Overview of Hepatic Encephalopathy
Hepatic encephalopathy, also known as hepatic coma, is a syndrome of central nervous system dysfunction based on metabolic disorders caused by severe liver disease or porto-corporeal shunt, and its main clinical manifestations are impaired consciousness, behavioral disorders and coma, which can be classified into acute and chronic. The main clinical manifestations are impaired consciousness, behavioral disorders and coma, and there is an acute and a chronic difference. Mild clinical manifestations may only have slight mental retardation, while severe cases have impaired consciousness, behavioral disorders and coma, which is the primary cause of death in end-stage liver disease. Proper clinical care for patients with hepatic encephalopathy is extremely important for the treatment of patients and improvement of their prognosis.
Main nursing problems
1. Limited self-care ability.
2. Nutritional disorders.
3. Risk of injury.
4. Potential complications, such as infection and gastrointestinal bleeding.
Nursing Measures
1. Psychological care
Explain to patients and their families the knowledge about hepatic encephalopathy and the various triggering factors leading to hepatic encephalopathy, and explain the basic practice of avoiding various triggers. Care for and comfort the patient, relieve the patient’s nervousness and anxiety, and make the patient actively cooperate with the treatment.
2. Activity guidance
Activities will increase the oxygen consumption of the liver and aggravate the damage of liver cells. Therefore, patients are required to take absolute bed rest to maintain sufficient blood supply to the liver, so as to facilitate the regeneration and repair of liver cells.
3.Safety care
When the patient is agitated, there should be someone to take care of the patient, add bed stalls, and use restraining belts if necessary to prevent the patient from falling out of bed.
4. Medication care
Use anti-hepatic encephalopathy drugs in a timely manner according to the doctor’s prescription, and observe the efficacy and adverse reactions of the drugs. Avoid using drugs that can aggravate hepatic encephalopathy and damage the liver. When liver insufficiency occurs, the detoxification function of liver is poor, so sedatives should be used cautiously.
5. Dietary care
For high-risk patients with hepatic encephalopathy, protein intake should be appropriately limited to less than 40g per day, but not persistently limited so as not to cause amino acid insufficiency, and plant proteins can be eaten after the condition is stabilized. Patients should be instructed to eat more meals with less food, and eat high-calorie, low-fat, easy-to-digest, vitamin-rich food, avoiding hard, deep-fried, spicy and stimulating food.
6. Maintaining smooth bowel movement
Enema or diarrhea, remove intestinal toxins, food accumulation, blood accumulation, etc., available saline or weak acidic liquid, avoid using soapy water.
7. Complications care
(1) Control infection Observe whether the patient has fever, abdominal pain and other symptoms. If infection occurs, follow the doctor’s instructions to apply antibiotics timely and accurately.
(2) Gastrointestinal bleeding For patients with gastrointestinal bleeding, stop bleeding in time and replenish fresh blood. After the bleeding stops, use saline or weak acidic solution to clean up the blood in the intestine to reduce the production and absorption of ammonia.
Health Advocacy
1. Patients should keep optimistic and relaxed mood and avoid mental tension.
2. Appropriate physical exercise such as walking, to the extent of not feeling fatigue.
3. Follow the doctor’s instructions to insist on long-term medication on time, do not increase or decrease the amount of medication or stop taking medication without authorization.
4. Limit the intake of protein, and eat a high-calorie, vitamin-rich, low-fat, easy-to-digest diet.
5. Regular follow-up, if there are behavioral disorders and the phenomenon of black stools, you should consult the doctor in time.