Joe, a known alcoholic for several years, is now in a hepatic coma. He is jaundiced, edematous, and with bleeding esophageal varices. The nurse reviewed his blood ammonia levels to be increased as well. Which of the following actions should the nurse perform in order to reduce ammonia intoxication?
A)Active and passive range-of-motion exercises to prevent venous stasis
B)Tap-water enemas to remove blood that may still be in the gut from the bleeding esophageal varices
C)Administration of insulin and glucagon to reduce serum-potassium levels
D)Holding all antibiotic medications so that the action of the intestinal bacteria on protein is enhanced

Question

Quizplus · Accepted Answer

Ammonia is formed in the intestines by the action of intestinal bacteria on proteins. Tap-water enemas may be given to remove protein-rich blood that has collected from bleeding varices. Because ammonia is formed during muscle contraction, active range-of-motion exercises are contraindicated (Choice A). To prevent skin breakdown in a client who is jaundiced and edematous, passive exercises, turning, and frequent skin care are indicated. In an effort to reduce serum-ammonia levels, potassium levels need to be increased, not reduced (Choice C), because potassium is necessary for cerebral metabolism of ammonia. Antibiotics that are poorly absorbed by the intestines, such as neomycin, are given, rather than withheld (Choice D), to decrease the intestinal flora that manufacture ammonia.

Joe, a Known Alcoholic for Several Years, Is Now in a Hepatic