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

Provider ordered lactulose for Lisa because she was admitted with the diagnosis of altered mental status and also she is an alcoholic.

Lactulose is a drug that given to Patients to prevent complications of liver disease. This is given in case of hepatic encephalopathy. This drugs doesn't cure the problem but it help to improve the mental status of the patient. This drug act as a colonic acidifier and decrease the amount of ammonia in the blood. If this drug is administered rectally we get the result that is, improvement in mental status occur in two hours. If it is taken through mouth then it may take 24-48 hours.

Lab study may show abnormal serum ammonia levels. So the provider ordered lactulose for Lisa. Lisa has an altered mental status at the time of admission and also she is an alcoholic. In hepatic encephalopathy, ammonia builds up in the circulation and reaches the brain. It causes confusion, disorientation, coma and even death. High ammonia levels are also seen in kidney failure, genetic disorders etc.

Nursing consideration and assessment include:-

*assess the patient for abdominal distension, presence bowel sounds, normal bowel function.

* assess the mental status of the patient.

* monitor serum ammonia levels regularly.

*monitor serum glucose levels.

*in hepatic encephalopathy adjust the dose of drug if the patient is having 2_3 soft bowel movements per day.

*mix lactulose with water or juice, if the drug is talking orally.

*administer the drug in an empty stomach.

*obsreve the patient for any side effects.