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.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Any condition that leads to extensive hepatocellular damage will increase the circulating total bilirubin concentration. Conditions include viral hepatitis, shock liver, alcoholic hepatitis and hepatocellular injury induced by drugs.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Transfusion of a single unit of packed RBCs is not likely to increase bilirubin levels. However, transfusion of multiple units over a short period almost inevitably leads to hyperbilirubinemia, particularly if hepatic functionality is already impaired.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
By exceeding the capacity of the liver to conjugate/excrete bilirubin, hemolysis can cause jaundice. However, the liver can excrete 300 mg/day of bilirubin and therefore significant hyperbilirubinemia is only apparent if hemolysis is rapid.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Hyperbilirubinemia is multifactorial and although laboratory values evaluating the production and excretion of bilirubin can guide the workup, a liver biopsy or cholangiography is necessary when no other diagnosis can be confirmed.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
Hyperbilirubinemia is also common in ICU patients who are recovering from cardiac surgery. Risk factors include prolonged cardiopulmonary bypass time, prolonged aortic cross-clamp time and use of an intraaortic balloon pump.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
The transition to terminal coagulopathy is disseminated intravascular coagulation and is appreciated by a decline in platelets and fibrinogen, which is presumed to occur from a consumption of these clotting components at the microvascular level.

Nursing Tip of the Day! - Critical Care Nursing

Category: Critical Care Nursing 
The counterbalance to systemic inflammatory response is called compensatory antiinflammatory response syndrome (CARS). CARS is associated with increased secondary infections, which can contribute to organ failure and death.