For a client in hepatic coma, which outcome would be the most appropriate?
A. The client is oriented to time, place, and person.
B. The client exhibits no ecchymotic areas.
C. The client increases oral intake to 2,000 calories/day.
D. The client exhibits increased serum albumin level.
Correct Answer: A. The client is oriented to time, place, and person.
Hepatic coma is the most advanced stage of hepatic encephalopathy. As hepatic coma resolves, improvement in the client’s level of consciousness occurs. The client should be able to express orientation to time, place, and person. Throughout the intermediate stages, patients tend to experience worsening levels of confusion, lethargy, and personality changes.
Option B: Ecchymotic areas are related to decreased synthesis of clotting factors. In order to make a diagnosis of hepatic encephalopathy, there must be confirmed the presence of liver disease (e.g., abnormal liver function tests, ultrasound or liver biopsy demonstrating liver disease) or a portosystemic shunt, and exclusion of other potential etiologies (e.g., intracranial lesions, masses, hemorrhage or stroke; seizure activity; post-seizure encephalopathy; intracranial infections; or toxic encephalopathy from other causes).
Option C: Although oral intake may be related to the level of consciousness, it is more closely related to anorexia. Triggers of hepatic encephalopathy include renal failure, gastrointestinal bleeding (e.g., esophageal varices), constipation, infection, medication non-compliance, excessive dietary protein intake, dehydration (e.g., fluid restriction, diuretics, diarrhea, vomiting, excessive paracentesis), electrolyte imbalance, consumption of alcohol, or consumption of certain sedatives, analgesics or diuretics all in the setting of chronic liver disease.
Option D: The serum albumin level reflects hepatic synthetic ability, not level of consciousness. Elevated blood ammonia levels are often seen in patients with hepatic encephalopathy. It is more useful, however, to assess the clinical improvement or deterioration of a patient undergoing treatment rather than monitor serial arterial blood ammonia measurements.
No comments:
Post a Comment