Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Refractory ascites carries a mortality of 21% at 6 months and 70% at 2 years. Treatment consists of serial therapeutic paracentesis, transjugular intrahepatic portosystemic shunt (TIPS) or liver transplantation.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Refractory ascites is diagnosed when maximal medical management for at least 1 week or repeated large-volume paracenteses within 4 weeks are insufficient to remove ascites. Diuretic failure can often be a cause.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Patients with a low ascitic protein content are particularly at risk of developing spontaneous bacterial peritonitis. Treatment should start as soon as infection is suspected with a third-generation cephalosporin, such as ceftriaxone or cefotaxime.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Spontaneous bacterial peritonitis arises from translocation of intestinal bacteria, predominantly Escherichia coli and Klebsiella. Common symptoms include fever, abdominal pain, nausea and vomiting, encephalopathy and renal dysfunction.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Spontaneous bacterial peritonitis occurs in 30% of patients with ascites and is defined by: Positive bacterial culture, ascitic fluid polymorphonuclear cell count ≥250/mm3 and absence of surgically treatable source of infection.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Ascites signifies progression from compensated to decompensated liver failure and carries a 20% 1-year mortality. Within the first decade of diagnosis, 50% of patients with cirrhosis will develop ascites.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
After removal of a large volume during a paracentesis, paracentesis-induced circulatory dysfunction can result from effective hypovolemia with activation of the renin-angiotensin system, resulting in hyponatremia and renal impairment.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Diuretics are started for initial control, but therapeutic paracentesis is indicated in settings of tense ascites to relieve abdominal pressure. The procedure is relatively safe when done under ultrasound guidance.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
With ascites, nonsteroidal antiinflammatory drugs (NSAIDs) should be avoided, not only because of the risk of renal injury but also because they impede diuretic-mediated sodium excretion.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
After addressing underlying causes of cirrhosis, including alcohol cessation or hepatitis C treatment, ascites management is focused on fluid removal. Treatment of cirrhotic ascites is salt restriction and oral diuretics to promote natriuresis.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Symptoms of ascites include weight gain, abdominal pain, fullness, early satiety and shortness of breath. Portal hypertension due to increased hepatic resistance or portal blood flow is the key pathophysiologic event in the formation of ascites.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Although computed tomography (CT) will identify ascites, ultrasound is the preferred imaging modality. It is a highly sensitive, low-cost, nonradiation-producing method that simultaneously allows evaluation of the liver and hepatic vasculature.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Cirrhotic ascites can be uncomplicated or complicated, the latter involving concomitant development of spontaneous bacterial peritonitis, hepatorenal syndrome or hepatic hydrothorax.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Ascites is the pathologic accumulation of peritoneal fluid, occurring most commonly in decompensated liver cirrhosis (85%), with malignancy, tuberculosis, heart failure and pancreatitis accounting for the remainder.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
In most forms of jaundice resulting from hepatic inflammation or hepatocellular damage, circulating levels of transaminases are elevated to a greater extent than the total bilirubin concentration.