# A client with decompensated cirrhosis presents with new ascites, abdominal pain, fever 38.4 C, confusion, and asterixis. Which interventions should the nurse anticipate? Select all that apply.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375014&lang=en  
> language: en  
> subject: Management of Care  
> category: MOC

## Question

A client with decompensated cirrhosis presents with new ascites, abdominal pain, fever 38.4 C, confusion, and asterixis. Which interventions should the nurse anticipate? Select all that apply.

1

Perform diagnostic paracentesis and send fluid for cell count and culture

2

Restrict protein severely to under 20 grams per day

3

Initiate lactulose to titrate to 3 to 4 soft stools daily

4

Administer IV albumin if peritoneal fluid PMN count exceeds 250 per mm3

5

Begin empiric IV cefotaxime or ceftriaxone for suspected SBP

## Explanation

Decompensated cirrhosis with new ascites and fever requires diagnostic paracentesis with PMN count over 250 confirming SBP — empiric ceftriaxone or cefotaxime is started. IV albumin (1.5 g/kg day 1, 1 g/kg day 3) reduces hepatorenal syndrome and mortality in SBP. Hepatic encephalopathy is treated with lactulose titrated to 3-4 soft stools per day plus rifaximin for resistant cases. Severe protein restriction is OUTDATED and worsens malnutrition — modest restriction (1.0-1.5 g/kg/day plant-protein-rich) is acceptable.

## In-depth explanation

SBP diagnosis: PMN count over 250 in ascitic fluid (single criterion). Watch for hepatorenal syndrome — IV albumin protective.

## Clinical scenario

Albumin 2.4, INR 2.0, ammonia 110. New onset confusion. No prior paracentesis.

## Key concepts

- **spontaneous bacterial peritonitis** — Infection of ascitic fluid without obvious source; common cirrhosis complication.
- **hepatic encephalopathy** — Cognitive dysfunction from impaired ammonia clearance; treated with lactulose, rifaximin.
- **asterixis** — Flapping tremor on wrist extension; sign of metabolic encephalopathy.

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