Problem 1: Case Overview A 65-year-old man is admitted to the hospital with the diagnosis of cirrhosis of the liver. During the admission assessment, the nurse collects the following data: The patient has been unable to eat secondary to nausea and vomiting for the past 3 days; he has seen moderate amounts of blood twice in the past 24 hours when he vomited; he has noted a slight yellow color to his skin and has had increased itching of the skin for the past 3 weeks; PMH of increased alcohol intake for 20 years. On exam, the following were noted: BP 90/60, p. 110. r. 20 Skin: moderate jaundice with drying and decrease turgor HEENT: sclera is yellow Lungs: clear to auscultation ABD: distended with increased venous markings. BS present. Liver palpable 1 cm below the costal margin EXT: thin, pulses 1+ present and bilateral, capillary refill decreased 1. How does the cirrhosis of the liver cause the jaundice seen in this patient? Explain relating to normal bile production and bilirubin metabolism. 2. On physical examination, the nurse noted abdominal distention. If on exam the distension was found to be fluid in the peritoneal cavity, how could you physiologically explain the relationship between the ascites (fluid in the peritoneal cavity) and his cirrhosis? 3. On the third day of hospitalization, the laboratory calls to tell the nurse the patient has a very high serum ammonia. Knowing how proteins are normally metabolized by the liver, explain why the elevated serum ammonia is concerning. Problem 2: Case Overview A nurse working on a medical–surgical nursing unit is caring for a 65-year-old man who was admitted with the diagnosis of benign prostatic hypertrophy. Before admission, he had complained of difficulty with urination, and in the emergency room, he was catheterized and 1000 cc of clear urine was obtained. Questions 1. Why does a patient with prostatic hypertrophy have urinary retention? 2. What complication of urinary retention should the nurse be concerned about? 3. What are the clinical manifestations of acute prostatitis? The posting addresses each of the questions associated with the particular case discussed using thorough explanations, examples, and clear critical thinking skills. The posting response should contain few grammatical errors. Min 2 sources may use more.

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