Question

Ms. Lula Ashe has been diagnosed with hepatic encephalopathy secondary to cirrhosis. Upon admission to the nursing facility the nurse finds the following: Yellow sclera and skin, multiple bruises, abdominal ascites and 3+ pitting edema of the lower extremities. Ms. Ashe has difficulty answer questions, acts annoyed and irritated when answering questions, and dozed off several times during the interview. The nurse observes Ms. Ashe scratch her arms and her lower legs very often. The following labs were below normal serum albumin, total protein, and potassium. Additional labs were elevated serum bilirubin, ammonia, and prothrombin. Answer the following questions regarding this case.

What data support the diagnosis of cirrhosis?

What data suggest that Ms. Ashe has hepatic encephalopathy?

Why is Ms. Ashe exhibiting pitting edema and abdominal distention?

What medications would the nurse anticipate the physician will order for the hepatic encephalopathy

Answer 1

1)The data that support the diagnosis of cirrhosis are

* Yellow sclera and skin, multiple bruises, abdominal ascites, pitting edema on lower extremities.

*Elevated serum bilirubin, ammonia and prothrombin

2) The data which supports hepatic encephalopathy

* Annoyed and irritable behaviour when answering questions

* Dozed off several time during interview

* Personality changes

* Poor concentration

3)Cirrhosis slow the normal flow of the blood circulating through the liver, thus increasing pressure in the veins that brings pressure to the liver from the intestines and spleen. Leads to swelling in the leg and abdomen. The increased pressure in the portal vein can cause fluid to accumulate in the legs _(ie, edema) and in the abdomen (ie, ascites).

4)The two medicines used often to treat hepatic encephalopathy are lactulose, a synthetic or man-made sugar and certain antibiotics. Some times lactulose and antibiotics use together.