UTI + Cirrhosis +Ascites + Pancytopenia

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UTI + Cirrhosis +Ascites + Pancytopenia
Patient with Cirrhosis and Ascites presents uncomfortable abdominal distention due to fluid
1. Order labs in ED (BMP, CBC,PT/PTT)
2. Order paracentesis by radiologist
Acting as the radiologist, review the results of the labs
Perform paracentesis, write post-procedure orders
1. Place in observation
2. Dx
3. Activity
4. Diet
5. VS
6. Call orders
7. Oxycodone 5mg po q 4h prn moderate pain
8. Acetaminophen 650 mg q 8 hours prn mild pain, headache,
Enter home meds in ORM
1. None at this time. (prescribed, but discontinued by patient)
2. Admission med rec
Unable to discharge after observation, create admission orders with attention to coaggulopathy,
question of bleeding following paracentesis
1. Use General admission orders
2. Indicate Inpt adm
3. Indicate allow natural death code status
4. VTE—assess risks for VTE and order SCDs only and provide reason for no pharmacologic VTE
prophylaxis (coaggulopathy, active bleeding)
5. Regular diet
6. No IVF
7. Order prn meds for pain, sleep, anxiety
8. Daily PT/PTT
9. Hb/Hct q8hours
10. Call orders for SBP >180 or < 90
11. Call orders call MD for drop in Hb > 1gm% in 24 hours
12. Consult Hematology—acquired coaggulopathy. Nursing to call

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Order PT—eval and treat
Order Social worker evaluation –home situation, finances for meds, alcoholism
Patient improves
Using discharge tab, release patient
1. f/u with you in 7 days
2. f/u with family MD in 1-2 weeks
3. Send home on acetaminophen as ordered in hospital. D/c oxycodone, anxiety meds. New
prescription for ambient 10mg @HS disp #10 1 po at HS prn insomnia
Open Health Issues and enter diagnoses:
1. Cirrhosis of liver (chronic)
2. Continued alcohol abuse (chronic)
3. Acquired coaggulopathy (acute)
4. Ascites (acute)
5. Medical noncompliance