Question

A client has cirrhosis of the liver with a new prescription for lactulose (Cephalac). Which indicates the drug is having the desired effect? A. The client sleeping more B. An increase in bowel movements C. Hypoactive bowel sounds D. A generalized increase in bruising

Short answer

Answer: B. An increase in bowel movements.

Step-by-step solution

Understand the purpose of lactulose for cirrhosis of the liver

Lactulose is a synthetic sugar that is used to treat constipation and reduce the production and absorption of ammonia in the body. Ammonia is produced by bacteria in the intestines and converted into urea by the liver, which is then excreted through the kidneys. In cirrhosis of the liver, the liver's ability to convert ammonia into urea is impaired, leading to elevated ammonia levels in the blood. High blood ammonia levels can lead to hepatic encephalopathy, which affects brain function. Lactulose helps reduce ammonia levels by trapping ammonia in the colon and expelling it through bowel movements.

Analyze each option

A. The client sleeping more: Lactulose doesn't directly affect sleep, but it could help improve sleep quality if hepatic encephalopathy was affecting the client's sleep. However, this is not the primary desired effect of lactulose, as it is more focused on reducing ammonia levels and constipation. B. An increase in bowel movements: Lactulose's primary role is to help with constipation and to reduce ammonia levels by trapping it in the colon and expelling it through bowel movements. An increase in bowel movements would indicate that lactulose is having the desired effect. C. Hypoactive bowel sounds: Hypoactive bowel sounds indicate decreased bowel activity, which is the opposite of the desired effect of lactulose. Lactulose aims to promote bowel movements to expel ammonia. D. A generalized increase in bruising: An increase in bruising is unrelated to the desired effect of lactulose and could indicate other issues, such as problems with blood clotting or platelet levels.

Determine the correct answer

Based on our analysis of the four options, the correct answer is B. An increase in bowel movements. This effect indicates that lactulose is successfully working to reduce constipation and expel trapped ammonia from the colon, ultimately reducing ammonia levels in the body and potentially improving brain function in individuals with cirrhosis of the liver.

Key concepts

Cirrhosis of the Liver

Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. Each time your liver is injured, it tries to repair itself, leading to scar tissue. Over time, more and more scar tissue replaces healthy liver tissue, impeding the liver's ability to function properly.

This can lead to a host of complications, including liver failure and portal hypertension, where blood flow through the liver is slowed, causing pressure to build up in the vein that supplies the liver with blood. Symptoms and signs of cirrhosis may include fatigue, easy bruising and bleeding, nausea, swelling in the legs and abdomen, and jaundice. Managing cirrhosis often focuses on slowing its progression, minimizing complications, and treating the underlying cause.

Hepatic Encephalopathy

Understanding Hepatic Encephalopathy

Hepatic encephalopathy is a decline in brain function that occurs as a result of severe liver disease. In this condition, toxins build-up in the bloodstream because the liver can't effectively remove them. One of the most common of these toxins is ammonia.

Signs and Symptoms

Patients with hepatic encephalopathy may experience confusion, altered level of consciousness, and coma as the condition progresses. This condition is reversible with the right treatment, which often includes managing the levels of toxins in the blood and can require medication, dietary changes, and other interventions.

Ammonia Toxicity

Ammonia toxicity occurs when there's an excess of ammonia in the blood. Ammonia is a byproduct of protein metabolism and is normally converted into urea by the liver and excreted via the kidneys. Causes of increased ammonia include liver diseases like cirrhosis, intake of excessive protein, and certain genetic conditions affecting the urea cycle.

Ammonia and the Brain

Elevated ammonia levels can severely impact brain function, leading to hepatic encephalopathy. Symptoms might include slurred speech, lethargy, and in severe cases, coma. Treatment aims to reduce ammonia levels, often through diet changes, medications such as lactulose, and other supportive measures.

NCLEX-RN Pharmacology

The National Council Licensure Examination for Registered Nurses (NCLEX-RN) covers a wide range of pharmacology concepts. Nursing candidates are expected to not only understand drug mechanisms, side effects, and interactions but also how these medications fit into patient care, particularly for chronic conditions like cirrhosis.

Medications and Nursing Interventions

A crucial aspect is understanding how medications like lactulose can reduce complications, such as hepatic encephalopathy, by expelling ammonia through increased bowel movements. Nurses must monitor drug efficacy and patient response, educate patients about their medications, and anticipate potential side effects or signs of worsening conditions.