In advanced cirrhosis with hepatic encephalopathy, which assessment finding should the nurse report immediately?

• A. Weight loss of 2 pounds in 3 days
• B. Anorexia for more than 3 days
• C. Change in handwriting and/or cognitive performance
• D. Constipation for more than 2 days

Answer: (C)

In hepatic encephalopathy, the most urgent signal is a change in mental status. The liver’s inability to detoxify ammonia allows it to affect brain function, so any new or worsening cognitive changes reflect a dangerous progression of brain involvement. A shift in handwriting, such as micrographia, is a concrete sign of motor and cognitive decline and often accompanies other neuropsychiatric changes like confusion or slowed thinking. Because encephalopathy can escalate quickly toward stupor or coma, reporting a new handwriting change or cognitive alteration right away prompts immediate assessment and intervention to prevent further deterioration.

Weight loss and anorexia are important but tend to reflect longer-standing or nutritional issues rather than an acute neurotoxic event. Constipation can worsen encephalopathy by increasing ammonia absorption, but it does not convey the same immediate risk as a new cognitive change.