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NR 507 Week 6 Discussion; Cirrhosis

Chamberlain University Nursing NR 507 Advanced Pathophysiology Aaron Boone 3 pages
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hepatic encephalopathy (HE). Acute changes in mentation, even if mild, are often the earliest indicator of HE and may signal hepatic decompensation (AASLD, 2022). Additionally, infections such as urinary tract infections are well-recognized precipitating factors for HE due to systemic inflammation and increased ammonia production (Fallahzadeh & Rahimi, 2022). Overall, Bayani’s altered mental status in the context of possible infection is consistent with the underlying pathophysiology of cirrhosis, particularly impaired ammonia clearance and cirrhosis-associated immune dysfunction. Identify and justify the diagnostic tests (including labs, imaging, or other diagnostic tests) that would be most appropriate for investigating a diagnosis of your assigned disease process in Bayani. What could the results of these tests look like in your assigned disease process? Initial laboratory testing should include a comprehensive metabolic panel (CMP) and liver function tests (LFTs). In cirrhosis, results may demonstrate elevated bilirubin, mildly elevated or even normal AST/ALT in advanced disease, and elevated alkaline phosphatase depending on etiology. As synthetic function declines, low serum albumin and prolonged prothrombin time (PT)/INR are common due to reduced clotting factor production (Fallahzadeh & Rahimi, 2022), so depending on the stage of cirrhosis that could be present, this could also be a finding. A complete blood count (CBC) may reveal thrombocytopenia from portal hypertension–related splenic sequestration, as well as anemia or leukopenia in advanced disease. It should be noted that ascites is not always present in cases of cirrhosis. Ascites is a complication of decompensated cirrhosis, so it is possible for the body to compensate in the presence of cirrhosis without developing ascites. Because Bayani presents with confusion, a serum ammonia level would be appropriate to assess for hepatic encephalopathy. In cirrhosis, ammonia levels are often elevated due to impaired hepatic detoxification and portosystemic shunting (AASLD, 2022). However, ammonia levels should be interpreted clinically, as they do not always correlate perfectly with severity of symptoms. Given his wife’s concern for a urinary tract infection, a urinalysis and urine culture are essential. Infection is a common precipitating factor for HE in cirrhotic patients due to cirrhosis-associated immune dysfunction (Fallahzadeh & Rahimi, 2022). Findings may include positive leukocyte esterase, nitrites, bacteriuria, and elevated white blood cells.

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