Describe the nursing management of a patient with hepatic encephalopathy
What will be an ideal response?
Suggested response: Hepatic encephalopathy occurs as a result of liver dysfunction, in this case alcoholic liver disease, or when there is decreased hepatic perfusion. When the liver cannot metabolise substances such as ammonia (produced when protein is digested), these toxins build up. Hepatic encephalopathy is more likely in the patient who is dehydrated, where there are electrolyte abnormalities (as in this case study), bleeding, infection, renal dysfunction and hypoxia. Dietary protein should be restricted, at least initially, to prevent increased levels of ammonia in the blood. In this case study the patient was receiving minimal nutrition support so dietary protein would not have been an issue. Nurses should be aware of the effects of sedatives and narcotics in prolonged liver disease as these can worsen hepatic encephalopathy. Sedation should be avoided and short-acting agents, such as propofol, used. Lactulose is usually given to acidify the colon and encourage diffusion of ammonia from the blood into the gut. Lactulose also encourages expulsion of ammonia ions.
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What will be an ideal response?