Michael has been diagnosed with frontal lobe abnormalities. As part of his care and evaluation, it is important to understand the specific functions that the frontal lobe is responsible for.

Potential Condition: Hepatic Encephalopathy

• The client has very high ammonia levels (236 mcg/dL), elevated liver enzymes, and low albumin, all pointing toward hepatic encephalopathy. Additional signs include a history of alcohol abuse, cirrhosis, and altered liver function, which commonly contribute to ammonia accumulation and neurotoxicity.

Actions to Take:

• Administer lactulose: Helps lower serum ammonia by promoting its excretion via the GI tract.

• Assess for asterixis: A classic sign of hepatic encephalopathy characterized by a flapping tremor of the hands.

Parameters to Monitor:

• Neurologic status: To detect changes in mental status or worsening encephalopathy.

• Safety measures: Clients with hepatic encephalopathy are at high risk for confusion, falls, and injury, necessitating close supervision and safety interventions.

A. Glomerulonephritis: This is an immune-mediated condition involving inflammation of the glomeruli and typically presents with proteinuria, hematuria, hypertension, and edema rather than urinary frequency, burning, or foul-smelling urine. The presence of E. coli and leukocytes does not support this diagnosis.

B. Kidney calculi: Kidney stones may present with flank pain, hematuria, and sometimes nausea or vomiting, but are not usually associated with urinary frequency, burning, or bacterial growth on urine culture. Randi’s symptoms point more toward an infectious etiology rather than a structural obstruction.

C. Lower UTI: cystitis (bladder infection) and possibly lower ureters: The burning, itching, frequent urination, and foul smell are classic signs of cystitis. The absence of flank pain and only a slightly elevated temperature further supports a lower tract infection rather than an upper one.

D. Upper UTI (pyelonephritis): Pyelonephritis typically presents with fever over 101°F, chills, nausea, vomiting, and significant costovertebral angle (CVA) tenderness or back/flank pain. Since Randi denies back pain and has only a mild temperature elevation, an upper UTI is unlikely.