You are caring for Rona, a 35-year-old female in a hepatic coma. Which evaluation criteria would be the most appropriate?
A. The patient demonstrates an increase in the level of consciousness.
B. The patient exhibits improved skin integrity.
C. The patient experiences no evident signs of bleeding.
D. The patient verbalizes decreased episodes of pain.
Correct Answer: A. The patient demonstrates an increase in the level of consciousness.
Increased level of consciousness indicates resolving of a comatose state. Ongoing assessment of behavior and mental status is important because of the fluctuating nature of impending hepatic coma. Other options are important evaluations but do not evaluate a patient in a hepatic coma who is responding to external stimuli.
Option B: Inspect pressure points and skin surfaces closely and routinely. Gently massage bony prominences or areas of continued stress. Use of emollient lotions and limiting the use of soap for bathing may help. Keep linens dry and free of wrinkles.
Option C: Closely assess for signs and symptoms of GI bleeding: check all secretions for frank or occult blood. Observe color and consistency of stools, NG drainage, or vomitus. The esophagus and rectum are the most usual sources of bleeding because of their mucosal fragility and alterations in hemostasis associated with cirrhosis.
Option D: Use small needles for injections. Apply pressure to small bleeding and venipuncture sites for longer than usual. Minimizes damage to tissues, reducing risk of bleeding and hematoma. Encourage the use of soft toothbrush, electric razor, avoiding straining for stool, vigorous nose blowing, and so forth.
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