For the purpose of this paper, a 43 year-old female of Aboriginal decent, who is originally from Saskatoon, was interviewed. For confidentiality reasons, the patient will be referred to as A.B. This paper will discuss the admitting diagnosis of A.B., the determinants of health with a focus on income and social status, as well as a reflection on nursing practice.
A.B. sought health care after two weeks of experiencing of fever, chills, coughing, and black tarry stool. The admitting diagnosis was pneumonia and upper gastrointestinal bleed (UGIB). She also has pertinent history of liver cirrhosis and previous UGIBs. The patient’s pneumonia has greatly improved but she remains at risk for hemorrhaging.
Pneumonia is defined as an infection of the lungs by bacteria, viruses, or fungi. As the pathogen evades the body’s defenses, the immune response causes inflammation of the alveoli, which prevents adequate gas exchange. Symptoms of pneumonia observed in A.B. included shortness of breath, coughing, and fever (CLA, 2012). In A.B., this inflammation resulted in pulmonary consolidation, which is the hardening of lung tissue due to increased fibrinous exudate (Mathis, Beckh, Gorg, 2011). The pleural effusion observed in the chest computed tomography might have also resulted from pneumonia and pulmonary hypertension (Twedell, 2009, Alonso, 2010, NIH, 2013).
The other admitting diagnosis was a UGIB, which is hemorrhaging of the upper gastrointestinal (GI) system consists of the esophagus, stomach, and first part of small intestine. Hemorrhage in the upper GI presents as occult blood in stool or frank red blood in vomit. Other indications of UGIB in A.B. are evident in her lab results as hemoglobin and red blood cell (RBC) levels remain low (Medlineplus, 2011). Physicians claimed that A.B.’s condition may be secondary to Mallory Weiss tears, which are lesions in the esophagus. These tears may be caused by pressure enforced on the upper GI due to vomiting (Medlineplus, 2012a). In A.B.’s scenario, portal hypertension due to liver cirrhosis could also have applied pressure to internal organs and caused UGIB. Furthermore, liver cirrhosis plays a major role in the patient’s hemorrhage risk factors since the liver is not able to produce clotting factors needed for coagulation and cessation of bleeding, which reflects her high international normalized ratio (INR) value (Bosch, Abraldes, Berzigotti, Garcia-Pagan, 2008)
The patient’s liver cirrhosis was most likely due to alcohol abuse. Liver cirrhosis occurs when more than 80 percent of the liver has been damaged and abnormal fibrogenesis and scar formation has destroyed hepatocytes. Evidence of liver cirrhosis is present in A.B.’s elevated liver function tests such as ALT, AST, GGT, and haptoglobin (Schuppan & Afdhal, 2008). As liver damage progresses, portal hypertension and lack of albumin production cause ascites, the accumulation of fluid in the peritoneal cavity (Medlineplus, 2012b). The lack of albumin...