Question

Mandy Adams is a 45-year-old woman who was brought to the emergency room (ER) by her family because she seemed disoriented and confused. She has a chronic history of drinking alcohol but has been able to maintain a job at UPS for the past 22 years. On presentation to the ER, Ms. Adams is confused, she does not seem to know where she is, or how she got there. Possible diagnosis hepatic encephalopathy

1. What medical care will be ordered for Ms. Adams? Please include ongoing diagnostic testing, lab work and treatment options.

2. What outcomes measures will indicate positive medical response?

3. What is the focus of nursing care for Ms. Adams? Please address the significant problems identified including the use of holistic care measures.

4. What are the areas for patient education?

Answer 1

1) Medical treatment include

• Antibiotics
• Lactulose so that ammonia will come out from the body and prevent to absorb toxins in blood.
• Diuretics
• Vitamin therapy

Diagnostic test -

• CT scan
• MRI (magnetic resonance imaging)

Lab work

• CBC(complete blood count )
• Liver enzymes (asparate aminotransferase ,alanine aminotransferase , alkaline phosphate ,gamma glutamyl transaminases.
• Albumin level
• Check prothrombin time .
• Ammonia level

Diet

• Low protein diet.
• High carbohydrate and moderate fat diet
• Low sodium
• Vitamin,minerals and electrolytes supplements.

2) Measures will indicate positive outcomes are the following:-

1. Protein reduced .
2. Ammonia level decrease ,when liver able to convert ammonia to urea.
3. Remains free from further complications .
4. Decrease level of liver enzymes ,comes at normal
5. Mr Adams become orientated .
6. Follows dietary regimen.

3) Hepatic encephalopathy is a reversible condition with proper treatment and diet . So as a nurse need to observe for bleeding as well as monitor liver function studies,complete blood count and renal function studies .Renal dysfunction is the complication of hepatic encephalopathy.Provide special skin care and trim nails because pruritis is associated with ammonia high Concentration and jaundice . Monitor Intake and output chart as well .Provide diet as mentioned above.

• 4) Repeat instructions to the client as well as his family about diet , treatments , tests etc.
• To maintaining fluid balance also helps to balancing the electrolytes levels in blood .
• Give explanation about the complication like kideny failure ,organ failure and so on .
• Avoid alcoholic habits
• Weighing daily
• Explain the importance of personal hygiene to avoid further complications.