A patient with cirrhosis presents with confusion and elevated ammonia levels. What intervention should the nurse prioritize?

Choice A reason: A high-sodium diet is strictly contraindicated in patients with cirrhosis. Excess sodium intake leads to increased water retention and exacerbates portal hypertension, which worsens complications such as ascites and peripheral edema. Most patients with chronic liver disease are placed on a sodium-restricted diet to manage fluid balance. Choice B reason: Lactulose is the gold standard pharmacological treatment for hepatic encephalopathy caused by hyperammonemia. It acts as an osmotic laxative that acidifies the colon contents, converting diffusible ammonia into non-diffusible ammonium ions, which are then excreted in the stool. This effectively lowers serum ammonia levels and improves the patient's neurological status. Choice C reason: High-protein meals should be avoided in the acute phase of hepatic encephalopathy. Ammonia is a byproduct of protein metabolism; therefore, excessive protein intake can further elevate ammonia levels and worsen cerebral toxicity. Patients are generally kept on a protein-restricted or moderate-protein diet until their mental status stabilizes. Choice D reason: Administering analgesics is not the priority and can be dangerous. Many analgesics, especially opioids and sedatives, are metabolized by the liver. In a patient with cirrhosis and encephalopathy, these medications can mask neurologic changes, prolong the state of confusion, or even precipitate hepatic coma due to impaired hepatic clearance.