The nurse is assigning rooms for four clients, each newly diagnosed, and being admitted to the acute neuro unit for treatment. The client with which condition should be assigned the only private room available?

Rationale for Correct Choices:

• Alcoholic cirrhosis: The client has a history of chronic heavy alcohol use, jaundice, RUQ tenderness, a distended abdomen, and abnormal liver ultrasound findings, all consistent with alcoholic cirrhosis. The presence of regenerative nodules and a nodular liver surface on imaging further supports this diagnosis.
• Aspartate aminotransferase (AST): The AST is elevated at 120 U/L (normal range: 10–40 U/L), which commonly occurs in alcoholic liver disease. In alcoholic cirrhosis, AST levels often exceed ALT and indicate ongoing hepatocellular injury.
• Ammonia: The client’s ammonia level is elevated at 90 mcg/dL (normal: 15–45 mcg/dL), suggesting impaired hepatic clearance and early signs of hepatic encephalopathy, both seen in advanced liver disease such as cirrhosis.

Rationale for Incorrect Choices:

• Acute pancreatitis: The client does not report severe epigastric pain radiating to the back, which is typical for pancreatitis. There is also no elevation of serum lipase or amylase, and imaging does not show pancreatic inflammation or edema.
• Hepatitis A: Hepatitis A usually presents with acute onset of symptoms like fever, malaise, and dark urine. It is typically short-term and not associated with the chronic liver changes (nodular liver, regenerative nodules) found in this client.
• Chloride: While slightly elevated, the chloride level is not specific to liver disease and has minimal diagnostic value in cirrhosis. It is not typically used as a marker for hepatic dysfunction or alcoholic liver disease.
• White blood cell count: The WBC count is elevated (16,000/mm³), but this can be attributed to various causes such as inflammation or infection. It does not specifically support the diagnosis of cirrhosis like AST and ammonia levels do.

Rationale:
A. Consider having the teen's caregiver wait in the clinic reception area: Adolescents with ASD may experience heightened anxiety in unfamiliar environments. Having their caregiver nearby can offer a sense of security and comfort, making the experience less overwhelming.

B. Encourage the adolescent to handle the physical exam instruments: Allowing the adolescent to touch and explore the equipment before use helps reduce sensory-related anxiety. It also increases cooperation by promoting a sense of predictability and control.

C. Allow time for talking before beginning the physical assessment: Taking time to communicate and build rapport before initiating the assessment helps reduce anxiety and fosters trust. Many adolescents with ASD need more time to process information and adjust to new interactions.

D. Familiarize the adolescent with the clinic setting and healthcare staff: Gradual exposure to the physical space and people helps reduce sensory overload and builds comfort with the environment. Structured familiarity can prevent overstimulation and improve cooperation.

E. Make every effort to establish eye contact with the adolescent: Insisting on eye contact can increase distress, as many individuals with ASD find direct eye contact uncomfortable or overwhelming. Respecting their communication style is more effective than imposing neurotypical expectations.