The nurse is caring for a 58-year-old client who was admitted to the medical unit with liver cirrhosis. Select the five complications for which this client is at risk.

Nursing care of a client with advanced liver cirrhosis requires recognition of multisystem complications resulting from portal hypertension, impaired detoxification, and reduced synthetic liver function. Cirrhosis leads to fluid imbalance, altered immunity, neurotoxicity from ammonia accumulation, and vascular changes affecting multiple organs. Clients with ascites, jaundice, and confusion are at high risk for life-threatening complications involving the respiratory, renal, hematologic, and neurological systems. Early identification of these risks is essential for preventing rapid clinical deterioration. A. Venous thromboembolism risk is low in liver disease as bleeding is more likely. While any immobile patient has some risk, cirrhosis is specifically characterized by a decrease in clotting factors (produced by the liver), which usually places the patient at a higher risk for bleeding rather than clotting. B. Hepatopulmonary syndrome occurs due to intrapulmonary vascular dilatation in advanced liver disease. This leads to ventilation-perfusion mismatch and hypoxemia, often worse in upright position. The client’s low oxygen saturation and respiratory symptoms suggest risk of impaired gas exchange. Progressive liver dysfunction increases likelihood of this complication. C. Esophageal varices develop due to portal hypertension from obstructed hepatic blood flow. Increased pressure causes collateral vessel formation in the esophagus that can rupture and cause life-threatening hemorrhage. This client’s ascites and portal hypertension indicate advanced disease stage, making variceal formation highly likely. Surveillance and prophylaxis are essential. D. Osteomyelitis is unrelated to liver cirrhosis and does not arise from hepatic dysfunction or portal hypertension. It is typically caused by direct bone infection or hematogenous spread from bacteremia unrelated to cirrhosis pathophysiology. There is no indication in the assessment data suggesting bone infection risk. E. Hepatorenal syndrome is a functional renal failure caused by severe vasoconstriction of renal circulation in advanced cirrhosis. Reduced effective circulating volume and systemic vasodilation lead to kidney hypoperfusion without structural kidney damage. This client’s hypotension and ascites place them at high risk for this fatal complication. F. Spontaneous bacterial peritonitis occurs due to infection of ascitic fluid in clients with cirrhosis. Ascites provides a medium for bacterial growth, especially with impaired immune function. Fever may be absent, but abdominal distension and worsening condition increase suspicion. This is a life-threatening complication requiring prompt recognition and treatment. G. Hepatic encephalopathy results from accumulation of neurotoxins, particularly ammonia, due to impaired liver detoxification. The client’s confusion, fatigue, and reported cognitive changes suggest early neurological involvement. Electrolyte imbalance and protein metabolism disturbances further worsen cerebral function. This is a key complication in advanced cirrhosis requiring close monitoring.