Question

Lisa is admitted to your floor with a diagnosis of altered mental status. Her history includes HTN, hyperlipoidemia, early dementia, and alcohol abuse. Her home medications are as follow:

Metoprolol 250 mg PO BID

Ezetimibe (Zetia) 10 mg PO Daily

Donepezil (Aricept) 5 mg PO Daily

At the admission, a provider ordered to continue her home meds and ordering lactulose 10 grams/ 15 mL PO QID

Why do you think the provider ordered lactulose for Lisa?

What would be Lisa's abnormal lab study that lead to ordering of Lactulose?

What are the nursing considerations and additional assessment for Lisa?

Answer 1

1.Altered mental status with history of hypertension, hyperlipidemia, early dementia and alcohol abuse are suggestive of hepatic encephalopathy. Lactulose has been prescribed to improve the mental status. It reduces the entry of ammonia into the portal bloodblood by decreasing the amount of production of urea. It is a non absorbable disaccharide. It changes the acidity in the colon and thereby reducing the amount of absorption of ammonia.

2.The increase in the level of ammonia in the blood is significant of the condition, hepatic encephalopathy. Hence in order to reduce the amount of ammonia in blood lactulose was prescribed. Increaae in the blood ammonia leads to neurologic dysfunction and brain damage.

3.Nursing considerationsconsiderations and additional assessment:

• Assessment of level of consciousness.
• Monitoring for signs of agitation or restlessness.
• Monitoring of vital signs in regular basis.
• Assessment of handwriting as the ammonia level increases , it gets worse.
• Assessment of deep tendon reflexes.
• Regular and daily assessment of serum ammonia level.
• Protein diet monitoring and alteration if there are evidence of impending coma.
• Monitoring of electrolyte imbalance.