The nurse is caring for a 58-year-old client who was admitted to the medical unit with liver cirrhosis and had a blood transfusion and endoscopic procedure for esophageal varices three days ago. The nurse begins to plan for the client's discharge and performs a focused assessment. For each client finding, indicate whether the clinical presentation has improved, is unchanged or worse.

Evaluating progression or improvement in a client with liver cirrhosis who has recently undergone blood transfusion and endoscopic treatment for esophageal varices is vital before discharge. Liver cirrhosis affects fluid balance, vascular pressure, and hematologic status, often leading to ascites, edema, anemia, and hemodynamic instability. Post-procedure and post-transfusion assessment helps determine therapeutic effectiveness and identify ongoing complications such as fluid overload or bleeding risk. Comparing trends in vital signs and laboratory values is essential for clinical judgment. • Temperature: The client’s temperature decreased from 99.2°F to 97.0°C equivalent (36.7°C), indicating resolution of low-grade inflammatory response. This improvement may reflect stabilization following treatment and absence of active infection. A normal temperature trend suggests reduced systemic stress. Therefore, temperature has improved. • Ascites: The client continues to have a markedly distended abdomen with ascites and no noted reduction in fluid accumulation. There is no documentation of decreased abdominal girth or improved fluid balance after interventions. Ascites in cirrhosis is chronic and often slow to respond to therapy. Therefore, the condition remains unchanged. • Blood Pressure: Blood pressure increased from hypotensive levels (98/58 mmHg) to a more stable range (121/73 mmHg). This suggests improved circulatory status, likely due to blood transfusion and medical management. Stabilization of hemodynamics is a positive response in a cirrhotic client with prior low perfusion. Therefore, blood pressure has improved. • Edema: Bilateral lower extremity edema is increased compared to prior assessment. This indicates worsening fluid retention, which is consistent with hypoalbuminemia and portal hypertension. Fluid redistribution and third spacing are common in advanced liver disease. • Hemoglobin: Hemoglobin increased from 10.8 g/dL to 12.1 g/dL following transfusion. This reflects effective correction of anemia and improved oxygen-carrying capacity. Blood transfusion is expected to raise hemoglobin levels in clients with cirrhosis-related anemia or procedural blood loss.