Medical Surgical Labs Liver Labs #4

Question

The nurse received labs on her client who is being treated with lactulose for hepatic encephalopathy. Albumin is 3.3 g/dL, calcium 8.4 mg/dL, and potassium 3.2 mEq/L. It is time for the client’s second dose. The client has only had one bowel movement since the first dose. What action should the nurse take?

Answers

  1. Hold the drug and contact the HCP.
    • Rationale:

      This answer is not correct because hypokalemia is expected in the client who is taking lactulose. When ammonia is excreted through the bowels from lactulose, potassium will be also.

  2. Administer the medication as ordered.
    • Rationale:

      This answer is correct because lactulose should not be stopped due to loose stools or low potassium. These are to be expected with the use of lactulose. Lactulose excretes ammonia through the bowels and potassium will be excreted as well. Lactulose is not used long-term, it is a short-term medication, usually used for 24-28 hours.

  3. Delay administering the medication by 2 hours.
    • Rationale:

      This answer is not correct because lactulose should be given as ordered at the appropriate time. It should not be delayed by two hours just because labs show low potassium.

  4. Titrate the dose downward.
    • Rationale:

      This answer is not correct because potassium levels are not an indicator for dose adjustment. There is no need to titrate the dose down unless there are more than four large bowel movements a day. The client has only had one bowel movement since starting the medication.

Overview

Lactulose is a drug used to facilitate the removal of ammonia from the body through the bowels. Hypokalemia is a result and is to be expected and is not a reason to stop the administration of the medication.

Explanation

Learning Outcomes

Lactulose is a drug used to facilitate the removal of ammonia from the body through the bowels. Potassium will also follow. Hypokalemia is a result to be expected and is not a reason to stop the administration of the medication. Lactulose is not used long-term, it is a short-term medication, usually used for 24-28 hours. Potassium levels will be monitored; however, potassium is not an indicator for dose adjustment or holding the drug. This is due to the priority of the client’s safety. Increased ammonia levels causes a decline in brain function which can lead to safety issues for the client.

Test Taking Tip

Remember when lactulose is used to remove ammonia from the body, that is the priority. Mental status changes are a safety concern for the client with high levels of ammonia. This is where Maslow’s Hierarchy of Needs will come into play over the ABC triage.

Video Rationale