What early sign of hepatic encephalopathy might the nurse observe?

The presence of asterixis is an early sign of hepatic encephalopathy and is characterized by a flapping tremor of the hands when the wrists are extended. It occurs due to the impaired liver function, which leads to an accumulation of toxins, especially ammonia, in the bloodstream that affect the central nervous system. Asterixis serves as a visible cue of altered neurological status in patients with liver disease.

In contrast, restlessness, while it can be a symptom associated with various conditions, is not a specific sign of hepatic encephalopathy. Similarly, complaints of fatigue are common in many illnesses and are not unique indicators of liver dysfunction. Decreased serum ammonia levels would not be indicative of hepatic encephalopathy, as this condition is typically associated with elevated ammonia levels due to the liver's inability to detoxify this substance effectively. Thus, asterixis is a definitive and observable sign that points toward the onset of hepatic encephalopathy.