Bob, a 79-year-old man with end-stage liver disease from a history of alcoholism, was hospitalized for GI bleeding likely caused by esophageal varices. Upon examining Bob, the advance practice nurse noticed asterixis, a sign of hepatic encephalopathy indicating worsening of his liver condition. Common emergencies in end-stage liver failure include GI bleeding, spontaneous bacterial peritonitis, hepatic coma, and renal failure. Assessment for alcohol-related cirrhosis involves checking for stigmata of liver disease and a history of alcohol use.

1. Case study;
Case study;Bob was a 79 year old father of three adult children who was dying of end stage
liver disease. He had been a lifelong alcoholic even though he stopped drinking for a period
of 7 years following an acute episode of his alcoholic cirrhosis. Bob and his wife have retired
in Florida. Bob was hospitalized with acute onset of GI bleeding no doubt from esophageal
varices. Bob’ s wife was very attentive visiting him daily. His three children lived in
Northern states but came to visit during this hospitalization. Bob was not an outwardly
religious guy but had an underlying spirituality that was fairly strong. You are the advance
practice palliative care nurse covering for the weekend. When you receive the consult for
advance care planning in this case, you wondered what directions his care might have to
take. Upon entry to his room you see his youngest daughter who is a nurse and his wife
sitting at the bedside. Bob is agitated and argumentative with his family. What concerns
have you identified? Upon physical exam you detect asterixis. What are the implications of
this symptom? What are four common emergencies in end stage liver failure? What are
some of the ways to assess for alcohol related cirrhosis? ORDER THIS ESSAY HERE NOW
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