NSG 210 Test 3 Study Guide

It is easily transmitted causes high morbidity there

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Unformatted text preview: s Stages:  ­Stage 1 Prodromal: pt may be asymptomatic. May have an inability to concentrate, sleep disturbances & subtle personality changes. Pt may appear slightly confused & unkempt.  ­Stage 2 Impending: pt has continuation of mental changes, but more exacerbated. May not be oriented x3 & difficult to awaken. Asterixis (flapping tremor of the hands) may occur. Deep tendon reflexes are hyperactive and simple tasks become difficult. Constructional apraxia (inability to reproduce a simple figure) & fetor hepaticus (sweet, slightly fecal breath odor) may begin to occur & progressively worsen  ­Stage 3 Stuporous: deterioration progresses w/ marked mental confusion, severe drowsiness, hyperreflexemia, liver flapping. Constructional apraxia & fetor hepaticus may continue.  ­Stage 4 Comatose: pt is unresponsive & lapses into comas & even seizures. Hyperreflexemia & asterixis are no longer present. Pt exhibits muscle rigidity instead Dx: Assessed & dx via EEG. Pt should be referred for a liver transplant after initial episode Tx: focused on nutrition & drug therapy & eliminating the precipitating cause of PSE  ­Nutrition Therapy For pts w/ serum ammonia level WNL, a high ­carb, moderate fat & high ­protein diet is recommended For pts w/ increased serum ammonia level, a moderate protein, moderate fat & simple carb diet is recommended Provide small, frequent meals Protein intake should be between 1.0 ­1.5g/kg, depending on degree of decompensation  ­Drug Therapy: includes administration of lactulose & non ­absorbable antibiotics Lactulose is administered to reduce serum ammonia levels. It is administered PO or via NG tube/enema...
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