Davao Doctors College, Inc.

College of Allied Health Sciences

Nursing Program

NRG304: CARE OF CLIENTS WITH PROBLEMS IN NUTRITION, AND

GASTROINTESTINAL, METABOLISM AND ENDOCRINE, PERCEPTION AND
COORDINATION (ACUTE & CHRONIC)
Learning Medical-Surgical Nursing One Case Analysis at a Time!

Message from your Course Instructor

Hello! I am SHAINA KEI C. WATANABE, and I will be your
clinical instructor for NRG304: CARE OF CLIENTS WITH
PROBLEMS IN GASTROINTESTINAL, NUTRITION,
METABOLISM AND AND ENDOCRINE, PERCEPTION
AND COORDINATION (ACUTE & CHRONIC) Before we
begin, allow me to introduce myself. I am Shaina, a faculty
member of the Nursing Program of Davao Doctors College,
Inc. I garnered by BS Nursing degree from this institution in
2019 and my Master of Arts in Nursing degree in 2022. I am
looking forward to guiding you in learning this course well.
If you want to reach me for any academic-related concerns,
you can do so through the following:

Contact No: Available upon request

Facebook account: Shaina Kei Watanabe
E-mail address: [email protected]
Consultation hours: MTW, 7:00AM – 3:00PM

Introduction to the Course

The course NRG304 with concepts, principles, theories and techniques of nursing care of at-risk
and sick adult clients in any setting with alterations / problems in nutrition, and gastro-intestinal,
metabolism and endocrine, perception and rehabilitation. The learners are expected to provide
safe, appropriate and holistic nursing care to at-risk and sick adult clients utilizing the nursing
process. Presented below are the specific details of this course:

Course Number: NRG 304

Course Credits 9 units (5 units Lecture, 4 units RLE)

Placement: Third year, Second Semester

Prerequisite: NRG 301

Schedule: MTW

Classroom: Quipper Classroom Code:

Requirements in Completing the RLE Activities

Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

Since most of our sessions for this semester will be delivered through distance learning activities,
the submissions will also be primarily done online. To do this, you need to have access to the
following applications:

1. Microsoft Office/Google Docs

2. Microsoft PowerPoint/Google Slides
3. Quipper
4. Google Meet
5. Internet connectivity

Please expect that you might need to print some parts of the worksheets in this module (i.e.,
documentation and transcribing parts). If any difficulties in participating in synchronous classes
are encountered, inform your instructor right away! For absences, secure an excuse slip from
your RLE supervisor.

Submissions must be submitted through the Learning Management System (LMS) so that it
will be traced and secured easily.

Daily Activities
Every week, you are expected to follow through the following deliverables:

Day 1 (Monday/Thursday) Day 2 (Tuesday/Friday) Day 3 (Wednesday/Saturday)

Virtual Circle Virtual Circle Virtual Circle

Completion of Module, to be Receiving of Handover Case Presentation (cont.)

submitted within the day
Case Presentation Weekly Quiz and Discussion of
Preparation of PPT Module and Quiz Answers
Presentation
Orientation of Next Week’s Activity

Now that you are done acquainting yourself with the instructor and the course itself, please
proceed to Module 1: Care of Clients with Liver Cirrhosis.
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

1:

Term: Second Semester S.Y. 2024-2025

Dates: Week 7 – February 24-26, 2025
Class Schedule: MTW: 7:00 AM – 3:00 PM
No. of Hours: 8 HRS/DAY
Instructions
The case analysis manuscript may be handwritten or computer written. Observe pagination.
Once done, send the compilation of your group’s answers to your clinical instructor.

After the submission, prepare a PPT presentation for your case presentation slated for Days 2
and 3 of your RLE classes. Each member of the group is expected to present during the case
presentations.

Learning Outcomes
At the end of this module, you are expected to:
1. Utilize the nursing process in the care of client with problems in Liver Cirrhosis.
2. Perform a comprehensive health history and assessment based on the case scenario
presented.
3. Utilize assessment information to formulate a patient-centered plan of care.
4. Discuss the therapeutics done for the simulated patient.
5. Explain appropriate nursing interventions per problems identified.
6. Document the care rendered to assigned patient in the simulated health care record
accurately.

