Liver Failure and Hepatic Encephalopathy

After working through this topic, the Canadian RN will be able to: - distinguish acute liver failure (ALF) from decompensated cirrhosis and from acute-on-chronic liver failure, and explain why hepatic encephalopathy (HE) is managed differently in each; - explain how ammonia and other gut-derived toxins produce brain dysfunction when the liver cannot clear them; - grade overt HE with the West Haven criteria, separate covert from overt HE, and elicit asterixis correctly; - name the common precipitants of HE and search for them at every episode; - give and titrate lactulose under an order, recognize over-treatment, and explain where rifaximin fits; - protect the airway, prevent aspiration and falls, and avoid sedatives in a client with altered consciousness; - recognize deterioration that needs escalation to the rapid response team, critical care or a transplant centre, including cerebral edema in ALF; - teach clients and families about adherence, nutrition, driving and when to seek help.