Encephalopathy Case Study (45 min)
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Outline
Mr. Farley is a 57 year old male with a history of alcohol abuse who is brought to the Emergency Department (ED) by some work friends with altered mental status (AMS) and a reported seizure. He has significant ascites and jaundice to his sclera and nail beds.
Mr. Farley is admitted to the Medical Stepdown Unit. He is confused, oriented to person only, and agitated. He keeps trying to climb out of bed and is yelling profanities at the nurses. His ammonia level results are 93 mcg/dL. He has also begun to show a fine tremor in his hands and arms. The provider is concerned he may be at risk for alcohol withdrawal in addition to experiencing hepatic encephalopathy. Mr. Farley is placed in bilateral soft wrist restraints for his safety. The provider orders 1 mg Ativan IV push PRN q5min for seizures, plus 2 mg Ativan IV push PRN q2h for signs of alcohol withdrawal. The provider also orders Lactulose 20 mg PO q6h, and Thiamine IV 100 mg BID. Mr. Farley’s level of consciousness continues to diminish and you determine through a bedside swallow study that he is unable to swallow safely at this time. The nurse inserts a nasogastric tube (NG Tube) for administration of Lactulose 20 mg PO q6h. After 48 hours, Mr. Farley’s ammonia level has decreased to 46 mcg/dL. He is now alert and oriented x 3, calm, and cooperative and unrestrained. He states that he can’t remember what happened or why he’s here. The last thing he remembers is going out for a steak dinner after work to celebrate a big sale and having “a few drinks”. The provider agrees that it is safe for Mr. Farley to be discharged home. 200% NCLEX Pass Guarantee. What diagnostic testing would you anticipate to determine the cause of Mr. Farley’s altered mental status (AMS)?
What do you believe might be going on physiologically?
What nursing assessments should be performed at this time?
What safety precautions should you initiate for Mr. Farley?
What medication orders would you anticipate from the provider?
What nursing action could you take to ensure that Mr. Farley receives his Lactulose?
What nursing considerations exist once a patient begins receiving Lactulose q6h?
What discharge teaching do you anticipate for Mr. Farley?
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MS2EXAM1
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Medication Administration
- Central Nervous System Disorders – Brain
- Shock
- Shock
- Urinary System
- Adult
- Respiratory Emergencies
- Cardiovascular Disorders
- Postpartum Complications
- Emergency Care of the Neurological Patient
- Neurological Emergencies
- Emergency Care of the Respiratory Patient
- Pregnancy Risks
- Vascular Disorders
- Noninfectious Respiratory Disorder
- Respiratory System
- Cardiovascular
- Endocrine and Metabolic Disorders
- Hematologic Disorders
- Disorders of the Adrenal Gland
- Neurologic and Cognitive Disorders
- Upper GI Disorders
- Lower GI Disorders
- Nervous System
- Labor Complications
- Liver & Gallbladder Disorders
- Oncology Disorders
- Substance Abuse Disorders
- Renal and Urinary Disorders
- Integumentary Disorders
- Renal Disorders
- Gastrointestinal Disorders
- Acute & Chronic Renal Disorders
- Respiratory Disorders
- Disorders of Pancreas
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Gastrointestinal
- Renal
- Endocrine System
- Disorders of the Thyroid & Parathyroid Glands
- Integumentary Disorders
- Musculoskeletal Trauma
- Urinary Disorders