# A nurse is planning care for a 50-year-old client presenting with jaundice, severe fatigue, and anorexia. Laboratory results show significantly elevated liver enzymes. Which dietary intervention should the nurse include in the care plan?

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> subject: Adult Health

## 문제

A nurse is planning care for a 50-year-old client presenting with jaundice, severe fatigue, and anorexia. Laboratory results show significantly elevated liver enzymes. Which dietary intervention should the nurse include in the care plan?

## 보기

1. Encourage the client to consume three large meals per day to maintain adequate nutrition
2. Administer prescribed analgesics every 4 hours for abdominal pain management
3. Provide small, frequent meals with balanced nutrition **✔ 정답**
4. Restrict fluid intake to 1000 mL per day to reduce liver workload

**정답: 3**

## 해설

Small, frequent meals are easier to digest and better tolerated in hepatitis patients with nausea and anorexia, helping maintain nutrition. Other options are inappropriate or not dietary interventions.

## 심화 해설

Understanding the Pathophysiology and Nutritional Demands

The client’s presentation of jaundice, severe fatigue, anorexia, and significantly elevated liver enzymes indicates acute hepatocellular injury. In this state, the liver’s capacity to synthesize proteins, regulate glucose, and detoxify metabolic byproducts is compromised. Anorexia and severe fatigue often make consuming large meals physically difficult and exhausting for the patient. A nutritional strategy that minimizes metabolic demand while ensuring consistent energy supply is essential. The principle is to avoid prolonged fasting, which forces the liver into gluconeogenesis and ketogenesis, and to prevent overwhelming the already stressed organ with a large metabolic load at one time.

Why Small, Frequent Meals Are the Priority Intervention

Providing small, frequent meals with balanced nutrition directly addresses the dual challenges of anorexia and impaired hepatic metabolism. This approach stabilizes blood glucose levels, reduces muscle catabolism, and provides a steady supply of nutrients for hepatocyte regeneration without exceeding the liver’s diminished functional capacity. The evidence supporting dietary management in steatotic and inflammatory liver conditions emphasizes structured nutritional patterns. A network meta-analysis on dietary interventions for metabolic dysfunction-associated steatotic liver disease (MASLD) confirms that specific dietary patterns are effective in improving hepatic enzyme profiles and glycemic regulation, underscoring that meal composition and timing are critical non-pharmacological tools [2]. Furthermore, evidence summaries for self-management education in patients with fatty liver disease highlight that nurses should guide patients toward balanced, portion-controlled meal planning as a cornerstone of care, reinforcing this exact intervention as an evidence-based nursing action .

Analysis of Incorrect Options

- Option 1 (Three large meals per day): This is contraindicated because a large metabolic load can exacerbate fatigue and nausea in a patient with anorexia. Large meals require significant hepatic processing and can worsen postprandial hyperammonemia or abdominal discomfort, making it harder for the client to meet their total daily caloric and protein requirements.

- Option 2 (Administer prescribed analgesics every 4 hours): This is a pharmacological intervention, not a dietary one, and it carries significant risk in the context of liver impairment. Many analgesics, particularly acetaminophen and NSAIDs, are hepatotoxic or metabolized by the liver. A fixed every-4-hour schedule without a specific indication of pain and careful drug selection could precipitate further liver damage. The question specifically asks for a dietary intervention.

- Option 4 (Restrict fluid intake to 1000 mL/day): Fluid restriction is not a standard intervention for reducing liver workload and can be harmful. Adequate hydration is necessary to maintain intravascular volume, support renal clearance of metabolic wastes, and prevent constipation, which can worsen hepatic encephalopathy. Fluid restriction is typically reserved for patients with dilutional hyponatremia or significant volume overload from ascites with severe edema, which is not indicated here. A randomized controlled trial on dietary management for liver disease emphasizes that interventions should focus on food quality and caloric distribution rather than fluid deprivation to improve liver fat content and metabolic health .References (research sources)

- [2]Comparative efficacy of dietary patterns on glycemic and liver enzymes in metabolic dysfunction-associated steatotic liver disease: a network meta-analysis.Meta-analysis/systematic reviewMusazadeh V, Faghfouri AH, Morvaridi M, Jazinaki MS, Mahmoudinezhad M, Barazandeh S, Shidfar F. (2026) · DOI: 10.1186/s12986-026-01161-w

## 임상 시나리오

Nutritional Support in Acute Liver InjuryManaging Anorexia and Impaired Metabolism
For clients with jaundice and elevated liver enzymes, the priority is to provide small, frequent meals with balanced nutrition. This approach prevents the metabolic stress of prolonged fasting and large meals, which can overwhelm the liver's diminished capacity.

Aim for a nutrient-dense diet with adequate protein (1.0-1.5 g/kg/day) and carbohydrates to support hepatocyte regeneration and prevent muscle wasting. Caloric intake should be around 30-35 kcal/kg/day.

CautionAvoid recommending three large meals, as this can worsen anorexia and fatigue. Do not restrict protein unless the client has severe encephalopathy unresponsive to standard therapy. Fluid restriction is not a standard intervention for reducing "liver workload" and is only indicated in cases of significant fluid overload or dilutional hyponatremia.

## 핵심 개념

- **Hepatocellular injury** — Damage to the main functional cells of the liver, impairing metabolism, detoxification, and protein synthesis.
- **Gluconeogenesis** — A metabolic pathway that results in the generation of glucose from non-carbohydrate substrates, which is taxing on a damaged liver.
- **Anorexia** — Loss of appetite, a common symptom in liver disease that makes consuming large meals difficult.

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