As the nurse cares for the patient with hepatic encephalopathy, what is an early sign that may be assessed?

Rationale: A. Dramatic confusion is incorrect because severe cognitive changes occur in the later stages of hepatic encephalopathy. Early stages are usually subtle and may include mild personality changes, sleep disturbances, or slight forgetfulness rather than dramatic confusion. B. Asterixis is correct because it is a classic early neurologic sign of hepatic encephalopathy. Also called a “flapping tremor,” asterixis is an involuntary, coarse, flapping movement of the hands or wrists when the patient extends the arms and dorsiflexes the wrists. It occurs due to impaired cerebral function from the accumulation of neurotoxins, most notably ammonia, that are normally detoxified by the liver. Asterixis often precedes overt changes in cognition or consciousness, making it an important early warning sign for nurses to identify and monitor. C. Somnolence is incorrect as it generally appears in moderate to advanced stages of hepatic encephalopathy. At this stage, patients may be lethargic, difficult to arouse, or show significant disorientation. D. Profound coma is incorrect because this represents end-stage hepatic encephalopathy. Patients in this stage are unresponsive, at high risk for respiratory failure, aspiration, and death, and require intensive care and often ventilatory support.