As you start with this module, you are free to consult and coordinate with your assigned clinical
instructor. Be sure to get his/her email address and contact number for collaboration and
assistance. Just keep going, you can do it!
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

Case Scenario: Patient with Liver Cirrhosis

Course in the Ward:

Mr. Nam Kyung Jin, a 68-year-old, male and a resident of Barangay 59 Davao City
was admitted to Davao Doctors Hospital due to abdominal distention, bilateral pedal
edema, shortness of breath and loss of appetite. He also claims he feels nauseated and
complains of fullness of his abdomen accompanied by mild abdominal pain.
The patient had been a former soldier. A heavy cigarette smoker for 40 years and claimed
he was an alcoholic beverage drinker at least 4-5 days a week. Five years earlier, the
patient was diagnosed with Hypertension and administered Amlodipine 10 mg 1 tablet
daily but did not follow his regimen diligently due to financial constraints.
In the interviews conducted with the patient, Andre stated the following:
“Nagsimulang lumaki ang tiyan ko nung February 2 pa ata at mga ilang araw makalipas
ay namanas ang dalawa kong paa. Sumasakit din yung tiyan ko dito sa bandang kanan
sa tagiliran. Mga nasa 6-7 out of 10 ang tindi ng sakit. Medyo nahihirapan akong huminga
nang dahil dito sa lumalaki kong tiyan. Hindi rin ako makatulog ng maayos sa gabi. Wala
din akong ganang kumain dahil parati akong naduduwal. Lugaw nalang ang aking
kinakain, kaso nasa dalawa o tatlong kutsara lang ang kaya kong maubos sa isang araw.
Medyo lumiit nga pangangatawan ko kumpara nung makalipas na linggo. Mula sa 60kgs
na timbang ko noong nakaraang linggo, ay nasa 55kgs nalang ako ngayon.

Sinabihan na ako ng doktor ko noon na tigilan kona ang aking paninigarilyo, kaso nga
lang ay tuloy parin ang nakagawian kong paninigarilyo at nasa isang kaha ng sigarilyo
ang nauubos ko sa loob ng isang araw. Umiinom parin ako ng alak ngayon dahil parati
akong iniimbita ng aking kabitbahay. Minsa’y ako lang mag-isa na nagtatagay sa bahay
kung wala akong ibang ginagawa.

Puno ng pagod ang pakiramdaman ko sa aking katawan, ni di ko narin gusto gumalaw-

galaw. Parati lang akong nakahiga dahil lumalala yung paghingal ko sa tuwing ako’y
lumalakad. Napagmasdan ko rin na hindi na araw-araw ang aking pagbabawas, aabutin
pa ng tatlong araw bago ako makapag bawas. Lubha naring naninilaw ang aking mga
mata at balat, at kakaunti nalang rin ang iniihi ko, kung kayat ay nagpa admit nalang
ako”.
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

Physical Examination:
Vital signs: Temperature- 37.5oC; BP- 140/90 mmHg; RR-23 cpm; PR- 95 bpm; Weight- 55kgs.

EYES: Pale palpebral conjunctivas; yellowish sclera; PERRLA.

EARS: Tympanic membranes clear; canals clear bilaterally.

SKIN: Yellowish discoloration; (+) small dilated blood vessels with a bright red centerpoint and

spider-like branches in nose, cheeks and upper trunk, (+) pruritus at right and left arm.

NARES: Paryngeal mucous pink and moist.

THROAT: Thyroid normal in size; no tonsillar enlargement, lymphadenopathy, or nodularity.

CARDIAC: Regular rate and rhythm; no murmurs, rubs, or gallops.

LUNGS: Breath sounds are heard in all areas of the lungs, no rhonchi, wheezing sound.

ABDOMEN: Abdominal girth-33 inches; distended abdomen, (+) tenderness in right upper quadrant.

MUSCULOSKELETAL: Muscle strenght 5/5 upper and lower extremities, full range of motion.

NEURO: 5/5 motor strength; GCS-15; deep tendon reflexes intact billaterally, sensation intact.
 Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

DDC-0002 Nam Kyung Jin 1/6/1952 405B Dr. MIRANDA None

February 9, 2025 ➢ Please admit under the service of Dr. Miranda.

9:45 AM ➢ Secure consent to care.
➢ LSLF diet
(+) bilateral pedal edema ➢ VS q 4h
(+) spider angioma ➢ IVF: PNSS 1L @ KVO rate
(+) jaundice ➢ Labs: CBC, U/A, FBS, BUA, BUN, S. CREA, SODIUM,
(+) mild abdominal pain POTASSIUM, PT, PTT, INR, FIBRINOGEN, HEPATIC
(-) BM for 4 days PANEL, ECG-12 LEADS, CXR-PA

Initial V/S: ➢ Meds:

