護理師對新診斷為肝硬化的病人進行出院衛教，下列哪些症狀提示肝腦病變的發生？（選所有適合的）
A nurse is providing discharge instructions to a client with a new diagnosis of cirrhosis. Which symptoms indicate the onset of hepatic encephalopathy? (Select all that apply.)
- AAsterixis (flapping tremors)✓ 正解撲翼樣震顫
- BAltered sleep-wake cycle✓ 正解睡眠-覺醒週期改變
- CIncreased ammonia levels in the blood✓ 正解血液中氨含量增加
- DDifficulty writing or drawing✓ 正解書寫或繪圖困難
- EHyperactivity and restlessness過動與躁動不安
肝腦病變是因為肝臟無法代謝氨（Ammonia），導致其堆積並傷害中樞神經。臨床表徵包括撲翼樣震顫（Asterixis）、睡眠障礙（白天嗜睡、夜間躁動）、書寫能力下降（constructional apraxia）以及血氨濃度升高。E 選項錯誤，通常呈現的是嗜睡與反應遲鈍，而非過動。
Hepatic encephalopathy occurs when the failing liver cannot metabolize ammonia, leading to CNS toxicity. Clinical features include asterixis (flapping tremor), altered sleep-wake cycle (daytime drowsiness, nighttime restlessness), impaired writing/drawing (constructional apraxia), and elevated serum ammonia. Hyperactivity and restlessness are not typical; lethargy and obtundation predominate.
美國護理師常運用格拉斯哥昏迷指數結合特定肝功能量表進行評估，台灣則依醫師臨床判斷為主。