A nurse is preparing a teaching plan for a client who is starting to receive hemodialysis for chronic kidney disease. Which of the following instructions should the nurse include in the teaching?

Rationale:
A. Contact the provider who will be performing the procedure: It is the provider’s legal and ethical responsibility to explain the procedure, including its purpose, risks, benefits, and alternatives. If the client does not understand, the nurse must contact the provider to clarify and ensure informed consent is valid.

B. Instruct the client's spouse to sign the consent form: A spouse may only sign the form if the client is legally unable to do so. If the client is competent but lacks understanding, they should not sign until they receive adequate information from the provider.

C. Read the consent form to the client using words the client will understand: While the nurse can clarify terms, reading or paraphrasing the consent form does not replace the provider’s obligation to explain the procedure fully and answer questions.

D. Provide teaching about the surgical procedure for the client: Nurses may reinforce information, but only the provider can give the detailed explanation required for informed consent. Providing full procedural teaching falls outside the nurse’s scope for consent purposes.

Rationale:

• Place on a Low-protein diet: A low-protein diet is often prescribed in clients with hepatic encephalopathy to reduce ammonia production from protein metabolism. With an ammonia level of 150 mcg/dL and signs of chronic liver disease, this is appropriate.
• Daily abdominal girth measurements: This client has a distended abdomen with dullness to percussion, suggesting ascites. Measuring abdominal girth daily helps monitor fluid accumulation and response to diuretics or fluid restriction.
• Daily weights: Weight tracking is essential in clients with ascites or fluid imbalance, common in cirrhosis. It provides a sensitive indicator of fluid retention or loss over time.
• Liver biopsy: With thrombocytopenia (platelets 120,000/mm³), active GI bleeding, and coagulopathy likely due to cirrhosis, liver biopsy poses a high bleeding risk and is not appropriate in this unstable condition.
• Administer lactulose: Lactulose is a first-line treatment for hepatic encephalopathy. It works by trapping ammonia in the colon and promoting its excretion. This is essential given the client's elevated ammonia level and risk for mental status changes.
• Liver ultrasound: A liver ultrasound is a non-invasive imaging tool to evaluate liver size, structure, and presence of masses or ascites. It is safe and appropriate in this client's condition and can guide further management.