T- 37.5oC 1. lactulose (Duphalac) 30 cc OD at HS.
P- 95 bpm 2. spironolactone (Aldactone) 25 mg, 1 tab OD.
R- 23 cpm 3. furosemide (Lasix) 40 mg IVTT q 12 hrs with
BP- 140/90 mmHg BP precaution.
O2 Sat: 96% 4. tramadol (Tramal) 50 mg IVTT q12 PRN for
pain.
5. diphenhydramine (Benadryl) 2% cream, apply
to the affected area BID.
6. losartan (Doxar) 50 mg, 1 tab OD at AM.
7. amlodipine (Norvasc) 5 mg, 1 tab OD
at PM.
8. lansoprazole (Prevacid) 30 mg, 1 cap BID.
9. ferrous sulfate (Feosol)1 tab OD at AM.
10. phospholipids (Essentiale Forte) 300 mg,
1 cap BID.
➢ I & O q shift.
➢ WOF unusualities.
➢ Daily abdominal girth measurement.

J.BETINOL, RN Dr. Miranda

PRC Lic.No.:0856807
 Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

DDC-0002 Nam Kyung Jin 1/6/1952 405B Dr. Miranda None

➢ Increase furosemide (Lasix) to 40mg IVTT q

February 9, 2025
8 hrs with BP precaution (Hold if SBP ≤ 100
12:40 PM
mmHg).
➢ Increase spironolactone (Aldactone) to
(+) Ascites
25mg/tab, 1 tab BID.
➢ Ceftazidime (Zeptrigen) 1g IV q8 hrs.
➢ V/S q4 hrs.
➢ I & O q shift.

J.BETINOL, RN / Dr. Miranda

PRC Lic.No.:0856807

➢ For CT-scan with contrast of whole abdomen.

February 10, 2025 ➢ For HBsAg.
1:30 PM ➢ For Ultrasound of the whole abdomen with
marking for paracentesis.
➢ Shift IV to heplock.
➢ For possible paracentesis.

J.BETINOL, RN / Dr. Miranda

PRC Lic.No.:0856807

A. NGO, RN DR. KULINTANG

 Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

DDC-0002 Nose,
DDC-1234 Nam Kyung
DonitaJin 1/6/1952
1/30/1969 405B 404B Dr. Miranda
Dr. Kulintang None
None

February 11, 2025 ➢➢ For

Forwhole
wholeabdomen
abdomenCT-Scan
CT-Scanas asOPD.
OPD
9:30 AM
February 11, 2022 ➢➢ Paracentesis done.
Paracentesis done
➢➢ Diagnostics:
Diagnostics:
- Vial 1: Gram Stain.
- Bottle 1: GS/CS
- Vial 2: Cell count, Total Protein, Albumin.
- Bottle 2: Sugar, Albumin
- Vial 3: Culture & Sensitivity.
- Bottle 3: Cell differential, cell count
- Vial 4: Cytology.
➢ Apply abdominal binder
➢ Apply abdominal binder.
➢ Decrease Furosemide to 20mg, IVTTq8 hrs
➢ Decrease Furosemide to 20mg IVTT q8 hrs.
➢ Vitamin K 10mg, IVTT q8 hrs x 3 doses
➢ Vit. K (Phytomenadione)10mg IVTT q8 hrs x
➢ Continue current management
3 doses.
➢ WOF: bleeding & hypotension
➢ Continue current management.
➢ Refer accordingly
➢ WOF: bleeding & hypotension.
➢ Transfer back to ward
➢ Refer accordingly.
➢ Transfer back to ward.
M.A.C. MALALA, RN Dr. Dumaguit

J BETINOL, RN / Dr. Miranda

PRC Lic.No.:0856807
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

Laboratory Results
*CBC: February 9, 2025 @ 1:00 PM
COMPLETE BLOOD COUNT Reference Range
WITH DIFFERENTIAL
Male Female

White Blood Cell (WBC) 11,700 4,500 - 10,000 K/uL

Segmented neutrophils (%) 76 54 – 62%

Band forms (%) 4 3 - 5 (>8% indicates L shift)

