When preparing a patient with hepatic encephalopathy for discharge home, which positioning action would best ease respirations?

• A. Elevate the head of the bed to 30 degrees
• B. Use a reclining chair
• C. Keep head flat
• D. Place patient in prone position

Answer: (A)

Elevating the head of the bed to about 30 degrees places the patient in a semi-Fowler’s position, which makes breathing easier. This angle allows the diaphragm to descend more fully with each breath and gives the chest wall more room to expand, increasing ventilation and reducing the work of breathing. It also helps lower the risk of aspiration by keeping the airway more aligned and above stomach contents in someone with altered mental status from hepatic encephalopathy. Lying flat can hinder diaphragmatic movement and impair ventilation, while prone or overly reclined positions are not as effective or practical for a patient being prepared to go home.