risk for Data: Subjective: Client states he "itches all over." Objective: Areas of excoriation noted. Meds: Benadryl Interventions: Administer Benadryl to relieve itching, provide diversions and distractions to assist patient in coping with discomfort of itching, reposition at least once every 2 hours (Lewis, Heitkemper, & Dirksen, 2000). Encourage abstinence from alcohol. Moisturize skin as needed., Patient ID: J. H., 58 y/o, Male History of ETOH abuse. Medical Dx: Alcoholic Cirrhosis "Cirrhosis is a chronic progressive disease of the liver characterized by extensive degeneration and destruction of the liver parenchymal cells" (Lewis, Heitkemper, & Dirksen, 2000, p. 1203). causes Problem: Hepatic Encephalopathy ND: Risk for injury r/t confusion. Data: Client is confused, is able to only answer simple yes/no questions. Elevated ammonia levels. Meds: Lactulose Interventions: Encourage fluids and give Lactulose to reduce ammonia levels; monitor behavior, speech, mental status, and serum ammonia levels (Lewis, Heitkemper, & Dirksen, 2000)., Patient ID: J. H., 58 y/o, Male History of ETOH abuse. Medical Dx: Alcoholic Cirrhosis "Cirrhosis is a chronic progressive disease of the liver characterized by extensive degeneration and destruction of the liver parenchymal cells" (Lewis, Heitkemper, & Dirksen, 2000, p. 1203). causes Problem: Jaundice Jaundice occurs when liver damage contributes to obstruction of the biliary tract (Lewis, Heitkemper, & Dirksen, 2000). Data: Yellowing of skin and sclera, Lab results Meds: None Interventions: Monitor, encourage patient to refrain from using alcohol., Problem: Hepatic Encephalopathy ND: Risk for injury r/t confusion. Data: Client is confused, is able to only answer simple yes/no questions. Elevated ammonia levels. Meds: Lactulose Interventions: Encourage fluids and give Lactulose to reduce ammonia levels; monitor behavior, speech, mental status, and serum ammonia levels (Lewis, Heitkemper, & Dirksen, 2000). may contribute to Problem: Diarrhea ND: Impaired skin integrity, risk for Data: 3-4 loose stools per day. Monitor electrolyte labs. Meds: None (Laxatives given to reduce ammonia levels). Interventions: Keep skin clean and dry, use barrier creams to prevent skin breakdown. Monitor., Patient ID: J. H., 58 y/o, Male History of ETOH abuse. Medical Dx: Alcoholic Cirrhosis "Cirrhosis is a chronic progressive disease of the liver characterized by extensive degeneration and destruction of the liver parenchymal cells" (Lewis, Heitkemper, & Dirksen, 2000, p. 1203). may lead to Problem: Social Isolation ND: Loneliness, risk for Data: Stays home at all times, unable to leave home. Meds: None Interventions: Evaluate social support system., Problem: Jaundice Jaundice occurs when liver damage contributes to obstruction of the biliary tract (Lewis, Heitkemper, & Dirksen, 2000). Data: Yellowing of skin and sclera, Lab results Meds: None Interventions: Monitor, encourage patient to refrain from using alcohol. will lead to Problem: Pruritis Pruritis occurs when bile salts accumulate under the skin as a result of obstructive jaundice (Lewis, Heitkemper, & Dirksen, 2000). ND: Impaired skin integrity, risk for Data: Subjective: Client states he "itches all over." Objective: Areas of excoriation noted. Meds: Benadryl Interventions: Administer Benadryl to relieve itching, provide diversions and distractions to assist patient in coping with discomfort of itching, reposition at least once every 2 hours (Lewis, Heitkemper, & Dirksen, 2000). Encourage abstinence from alcohol. Moisturize skin as needed.