The nurse plans care for a client with a brain tumor who developed a syndrome of inappropriate antidiuretic hormone.
Which interventions should the nurse include in the plan? Select all that apply.

Managing hepatic encephalopathy requires understanding the biochemical role of ammonia in brain toxicity. Knowledge of the enterohepatic circulation and the pharmacological action of osmotic laxatives is necessary to facilitate the excretion of nitrogenous wastes and improve neurological status.

Choice A rationale

Loop diuretics are used to treat ascites or edema but do not directly lower serum ammonia. Excessive diuresis can actually trigger hepatic encephalopathy by causing dehydration and electrolyte imbalances, such as hypokalemia, which increases renal ammonia production and toxicity.

Choice B rationale

Lactulose is a disaccharide that acidifies the colon, converting ammonia into non-absorbable ammonium ions. This osmotic effect also promotes bowel movements, facilitating the rapid excretion of these toxins from the gut, thereby reducing blood ammonia levels and confusion.

Choice C rationale

Restricting fluids does not lower ammonia and can worsen hepatic encephalopathy by causing dehydration and constipation. Adequate hydration and bowel motility are necessary to ensure that nitrogenous wastes are flushed from the gastrointestinal tract effectively to prevent systemic accumulation.

Choice D rationale

Protein breakdown in the gut by bacteria produces ammonia. Increasing protein intake in a client with end stage cirrhosis would likely worsen encephalopathy by providing more nitrogenous substrate for ammonia synthesis, further elevating toxic levels in the blood.

The scenario requires applying family systems theory and interdisciplinary communication principles within hospice care. Effective coping begins by clarifying the support structure available to the family, necessitating an understanding of how various professional roles function to alleviate the burden of end of life care.

Choice A rationale

Planning for hospital readmission contradicts the primary goal of hospice, which focuses on maintaining a comfortable home death. Focusing on hospitalization initially can create anxiety and undermine the family's confidence in managing the client's care at home.

Choice B rationale

Hospice typically provides intermittent visits rather than continuous 24-hour home care. Suggesting the nurse will meet all daily basic needs is unrealistic and provides false expectations, which can negatively impact the family's long-term ability to cope with caregiving.

Choice C rationale

While bereavement support is a standard component of hospice services, discussing post-death visits during the initial assessment is premature. Families need immediate support strategies and role clarity to manage the active dying process before focusing on aftercare services.

Choice D rationale

Clarifying the roles of the interdisciplinary team empowers the family by identifying specific resources for physical, emotional, and spiritual needs. This foundational knowledge reduces uncertainty, establishes a support network, and is the essential first step in facilitating effective coping.