A nurse is caring for a 52-year-old client with hepatitis B who is experiencing fatigue and jaundice. Which nursing intervention is the priority to ensure client safety?

Hepatitis B can lead to hepatic encephalopathy, causing confusion and increased fall risk, making fall precautions and neurological monitoring the priority safety measure. Encouraging activity may worsen fatigue, comfort measures are supportive but not the highest priority for safety, and visitor restriction is unnecessary as transmission requires blood/body fluid contact.

Understanding the Priority
For a client with hepatitis B presenting with fatigue and jaundice, the nurse must recognize that jaundice indicates significant hepatic dysfunction. The liver’s impaired ability to metabolize toxins, particularly ammonia, places the client at high risk for developing hepatic encephalopathy, a neuropsychiatric syndrome that can rapidly alter mental status and physical safety. While fatigue, comfort, and infection control are important, the immediate safety risk stems from potential neurological deterioration.

Why Fall Precautions and Neurological Assessments Are the Priority
Hepatic encephalopathy can manifest subtly at first, with changes in sleep patterns, attention, or mild confusion, and can progress to disorientation, asterixis, and somnolence. A client with fluctuating mental status is at extreme risk for falls and injury. According to the Chinese Guidelines on the Management of Hepatic Encephalopathy in Cirrhosis (2024), early detection through frequent neurological assessment is a cornerstone of management and secondary prevention ^[1]. Implementing fall precautions, such as keeping the bed in a low position, ensuring the call light is within reach, and frequently orienting the client, directly mitigates the most immediate physical safety threat.

Analysis of Other Options
- Option 1: Encouraging increased physical activity is contraindicated. The client’s fatigue is a symptom of hepatic inflammation and metabolic disturbance. Rest is essential to reduce the liver’s metabolic demand, and activity could exacerbate fatigue and potentially precipitate an encephalopathic episode.
- Option 3: Providing comfort measures like rest and hydration is a fundamental part of care, but it is not the priority over a direct safety intervention. While rest is therapeutic, it does not actively protect the client from the immediate risk of injury from a fall due to an undetected change in neurological status.
- Option 4: Restricting all visitors is an excessive and outdated approach to infection control for hepatitis B. The virus is bloodborne and is not transmitted through casual contact. Standard precautions are sufficient. This action addresses an incorrect understanding of transmission risk rather than a genuine physiological safety threat to the client.

Pathophysiology and Clinical Application
The liver normally converts ammonia, a byproduct of protein metabolism, into urea for excretion. In hepatitis and resulting hepatic dysfunction, this detoxification pathway is compromised, leading to hyperammonemia. Ammonia crosses the blood-brain barrier, where astrocytes metabolize it, causing osmotic imbalance, cellular swelling, and impaired neurotransmission. This directly produces the symptoms of hepatic encephalopathy. A client with new or worsening jaundice has laboratory evidence of significant hepatocyte damage, making the risk of encephalopathy clinically relevant. The priority nursing action is therefore to establish a safety net through fall precautions and serial neurological assessments, which may include evaluating orientation, asterixis, and changes in level of consciousness, to detect and respond to deterioration immediately ^[1].