nursing case analysis example – Mr smith

Nursing case analysis example – Mr smith

1.Mr. Smith has expressed an interest in complementary and alternative therapies. What complementary therapies might Mr. Smith explore and what are some considerations for Mr. Smith when choosing a complementary therapy?


            Mr. Smith is a terminal ascites and HCC patient and this means that his ascites and tumor are beyond the transplantation level. The average survival for stage 4 HCC patients is less than 3 – 4 months (Kumar & Panda, 2014). The therapy available for end stage HCC patients is only symptomatic and there is no definitive direct treatment of the tumor. In this respect, Mr. Smith is only eligible to the available palliative treatment, which includes psychological support, management of nutrition and pain. Palliative therapy is a strategy that improves the patient’s quality of life and enables the family to cope with the life-threatening disease through the relief and prevention of suffering by way of identifying, assessing and treating sources of pain and other challenges – spiritual, psychosocial and physical. HCC patients, like Mr. Smith, often present multiple symptoms linked to decompensated cirrhosis such as ascites, hepatic encephalopathy, peripheral edema and variceal bleeding (Pinter et al. 2011). The symptom that Mr. Smith was diagnosed with is ascites. It is well documented that unrelieved HCC symptoms have a negative impact on the outcomes of the patient, including mood states, quality of life and functional status. Consequently, understanding this aspect is equally important when providing therapy to end stage HCC patients like Mr. Smith. The recommended therapies for Mr. Smith are pain management therapy, nutrition management, psychosocial needs management as well as the management of symptoms. In addition, the choice of suitable drugs to treat the associated symptoms requires a thorough understanding of the drugs pharmacokinetic as well as their side effect profiles. Worse liver conditions tend to increase the susceptibility of the patient to hemodynamic and pharmacokinetics changes. Mr. Smith’s is a stage 4 ascites patient and therefore his liver condition is worse. This means that if pharmacokinetics are introduced to his body, then the liver conditions are likely to worsen. nursing case analysis example – Mr smith.

  1. Mr. Smith is receiving the following medications: Thiamine, folic acid, and multi vitamins. What are the benefits of these medications with someone who is diagnosed with Cirrhosis?

Liver cirrhosis is a serious disease that demands professional medical attention.  Chronic cirrhosis can damage the liver and affect a patient’s ability to process hormones, medicines and nutrients. Proper vitamin supplementation, including taking medications such as thiamine, multi vitamins and folic acid may help Mr. Smith improve his overall health and also protect his liver from further corrosion. Cirrhotic patients often experience a deficiency in vitamin B1 (Thiamine). Most patients diagnosed with end-stage cirrhosis often manifest thalamic lesions. The causes of thiamine deficiency among end-stage liver patients like Mr. Smith include impaired absorption, loss of hepatic storage of the vitamin as well as reduced dietary intake (Berger & Ford, 2017) nursing case analysis example – Mr smith. Thiamine supplementation is highly encouraged for patients suffering from end-stage cirrhosis of either nonalcoholic or alcoholic etiologies. Mr. Smith is one such patient who is suffering from end-stage liver illness and the uptake of thiamine will help his body offset the existing vitamin deficiency. In addition, folic acid (also known as Vitamin B9), will enable the body of Mr. Smith to form red blood cells and also help his body to prevent neural tube problems. Folic acid is also important since it plays a crucial role in the metabolism of proteins and helps minimize blood homocysteine levels in the body. The damage of the liver reduces the ability of a person to process this vitamin and consequently leads to the deficiency of folic acid in the body. Taking folic acid medications will help Mr. Smith to lower the risk of vitamin B9 deficiency. Further, the presence of multi vitamins in Mr. Smith’s medication is useful since it will be able to offset vitamin deficiency in his body that might have been occasioned by the damage of his liver (Kwarta, Nagle & Welstead, 2014). Conclusively, it has been noted that damaged liver impairs the processing of vitamins and as a result, giving Mr. Smith with folic acid, thiamine and multi vitamins supplement will help him offset vitamin deficiency in his system. nursing case analysis example – Mr smith.

3.Describe the relationship between alcohol intake, cirrhosis and HCC (hepatocellular carcinoma) in relation to Mr. Smith’s case?