Basophils (%) 0.75 0 – 1% 0 - 0.75%

Eosinophils (%) 2 0 – 3% 1 – 3%

Lymphocytes (%) 18 24 – 44% 25 – 33%

Monocytes (%) 8 3 – 6% 3 – 7%

Hemoglobin (HGB) 8.5 13.5 - 16.5 g/dL 12.0 - 15.0

g/dL
Hematocrit (HCT) 25.5 41 – 50% 36 – 44%

Red blood cell (RBC) 3.6 4.5 - 5.5 M/uL 4.0 - 4.9
M/uL
MCV 92 80 – 100 fL

MCH 32 26 – 34 pg

MCHC 34 31 – 37 g/dL

Platelet 420,000 100,000 - 450,000 K/uL

*COAGULATION PROFILE: February 9, 2025 @ 1:00 PM

COAGULATION PROFILE Reference Range

Partial thromboplastin time (PTT) 45 30 – 45 sec

Prothrombin time (PT) 16 10 – 12 sec

International Normalized Ratio (INR) 3 1-2

Fibrinogen 167 170 – 420 mg/dL

Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

*Basic Metabolic Panel: February 10, 2025 @ 9:00 AM

BASIC METABOLIC PANEL Reference Range

Sodium 141 135-147 mmol/L

Potassium 4.5 3.5-5.2 mmol/L

Blood Uric Acid 5.4 2.4-5.7 mg/dL

Blood Urea Nitrogen (BUN) 36 7-20 mg/dL

Creatinine 1.4 0.5-1.2 mg/dL

Glucose-FBS 86 60-110 mg/dL

*Hepatic Panel: February 10, 2025 @ 9:00 AM

HEPATIC PANEL Reference Range

Age 25-60 Age >61
Albumin 2.0 3.5 – 5.0 g/dL
Alkaline Phosphatase 180 33 – 131 IU/L 51 – 153 IU/L
Aspartate Aminotransferase 60 15-50 IU/L
/SGOT
Alanine Aminotransferase /SGPT 70 6-50 IU/L
T. Bilirubin 3.1 0.1 – 1.2 mg/dL
D. Bilirubin 2.2 0 – 0.3 mg/dL
Total Protein 4.5 6.3 – 8.5 g/dL
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

*Urinalysis: February 9, 2025 @ 11:00 AM

Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

*Chest X-ray: February 9, 2025 @ 12:00 NN

Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

*ECG-12 Leads: February 10, 2025 @ 8:00 AM

Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

*HBsAg Test: February 11, 2025 @ 10:00 AM

*Ultrasound of Whole Abdomen Results: February 11, 2025 @ 10:00 AM

Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

What to Do?
To immerse yourself in the care management of your patient, let us do some detailed description
of your patient care tasks. Using the Case Scenario assigned to you, you are expected to perform
the following:

1. Fill-up the needed data based on the given scenario/case.

2. Conduct a history taking and physical assessment of your patient. Discuss the health
history of the patient narratively, in chronological order as much as possible. Use the DDC
Health Assessment form for documenting PA findings.
3. Discuss the pathophysiology of the patient’s condition. Discuss the FF: definition of
diagnosis, etiology, symptomatology, schematic diagram of the pathophysiology of the
condition of the patient, narrative description of the condition of the patient.
4. Interpret the therapeutics done for the patient: doctor’s orders, laboratory and
diagnostic tests done, and surgical procedures to be performed. Use format presented.
5. Present your drug study and IVF data. One drug study per student. Transcribe the
IVF and medications in the appropriate sheets.
6. Formulate a patient-centered care plan for your patient. Integrate in your care
intervention significant bioethical and legal standards of patient care. One NCP per
student.
7. Document the care given by making a nurse documentation following the FDAR format.
8. Clinical Reasoning Questions - Collaboration: In one of your clinical tasks, you found
that the Nurse was administering Alaxan FR to a patient diagnosed with Liver Cirrhosis. When
you asked the nurse why this was prescribed by the doctor, the nurse said that it is the pain
reliever of the patient for a very long time. You found while consulting the chart with your
clinical instructor that the doctor clearly instructed not to give all forms of NSAID medicines.
You are asked by your clinical instructor to refer the matter to the staff nurse. Using C-U-S as
an assertive technique, what would you tell the staff nurse? Answer narratively

9. Clinical Reasoning Questions - Ethico-Moral-Legal: Dr. Abravelo ordered the

patient diagnosed with Liver Cirrhosis to undergo liver function tests such as HCV, HBSAG,
SGPT and SGOT and scheduled him for initial care with dialysis. The patient, however,
was not entirely persuaded of the procedure and verbalized that he could be treated
favorably with natural remedies like herbal medicines that he heard on TV and radio.
Davao Doctors College, Inc.
College of Allied Health Sciences
Nursing Program

What would be your nursing action in this scenario? What ethical principle is applicable in
this scenario? Justify? Answer narratively.

Have you answered all of the questions above? Great! Congratulations! You have
completed this module. You may now proceed to the next activity for the week. Please wait for
further instructions from you instructor

References:
Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erb’s fundamentals of nursing: Concepts,
process, and practice (10th ed.). Pearson Education, Inc.

Hinkle, J. & Cheever, K. (2018). Brunner and Suddarth’s textbook of medical-surgical nursing
(14th ed.). Wolters Kluwer