A 45-year-old client with a history of alcoholic cirrhosis is admitted to the medical-surgical unit with an acute exacerbation of hepatic encephalopathy, presenting with significantly altered mental status (Glasgow Coma Scale score 10) and asterixis. Serum ammonia level is 150 μmol/L (normal: 11-35 μmol/L). When reviewing the newly prescribed treatment plan, which intervention should the nurse prioritize to facilitate the client's recovery?

Hepatic encephalopathy is a serious complication of cirrhosis caused by elevated ammonia levels. Lactulose is the first-line treatment as it reduces ammonia absorption and promotes its elimination through the bowel. Lactulose acidifies the colon, converting ammonia (NH3) to ammonium (NH4+), which is not absorbed and excreted in stool, while also acting as an osmotic laxative. Administering lactulose as prescribed is the priority to directly address the underlying cause and prevent progression to coma.

- Option 2 (Encourage a high-protein diet): High protein intake can increase ammonia production from gut bacteria, worsening encephalopathy; a low-protein diet is typically recommended initially.
- Option 3 (Increase fluid intake): While hydration is important, overhydration can exacerbate dilutional hyponatremia in cirrhotic patients; fluid restriction may be needed instead.
- Option 4 (Administer sedatives): Sedatives can depress the central nervous system, masking neurological symptoms and increasing risk of aspiration or respiratory depression in patients with altered mental status.