A patient with cirrhosis and grade 2 hepatic encephalopathy has been started on lactulose. Which nursing actions reflect appropriate management of this patient? Select all that apply.
Select All That Apply
Choose your responses, then check the answer.
Explanation
Hepatic encephalopathy management with lactulose targets 2 to 3 soft stools daily — too much causes hypokalemia and dehydration. Frequent neurologic assessment, ammonia and K+ monitoring, and reorientation are core nursing care. Choice 4 is wrong: current AASLD/EASL guidelines recommend a normal-protein diet (1.2 to 1.5 g/kg/day) — severe protein restriction worsens muscle wasting and outcomes; only transient short-term restriction is occasionally used.
Lactulose works by acidifying the gut and trapping NH4+ for excretion; over-titration causes the very K+ losses that worsen encephalopathy. The "no protein restriction" rule is one of the highest-yield NCLEX traps — older textbooks teach the opposite of current evidence.
Cirrhotic patient admitted with grade 2 hepatic encephalopathy (drowsy, asterixis present, mild disorientation). Provider has ordered lactulose titrated to therapeutic effect along with supportive care.
Hepatic encephalopathy — Reversible neuropsychiatric syndrome of cirrhosis driven by gut-derived ammonia bypassing the failing liver.
Asterixis — Flapping tremor of dorsiflexed hands; classic clinical marker of encephalopathy grade 2.
Lactulose titration — Adjust dose to 2 to 3 soft stools per day; over-titration causes hypokalemia and worsens encephalopathy.