Testino, et al. (2015) argues that it is widely acknowledged that one cause of end-stage cirrhosis and HCC is the consumption of alcohol. Prior research conducted on the subject concluded that the most common cause of chronic liver disease and HCC is alcohol – responsible for 32 percent to 45 percent of cirrhosis and HCC. It has been revealed that there is a link between metabolic changes, alcohol intake and hepatitis virus. Alcohol intake could be a factor in the development of hepatocellular carcinoma through direct mechanisms (genotoxic) and indirect means (cirrhosis). The fact that Mr. Smith was diagnosed with HCC and stage 4 ascites can be correctly linked to his 20 year history of consuming alcohol. nursing case analysis example – Mr smith It has been noted that the consumption of alcohol leads to both liver illness as well as HCC. Therefore, it is no surprise that Mr. Smith was diagnosed with the two illnesses. Studies reveal that the consumption of alcohol results in liver damage via exudative stress, inflammation and endotoxins. The range of hepatic injury occasioned by alcohol consumption ranges from biochemical or clinically insignificant damage to fatty liver, alcoholic hepatitis all the way to chronic liver disease. The primary role of the liver is to carry out alcohol metabolism. This means that alcohol has far reaching consequences on the performance of the liver. Similarly, alcohol consumption is linked to certain types of cancer such as head and neck; pharynx, oral cavity, larynx, bowel, esophagus, and obviously, liver. Studies have revealed that alcohol could be a critical initiating factor of cancers by enhancing the expression of certain oncogene or impairing the ability of the cell to fix their DNA and as a result, increasing the possibility that oncogenic mutations will occur (Testino, Leone & Borro, 2014). These reasons provide a clear basis as to why Mr. Smith was diagnosed with both cirrhosis and HCC. nursing case analysis example – Mr smith

Mr. Smith’s friend from his community told him that he should think about organ and or tissue donation upon his death to help out someone in his community. Is Mr. Smith eligible to donate any organs or tissues? Explain your answer.

Organ and tissue donations have become increasingly prevalent in the society today. Terminally ill patients suffering from end-stage cirrhosis and cancer are eligible to donate their organs or tissue to other patients upon their death, but this depends on the patient’s medical condition. Mr. Smith can donate organs such as heart, kidneys, small bowel, pancreas and lungs and tissues such as eyes, heart values tendons and bones to needy patients upon his death (Alberta Health Services, 2016). The reason why Mr. Smith is eligible to donate this body organs and tissues is that the danger of passing on cancer or cirrhosis to the recipient is extremely low. The reason for these low incidences is that the recipients of the organs or tissue are often given medication aimed at suppressing their immune systems and help to curb rejection of the new organ or tissue. nursing case analysis example – Mr smith This enables the immune system to identity and kill the cells containing cancer that may have been mistakenly transplanted with the tissue or organ to the recipient.  However, for patients with actively spreading cancer cells, it is not recommended for them to give out their tissues or organs due to the risk of spreading the cells to the recipient. This means that Mr. Smith can only donate parts of his body organs and tissues if it has been established, beyond reasonable doubt, that the transplant will not endanger the health of the recipient. Upon death, Mr. Smith’s body tissue and organs may be used but careful evaluation of Mr. Smith’s organs and tissues is expected to be carried out upon his death before a decision is made on whether his organ or tissue is medically safe for donation (Accreditation Canada, 2016). nursing case analysis example – Mr smith.



Accreditation Canada (2016). Organ and tissue donation standards for deceased donors. Received from

Alberta Health Services (2016). Organ, tissue, and eye donation. Retrieved from

Berger, S. H., & Ford, R. M. (2017). Alcoholic Liver Disease and Nonalcoholic Fatty Liver Disease. Sitaraman and Friedman’s Essentials of Gastroenterology, 211.

Kumar, M., & Panda, D. (2014). Role of Supportive Care for Terminal Stage Hepatocellular Carcinoma. Journal Of Clinical & Experimental Hepatology, 4S130-S139. nursing case analysis example – Mr smith

Kwarta, E., Nagle, S., & Welstead, L. (2014). Update on malnutrition in liver cirrhosis: assessment and treatment. Current Hepatology Reports, 13(1), 24-34.

Pinter, M., Sieghart, W., Hucke, F., Graziadei, I., Vogel, W., Maieron, A., & … Peck-Radosavljevic, M. (2011). Prognostic factors in patients with advanced hepatocellular carcinoma treated with sorafenib. Alimentary Pharmacology & Therapeutics, 34(8), 949-959.

Testino, G., Leone, S., & Borro, P. (2014). Alcohol and hepatocellular carcinoma: a review and a point of view. World journal of gastroenterology: WJG, 20(43), 15943.

Testino, G., Leone, S., Sumberaz, A., & Borro, P. (2015). Alcohol and Cancer. Alcoholism: Clinical & Experimental Research, 39(11), 2261. nursing case analysis example – Mr smith

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