The nurse is completing preoperative teaching on a client. Which of the following response should the nurse offer to a client who asks why he's having a total colectomy with ileostomy formation to treat his ulcerative colitis?

The client's ammonia level is critically elevated (250 mcg/dL), which can lead to altered mental status, confusion, and lethargy, consistent with hepatic encephalopathy. In cirrhosis, the liver loses its ability to detoxify ammonia, leading to its accumulation in the bloodstream. This excess ammonia crosses the blood-brain barrier, impairing neuronal function and causing hepatic encephalopathy.

Incorrect answers:

DKA is characterized by high blood glucose (>250 mg/dL), metabolic acidosis, and ketonemia. This client has a moderate glucose elevation (148 mg/dL) but no signs of acidosis, Kussmaul respirations, or ketonuria.

Dehydration: While dehydration can contribute to mental status changes, severe hyperammonemia is a direct cause of hepatic encephalopathy. The client's crackles in the lungs and peripheral edema suggest fluid retention, not dehydration.

Acute kidney disease presents with rising creatinine levels, oliguria, and electrolyte imbalances. This client’s creatinine level is normal, ruling out acute kidney disease.

Malnutrition is characterized by low albumin, muscle wasting, and weight loss, but this client's elevated glucose is more likely due to diabetes mellitus rather than malnutrition.

A. Void prior to the paracentesis: Before a paracentesis, the patient is typically instructed to void to reduce the risk of puncturing the bladder during the procedure. It is an essential preparatory step.

B. Ask about family history of malignant hyperthermia: Malignant hyperthermia is related to anesthetic agents, not paracentesis.

C. Place the patient in the prone position for the procedure: The correct position for paracentesis is high Fowler’s (sitting upright at 45–90°) to allow fluid to collect in the lower abdomen for easier drainage.

D. Administer metronidazole prophylactically for infection: This is not a routine intervention before a paracentesis, as the risk of infection is managed with sterile technique during the procedure.