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Accumulation of free fluid in the liver. Ascites
65% of cirrhosis patients develop this condition. Ascites
Anything that can cause liver failure can cause what? Cirrhosis
Do we only see ascites with cirrhosis? No we can see it from other conditons aht cause liver failure.
What causes fluid to leak from the portal vein and cause ascites? The portal vein doesn't have enough albumin to hold fluid in there, so the fluid is going to leak into the abdominal cavity.
In addition to cirrhosis, what other things can cause ascites? Portal hypertension, fluid retention from aldosterone, and decreased colloidal osmotic pressure from decreased albumin.
Medically, how do we treat ascites. Avoid normal saline IV fluids, provide a low sodium diet IF THE PATIENT HAS EDEMA, and administer diuretics. Paracentesis, laveen shunts and TIPS may be used as well.
Unless the patient with ascites has edema, we don't restrict the: Sodium
What diuretics are used to treat ascites? Lasix and Aldactone
Why are diuretics used to treat ascites? They are used to try and get rid of some of the excess fluid the patient is retaining.
A loop diuretic that works on the distal Loop of Henle. It decreases the reabsorption of sodium. Potassium is lost with this diuretic. Lasix
What is the drug of choice in treating ascites? Aldactone
Why would aldactone be used to treat ascites? It decreases the production of aldosterone, so we are going tot stop the sodium and water retention problem with it.
Even though aldactone is potassium sparing, that is not why we give it to treat ascites. Why do we use it? Because it decreases production of aldosterone.
What is paracentesis used for when treating ascites? To withdraw fluid out of the peritoneal cavity. Basically tapping the ascitic fluid.
What position should the patient with ascites be in for a paracentesis? They should be sitting up to pull fluid away from the diaphragn and lungs. This will decrease the risk of pleural effusion and pneumothorax.
How much fluid can be removed from a patient with ascites when a paracentesis is performed? ALOT, there is not a set amount.
What is meant by a hyperdynamic state when referring to a patient with ascites? Their body has gotten used to having all this extra fluid, then all of a sudden it is removed with a needle. The patient could go into shock just like that.
Instead of focusing on how much fluid is taken out in when a paracentesis is performed on a patient with ascites, it is important to focus on: How the patient is tolerating the procedure. A patient can go into shock with 1/2 L or 1 L removed. It all depends on how he body has compensated and how used to the fluid the body is.
What condition do we worry about during and after a paracentesis for a patient with ascites? Hypovolemic Shock
Why do we have the patient empty their bladder before a parancentesis? So that they can sit up and sit still during the procedure.
As nurses what do we need to do prior to a paracentesis? We need to get baseline vitals and have the patient empty their bladder.
What would FFP do for a patient who has had a paracentesis? It helps to expand the fluid volume and that helps to counteract some of the shock the body may encounter when fluid is removed.
Why is parcentesis only a temporary measure in treating ascites? Because nothing has been done to fix the problem. The patient still has the leaky pipes, there is still a lack of albumin, and there still might be issues with aldosterone.
Why would a patient with ascites have a paracentesis? It is only palliative. It would be done to help the patient breathe more easily or ambulate better.
How much protein is lost with every liter of fluid removed in a paracentesis? 10-30 grams of protein
What is the big thing about paracentesis that we need to know. Patients can go into shock very easily, we need to monitor them before, during and after for signs of shock.
What is something we can administer to help with the deficiency of albumin. We can give albumin, it is really expensive and it comes in a litte golden colored vial. It is not used that often.
A little catheter that is put into the abdomen in the peritoneal space. It is threaded under the SC tissue and then it reroutes fluid into the jugular to that it will go around in the sysemic circulation. Laveen Shunt
Why aren't laveen shunts really used anymore? Because they clot a lot and then they have to back in and have them surgically replaced. This runs the risk of infection.
What procedure would be used instead of a laveen shunt for ascites caused by portal hypertension? TIPS
What are the nursing implications for ascites? Measure the abdomen, take daily weights, check for hypokalemia, check for thrill, assess for respiratory rate and effort, put patient in high Fowler's, get psych support for patient, and perform diet teaching.
Why do we take daily weights of a patient with ascites? It is much more valid than measuring the abdomen.
How do we palpate for a thrill in the patient with ascites? Have the patient put their hand midline and you put your hand across and tap and you will feel the wave of the fluid sloshing around in the abdomen.
When tapping the abdomen, if you feel a wave of fluid against your hand, that is considered a: Thrill for ascites.
Why is a patient put in High Fowlers when they are being treated for ascites? To keep the fluid away from their lungs.
What will we include in the diet of a patient who has ascites. Protein because the patient is deficient in protein.
What do we need to keep assessing in the patient with ascites because we are including protein in their diet? Why? We need to monitor ammonia levels becaue the liver might not be able to handle the extra protein.
Even if ammonia levels aren't being checked regularly in a patient with ascites, what should we as nurses watch for? We need to watch their mental status and watch for those subtle changes. Maybe do the handwriting thing or the math thing. We want to keep them from getting hepatic encephalopathy while we are trying to take care of the ascites.