Help CP for Hepatic Encephalopathy

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I'm doing a CP for a pt with Hepatic Encephalopathy. His ammonia levels were high and H&H low. I'm working on my psychosocial nursing dx. I wanted to do "Disturbed though process r/t high levels of serum ammonia AEB serum ammonia lab value 88 (18-45), client exhibiting slurred speech, forget fullness, unsteady gate, slow movements, drowsiness, and asking 4 times "when is lunch?" after being told when lunch was."

I'm having trouble with my short term goal (we don't do long term). I was thinking "client will remain free of injury by end of shift." or "Client will not fall or injury self by end of shift."

Since this is for psychosocial, I wasn't sure if these were appropriate goals. We do a physical, psychosocial, and educational dx per client. Since its a psychosocial dx, does the goal have to be a psychosocial thing? He didn't have any anxiety, fears, or ineffective coping. He was pretty positive and upbeat about his tx and prognosis.

Any advice is appreciated. thank you!

Specializes in Surgical Intensive Care.

why is this pt. encephalopathic? are you concerned with any risks for injuries r/t this patient's current psychosocial status or behaviors? a good piece of advice is, if you have to "make it work" there is probably a reason. don't fill a space just because it is empty, think about this "individual patient's circumstances" and what really exists; what is ​best...?

Specializes in Medical-Surgical/Float Pool/Stepdown.

Look up the medication called Lactulose, what it is used for, and how it affects a Pt's Ammonia levels...

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