Elevated serum ammonia level causes which complication of cirrhosis?

Choice A reason: The red blood cell (RBC) count provided is significantly below the normal range (4,700,000-6,100,000/μL). However, the unit of measure given in the question (48,000/μL) is incorrect for RBCs, so it may not be consistent with the symptoms of fatigue and palpitations. Typically, a low RBC count can contribute to these symptoms, but in this case, the measurement provided is not clear.
Choice B reason: Platelets of 120,000/μL are below the normal range (150,000-400,000/μL). While low platelet counts (thrombocytopenia) can lead to bleeding and bruising, they are not typically associated with symptoms of fatigue and palpitations. This finding is more indicative of a potential bleeding disorder rather than anemia or another condition that would cause the given symptoms.
Choice C reason: Hemoglobin (Hgb) of 6.9g/dL is significantly below the normal range (14-18g/dL) and indicates severe anemia. Anemia is a common cause of fatigue and palpitations because the body has a reduced capacity to carry oxygen to tissues. Low hemoglobin levels can lead to decreased oxygen delivery, resulting in increased fatigue and compensatory palpitations as the heart works harder to circulate oxygen-poor blood.
Choice D reason: White blood cell (WBC) count of 11,000/mm³ is slightly above the normal range (5,000-10,000/mm³) and indicates a mild leukocytosis, which is usually a sign of infection or inflammation. While leukocytosis can cause fatigue if there is an underlying infection, it is not directly associated with palpitations and severe fatigue. The primary concern with fatigue and palpitations lies more with oxygen-carrying capacity, which is affected by hemoglobin levels.

Choice A reason:
Monitoring for signs of dehydration is essential because Mr. Carter's symptoms (fatigue, nausea, and jaundice) and laboratory results indicate acute hepatitis A, which can cause significant fluid loss due to nausea and reduced oral intake. Assessing hydration status ensures timely intervention to prevent complications such as hypovolemia. Additionally, high bilirubin levels and elevated liver enzymes suggest hepatic dysfunction, which may impair the body's ability to maintain fluid balance.
Choice B reason:
Educating Mr. Carter on proper hand hygiene is crucial to prevent the transmission of hepatitis A, which is highly contagious and spreads via the fecal-oral route. Since Mr. Carter has recently traveled to an area with poor sanitation, providing education on hygiene practices is an immediate priority to protect others. Proper handwashing with soap and clean water significantly reduces the risk of spreading the infection.
Choice C reason:
Encouraging a high-protein diet to repair liver damage is not appropriate during the acute phase of hepatitis A. Protein metabolism requires significant liver function, which is impaired in Mr. Carter’s case due to elevated ALT and AST levels. Emphasizing adequate hydration and balanced nutrition (without overloading the liver with protein) is more suitable. Dietary recommendations for hepatitis A focus on small, frequent meals and avoiding foods that burden liver function.
Choice D reason:
Administering intravenous antibiotics is unnecessary because hepatitis A is a viral infection, not bacterial. Antibiotics do not address viral infections and would not benefit Mr. Carter’s recovery. Supportive care, including hydration, rest, and symptom management, is the mainstay of treatment for viral hepatitis A.
Choice E reason:
Advising rest and limiting physical activity is vital to support Mr. Carter’s recovery. Fatigue and jaundice indicate that his liver is under significant strain, and rest helps reduce metabolic demands on the liver, allowing it to heal more effectively. Light activity may be reintroduced as symptoms improve, but physical exertion should be avoided during the acute phase.
Choice F reason:
Educating the patient about the need for lifelong hepatitis A vaccination is unnecessary because recovery from hepatitis A usually provides lifelong immunity. Vaccination is more relevant for individuals who are at risk and have not been exposed to the virus. Mr. Carter’s current care plan should focus on managing the acute phase of the disease and preventing transmission to others.