A nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment, the nurse notes that the patient has a flapping tremor of the hands. The nurse should document the presence of what sign of liver disease?
A.
Asterixis
B.
Fetor hepaticus
C.
Palmar erythema
D.
Constructional apraxia
The Correct Answer and Explanation is:
The correct answer is A. Asterixis.
Explanation:
Asterixis is a classic sign of hepatic encephalopathy, which is a decline in brain function due to severe liver disease. This condition can result from the liver’s inability to detoxify harmful substances, leading to a buildup of toxins in the bloodstream that affect brain function. One of the hallmark symptoms of hepatic encephalopathy is asterixis, also known as “liver flap” or “flapping tremor.”
Asterixis is characterized by a rapid, irregular flapping or tremor of the hands and wrists, which is noticeable when the patient extends their arms and hands. This tremor is due to a lack of motor control and is a result of the toxic effects on the brain. It typically occurs in patients with advanced liver disease and can be a useful clinical sign to differentiate hepatic encephalopathy from other types of neurological disorders.
Here’s a brief overview of the other options and why they are not correct in this context:
- B. Fetor hepaticus: This term refers to a distinctive, musty or sweet odor of the breath that is sometimes associated with liver disease. It is caused by the presence of certain compounds, such as dimethyl sulfide, which accumulate in the bloodstream due to liver dysfunction. Although fetor hepaticus is associated with hepatic encephalopathy, it is not related to the flapping tremor observed in this patient.
- C. Palmar erythema: This is characterized by redness of the palms and is another sign associated with chronic liver disease, particularly cirrhosis. It is thought to result from hormonal imbalances related to liver dysfunction. While palmar erythema is indicative of liver disease, it does not present as a tremor.
- D. Constructional apraxia: This is a disorder where individuals have difficulty drawing or constructing objects due to a loss of spatial awareness. It is more commonly associated with neurological conditions like stroke or dementia rather than liver disease.
In summary, the presence of a flapping tremor of the hands is best documented as asterixis, a key sign of hepatic encephalopathy linked to liver dysfunction.