A nursing care plan allows a nurse to identify the most pressing concerns for a client, develop nursing interventions and evaluate them. This report details a nursing care plan for a client with liver cirrhosis presenting with unresolved chronic sciatic pain. My client D.R was a gentleman who presented with this disease. He is 75 years old and quite sharp for his age. He reports that prior to his liver disease and resulting ascites over two years ago, he enjoyed good health with no complications
D.R. is a 75-year-old male who presented to the hospital with an alpha pump infection, related to an electric pump inside his abdomen which removes ascitic fluid and directs it through the urine. Urinalysis showed E.faecalis in his urine. Previous health history included chronic liver disease and liver cirrhosis related to excessive alcohol consumption, sciatica, and tonsil removal. Upon doing the head to toe assessment (for more information on assessments, see Appendix A) client reported pain in the back that shoots down his left leg. He rated it 0 at rest and 9/10 on a 0-10 scale when he moves. I then performed the PQRSTUAA pain assessment for his pain. He informed me that he had it checked out about seven months ago and was told it was sciatic pain. He was recommended stretching and being active to relieve the pain. He informed me that the ascites limits his movement and prevents him from being as active as he was before, so it is difficult to exercise on his own. He also stated that he tried a heating pad, but it didn’t help in alleviating the pain. In terms of exercises, he told me that he tried them a few times and they reduced the pain for a couple minutes but then it returned, he stated that they were a bit difficult to do consistently. He described the pain as a “sharp zap down his leg to his foot”, he also stated that sometimes it feels worse when he sits so he lies back down to alleviate it. He said he feels it when he changes position such as when he sits up from lying down and when he starts walking.
From my assessments and the information I gathered from conversations with D.R. I found that relieving his pain was a priority. It was his ninth day in the hospital when I was taking care of him in my first shift of the week on Thursday. His infection was clearing with the antibiotics (see Appendix C for more information) as evidenced by blood work and clearing of his urine (it was not as cloudy, more yellowish in color, and free from the bacteria). He had no other problems besides the liver damage, nerve pain and minor skin injuries. Besides the wounds on his elbow, lower back and foot, there were red spots on his arms due to bruising from his IVs and blood tests related to his liver disease which affects clotting factors and thereby thinning his blood which pooled under his skin (Lackner & Tiniakos, 2018). Other than this, his skin was free from impairment. His heart, lung and bowel sounds were normal. He had no swelling in his legs, but according to his progress notes, he had edema in his legs and feet when he was admitted but that resolved and was not apparent when I was taking care of him. His focused neuro assessments did not display anything concerning. He was alert and oriented to person, place and time, his eyes were PERRLA and he displayed equal strength in his extremities. He had good cognitive and social functioning (see Appendix A). Potential problems included increased risk of infection due to impaired liver function and ascites, impaired skin integrity and potentially; increased risk of bleeding due to liver damage.
The main problems identified were his nerve pain and skin impairment (for more information see Appendix B). His infection was responding to treatment and his ascites (which was one of the main symptoms of his liver cirrhosis) was in control. His nerve pain was immobilizing him, affecting his movement, blood circulation and skin health. The skin impairment he had was mild but had the potential to become worse. Skin health is important as skin is one of the first defenses against infection. It is a physical barrier against pathogens. Due to his age (75) he is already at risk for skin impairment due to age related changes in skin elasticity and decreased turgor (Haydont, Bernard & Fontunel, 2019).
The nursing diagnosis I formulated was: Increased pain related to the sciatic nerve as evidenced by lower back pain, pain that’s worse when sitting and shooting pain down left leg while walking, fatigue, facial grimace upon change in movement, and guarding of left leg.
Planning and Implementation
Taking into consideration that his pain was limiting his movement and was affecting his ability to walk and be active, I prioritized treating his pain before the impaired skin integrity. Resolving his pain would improve his quality of life and prevent him from being bedbound. Alleviating his pain was a priority over providing wound care as it would increase his mobility and willingness to ambulate thereby decreasing his chances of incurring another pressure wound, decreasing his risk of disuse atrophy of his muscles and enable the pressure injury to heal. As when muscle is not used it shrinks in size and becomes fat. More importantly, it was a personal concern of the patient, he wanted a relief from the nerve pain that he’s been having, which seemed to become worse after he came to the hospital. He was tired of staying in bed all day.