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Management and Treatment

- The management and treatment of ascites depend on the underlying cause and the severity of the condition.

- The general principles are:

  • Treat the cause of ascites if possible. For example, if ascites is due to liver cirrhosis, antiviral therapy for hepatitis B or C infection, abstinence from alcohol, or liver transplantation may be indicated.
  • Restrict sodium intake to less than 2 g/day to reduce fluid retention and edema. A low-sodium diet consists of avoiding processed foods, canned foods, salted snacks, cheese, cured meats, sauces, and adding salt to food.
  • Use diuretics to increase urine output and decrease fluid accumulation. The most commonly used diuretics are spironolactone and furosemide. The dose and frequency of diuretics should be adjusted according to the patient's weight, urine output, serum electrolytes, and renal function. The goal is to achieve a weight loss of 0.5 kg/day for patients with peripheral edema and 0.25 kg/day for patients without peripheral edema.
  • Perform therapeutic paracentesis to remove large volumes of fluid from the abdomen and relieve symptoms such as abdominal discomfort, dyspnea, or early satiety. This procedure should be done under sterile conditions and with local anesthesia. The amount of fluid removed depends on the patient's tolerance and hemodynamic status. Generally, no more than 5 L of fluid should be removed at one time. Albumin infusion may be given to prevent circulatory dysfunction after large-volume paracentesis.
  • Consider transjugular intrahepatic portosystemic shunt (TIPS) for patients with refractory ascites that do not respond to diuretics or repeated paracentesis. TIPS is a procedure that creates a shunt between the portal vein and the hepatic vein using a stent, thereby reducing portal pressure and improving blood flow. TIPS can improve ascites control but may also increase the risk of hepatic encephalopathy, bleeding, infection, or shunt dysfunction.

Questions on Management and Treatment

Correct Answer is B

Explanation

Ascites is not a genetic disorder and is not inherited from one's parents. It is a condition that develops due to various underlying medical conditions.

Correct Answer is B

Explanation

A high-protein diet is not specifically indicated to promote reabsorption of fluid in the abdomen. It is essential for clients with cirrhosis and ascites to follow a balanced diet that meets their individual nutritional needs.

Correct Answer is B

Explanation

Deep breathing exercises are beneficial for promoting lung expansion, but they may not be the priority in a client experiencing severe respiratory distress.

Correct Answer is C

Explanation

Reduced ankle edema and lower extremity swelling are not early signs of ascites progression. Ascites primarily affects the abdominal cavity, not the extremities.

Correct Answer is A

Explanation

A high-fat diet is not recommended for clients with cirrhosis and ascites. A balanced diet with appropriate protein and carbohydrate intake is more appropriate for managing this condition.

Correct Answer is D

Explanation

This statement is correct. Liver disease, particularly cirrhosis, is the leading cause of ascites due to its impact on fluid balance in the body.

Correct Answer is C

Explanation

Heart failure can result in fluid overload, but it is not directly related to the development of ascites in individuals with alcohol abuse.

Correct Answer is D

Explanation

This statement is correct. Chronic hepatitis C infection can lead to liver inflammation and fibrosis, which, in turn, can progress to cirrhosis, increasing the risk of developing ascites.

Correct Answer is C

Explanation

Cold and clammy extremities are not typical manifestations of ascites and are not directly related to fluid overload in congestive heart failure (CHF).

Correct Answer is D

Explanation

This statement is correct. The kidneys' primary function related to fluid balance is filtration and excretion of waste products and excess fluid, which helps maintain proper fluid balance in the body. In chronic kidney disease (CKD), impaired kidney function can lead to fluid retention and contribute to the development of ascites.

Correct Answer is B

Explanation

Rapid and irregular heart rate is not directly related to ascites. It may be associated with other conditions such as heart disease or infection.

Correct Answer is C

Explanation

Atelectasis is the collapse of part or all of a lung, and while it can be associated with difficulty breathing, it is not directly related to ascites.

Correct Answer is C

Explanation

Inflammation of the pancreas (pancreatitis) is not directly related to the abdominal pain and discomfort experienced by the client with ascites.

Correct Answer is D

Explanation

This statement is correct. Respiratory distress and cyanosis are concerning findings in a client with ascites, as they may indicate severe pulmonary edema or other respiratory complications that require immediate intervention and medical attention.

Correct Answer is D

Explanation

This statement is correct. Fatigue and weakness are common symptoms in clients with chronic liver disease and ascites, and they can be related to malnutrition, which is often seen in these clients due to poor appetite, nutrient malabsorption, and other factors related to liver dysfunction.

A complete blood count (CBC) is a blood test that evaluates the number and types of blood cells. While it may be useful for other diagnostic purposes, it is not used to visualize ascites.

Injecting medication into a joint for pain relief is not related to paracentesis or the management of ascites.

Elevated thyroid-stimulating hormone (TSH) is not directly related to the presence of ascites.

Bone Density Scan (DEXA scan) is used to assess bone health and is not directly related to the evaluation of ascites in clients with cirrhosis.

Pulmonary function tests are used to assess lung function and are not directly related to determining the underlying cause of ascites.

This statement is correct. Placing the client in a side-lying position helps to facilitate fluid drainage from the abdomen and can provide immediate relief to the client with ascites who is experiencing discomfort and difficulty breathing.

Increasing carbohydrate consumption for sustained energy is not directly related to reducing fluid accumulation in the abdominal cavity for clients with ascites.

Fasting for at least 12 hours before the procedure may not be necessary for a paracentesis, as it is typically a minor procedure and does not require prolonged fasting.

This statement is correct. Spironolactone is a potassium-sparing diuretic, which means it can lead to hyperkalemia (elevated potassium levels) if not monitored carefully. Hyperkalemia can cause irregular heart rhythms and other serious complications.

Hypothermia and shivering are not typical complications of therapeutic paracentesis. The procedure is performed under controlled conditions to minimize the risk of temperature-related complications.

Applying cold packs to the abdomen may provide temporary relief for localized pain but will not directly address the underlying issue of ascites or reduce abdominal distention.

Hypernatremia (elevated sodium levels) and increased thirst are not typically associated with spironolactone use.

Applying an abdominal binder may be beneficial in certain cases, but it will not directly address the underlying cause of ascites or reduce fluid accumulation in the abdomen.

Restricting fluid intake may not be appropriate for all clients with ascites, as fluid restriction could lead to dehydration and further imbalances in fluid and electrolyte levels.

Maintaining a supine position during the procedure is not required. The nurse should position the client comfortably, which may include elevating the head of the bed or placing the client in a side-lying position to facilitate fluid drainage. QUESTION
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