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The patient with cirrhosis of the liver Scenario: Mr.X was admitted to the hospital with a diagnosis of liver failure. He is awake, but lethargic. His abdomen is distended ( ascites) and his foley catheter has low urinary output, which is tea colored. He is short of breath and the doctor has ordered oxygen via nasal cannula. Mr.X's ammonia level  is high due to liver failure. Lactulose ( po) has been ordered by the doctor.                      THE LIVER The liver is the largest organ in the body. It lies in the right, upper quadrant  of the abdomen. It's functions include: - detoxifies harmful substances and stores glycogen, vitamins and minerals - metabolizes protein and carbohydrates - produces and excretes bile which is used to emulsify fats, turns ammonia    into urea which is excreted by the kidneys - transports bile salts and pigments used in the digestion of food - produces clotting factors like fibrinogen and prothrombin  * Liver failure and its connection to kidney

                                                                                                                Indications for IV Therapy or blood transfusion                                                  There are numerous reasons a patient may require IV therapy. Examples:                                           1) The patient who was involved in a trauma, in the field and unable to                                         take fluids by mouth.                                                                                                         2) The patient who is having surgical intervention and has been ordered                         NPO ( nothing per orally), by the doctor.                                                                   3) The patient who is in Hypovolemic shock in the ER and needs IV fluids                     or a blood transfusion.                                                                                                  4) The patient who has

Myocardial infarction A heart attack is the layman's term for a (MI) myocardial infarction.     It is caused by  a lack of blood supply to the heart muscle. A blood clot  or plaque, may obstruct the flow of blood. This typically occurs in the    patient with CAD (   coronary artery disease) .  Symptoms include:                           chest pain which may radiate to the shoulder and jaw, pressure or                                                             tightness in the chest, anxiety, nausea, vomiting and shortness of breath.                                                                                                              Cardiogenic shock The left ventricle receives its blood supply from the LAD ( left anterior descending) artery. If the flow of blood to the left ventricle is obstructed by a clot or plaque, part  of the heart muscle may die. This lack of blood flow to the left ventricle causes pump failure. Cardiogenic shock may result from pump failure.     

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Chest pain is a very common complaint . It may occur anywhere and anytime, even at rest. It may be related to stress or actual damage to the heart. A patient having a heart attack, may very readily complain of chest pain. Helpful hints: If the patient in your care is complaining of chest pain,   immediate action should be taken to assess the pain. Chest pain may be sharp, severe and stabbing. It may also feel like pressure in the chest or  Like a pair of hands squeezing the chest.  It is important to do a pain assessment on a scale of 1-10 and document results. It is also of note to ask the patient to describe the character  and duration of the pain. Always remember to document all interventions. Follow your Institution's policies, procedures and MD orders for chest pain. Do you know your heart Simple EKG interpretation: The EKG (Electrocardiogram) is a noninvasive, simple diagnostic test. It is  a reflection of  the electrical conduction system of the heart. It consists of 12 lead