Medical management

Lactulose is administered to reduce serum ammonia levels.

Patient is closely monitored for hypokalemia and dehydration.
IV administration of glucose to minimize protein breakdown.
Administration of vitamins to correct deficiencies.
Antibiotics may also be added to the treatment regimen.
Neurologic status is assessed frequently.
Mental status is monitored by keeping a daily record of hand writing
and arithmetic performance.
I&O and body weight are recorded each day.
Vital signs are recorded every 4 hrs.
Potential sites of infection (peritoneum, lungs) are assess frequently
and abnormal findings are reported promptly.
Serum ammonia level is monitored daily.
Protein intake is moderately restricted only in patients who are
comatose or who have encephalopathy that is refractory to lactulose
and antibiotic therapy
Patient and family are advised about foods that are high in proteins
which may need to be limited in the diet for the short term to reduce
production of ammonia.
Enteral feeding is provided for patiens whose encephalopathic state
persist.
Reduction in the absorption of ammonia from the GI tract is
accomplished by the use of gastric suction, enemas or oral antibiotics.
Electrolyte status is monitored and corrected if abnormal.
Sedatives, tranquilizers and analgesics medication are discontinued.
Benzodiazepine antagonists such as flumazenil may be administered
to improved encephalopathy.
Nursing management
Maintain safe environment to prevent injury, bleeding and infection.
Administer prescribed treatments and monitors patient for the
numerous potential complications.
Encourage deep breathing and position changes to prevent
atelectasis, pneumonia and other respiratory complications.
communicate with patients family to inform them about the patients
status and supports them by explaining the procedures and
treatments that are part of the patients care.
Educate patient about self care
Assess patients physical and mental status and collaborate closely with
the primary provider.
Home visit
Evaluate patients fluid volume status and be alert for changes indicative
of hypovolemia due to decrease intake and for decrease urine output.
Monitoring of laboratory values continues to be important and the
home nurse must obtain prescriptions to correct abnormalities,
especially electrolyte imbalances which also can worsen encephalopathy.
Assess safety of home environment.
Reminds the patient and family about the importance of dietary
restrictions, close monitoring and follow-up.
Observe patient for subtle behavior changes of worsening hepatic
encephalopathy.