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JODHPUR AIIMS SNO-2018
Medical & Surgical Nursing
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How should a nurse assess whether a patient with cirrhosis has asterixis?

Appeared in: JODHPUR AIIMS SNO-2018

Explanation

  • Asterixis, or 'flapping tremor', is a classic motor sign of hepatic encephalopathy, a complication of cirrhosis.
  • The standard clinical test to elicit asterixis begins with asking the patient to extend their arms forward.
  • Following arm extension, the patient is asked to dorsiflex their wrists (bend them upward).
  • The inability to hold this position, resulting in jerky, flapping movements of the hands, confirms the presence of asterixis.

Why Other Options Were Wrong

  • Option B: Leaning forward is a position used to facilitate breathing or listen to specific heart or lung sounds. It is not related to the neurological assessment of asterixis.
  • Option C: While a flapping tremor can sometimes be observed in the feet, the primary, most reliable, and standard method for assessing asterixis involves the upper extremities (arms and hands).
  • Option D: Measuring abdominal girth is a key nursing assessment for cirrhosis, but it is used to monitor a different complication: ascites (fluid accumulation in the peritoneal cavity).

Related Visual

Visual explanation — Related Visual
Clinical Relevance
  • Nursing practice connection: Use the key finding related to Clinical assessment for hepatic encephalopathy to guide bedside assessment, documentation, and the next nursing action.
  • The presence of asterixis is a significant clinical finding that indicates worsening hepatic encephalopathy, a potentially life-threatening condition.
  • Early detection of asterixis allows for prompt intervention, such as administering medications like lactulose to reduce ammonia levels, which can prevent progression to more severe stages of encephalopathy, coma, and death.
  • What if? If the patient was unable to follow commands to extend their arms due to lethargy (Stage 2-3 encephalopathy), the nurse would need to rely on other signs like changes in mental status, slurred speech, and drowsiness, and report these findings immediately. Asterixis may be absent in later stages.
How to Approach the Question
  • First, identify the key term in the question: 'asterixis'.
  • Recall or determine the definition of asterixis, which is a 'flapping tremor' associated with metabolic encephalopathies, particularly hepatic encephalopathy.
  • Think about the specific physical maneuver used to elicit this sign. The classic test involves a specific posture of the arms and hands.
  • Evaluate each option against this knowledge.
  • Option A describes the first step of the standard test.
  • Options B, C, and D describe assessments for different conditions (respiratory/cardiac, other neurological signs, and ascites, respectively). Eliminate these as incorrect for assessing asterixis.
Concept Tested & Keywords
  • Concept Tested: Clinical assessment for hepatic encephalopathy
  • Stem keywords: nurse, assess, cirrhosis, asterixis
  • Lead-in keywords: How
  • Clinical cues: Patient with cirrhosis, which is a risk factor for hepatic encephalopathy.

Question ID

Qkj7dEGE1KJTLgg7V23JV2

Reference Book

E6 Medicine Davidson Principles Practice 24e p. 867-869

E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 1562-1564

E6 Medicine Macleod Clinical Examination 15e p. 129-131

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