Case Study: Hepatic Encephalopathy

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Care Plan


Patient: is a 55-year-old male, came into the hospital confused and incontinent, stated he had pain in his abdomen but could not state where exactly, pointed to the whole abdomen. Patient lives at home with a friend in an apartment that had beer bottles all over his apartment. Patient drinks 24 beers a day and smokes a pack a day. Blood tests were done when patient was admitted into the hospital: ammonia levels were high (79), Hemoglobin was low (105), Platelet count low (113), Magnesium normal (0.60), Potassium normal (4.9), Sodium normal (141), urea normal (4.0), ALT high (76), leukocytes high (8.1)

Nursing Diagnosis: Hepatic Encephalopathy secondary to cirrhosis due to alcohol abuse

Primary Diagnosis: Hepatic Encephalopathy- …show more content…

· It is a neuropsychiatric manifestation of liver damage (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2014) (Miyoshi, K. & Morimura, Y., 2010).

Pathophysiology:
· Ammonia is a bacterial and enzymatic deamination of amino acids in the intestines (Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2014).
· The ammonia that is created then goes to the liver through the portal circulatory and is converted to urea, which in the excreted by the kidneys. (when the liver is working normally and not damaged) (Gallbladder and hepatic portal system, 2014)
· When the liver is damaged and unable to covert ammonia to urea, the ammonia level builds up in the systemic circulation due to shunting of blood, passed the liver. The ammonia then crosses the blood brain barrier and produces neurotic manifestations (Lewis, Dirksen, Heitkemper, Bucher, & Camera,

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