GETTY
CPD reflective account The pressure of large volumes of fluid can compress the bowel and reduce blood supply to the abdominal organs. Reduced gut function and renal perfusion are possible consequences. This explains why most patients with ascites have poor appetites.
Treatment
Ascites A CPD article gave Abby Morrow-Barnes a better understanding of the causes and treatment of ascites I have looked after patients with ascites and those who have had large-volume paracentesis. This article has increased my understanding of ascites and helped to improve my nursing care. In liver disease, the flow of the blood to the liver and blood pressure in the blood vessels alter, leading to ascites – the accumulation of fluid in the peritoneal cavity which can cause abdominal distention. Its presence marks the transition from the liver being able to compensate for limited damage, to a liver that can no longer perform its functions. Once ascites is present, the prognosis for a patient with liver disease is poor. I now understand why most patients with ascites have chronically low blood pressure. The liver atrophies as it becomes damaged by disease, and the blood delivered to the liver starts to meet resistance. Pressure then rises in the portal vein. This in turn causes a rise in endogenous vasodilators,
blood being redirected away from major organs and an increased blood flow to the liver. The kidneys then activate the renin-angiotensin-aldosterone system to increase blood volume. Sodium and water are continuously reabsorbed from the loop of Henle, increasing blood volume, but the blood pressure remains inadequate. Fluid accumulating in the peritoneal cavity reduces the space available for lung expansion and can lead to shortness of breath. The stomach can also be compressed, leading to reduced appetite, and nausea and vomiting.
This reflective account is based on NS729 Fullwood D, Purushothaman A (2014) Managing ascites in patients with chronic liver disease. Nursing Standard. 28, 23, 51-58.
Treatment for patients with ascites aims to reduce sodium intake and increase renal sodium excretion. Diuretics are used in conjunction with salt restriction to increase the excretion of sodium via the kidneys. Patients should be monitored frequently. Bed rest with legs elevated is advocated and is likely to reduce peripheral oedema. Large-volume paracentesis is the insertion of a catheter into the peritoneal cavity to drain the fluid, and is the first line therapy in patients with large or grade 3 ascites. The fluid is drained continuously via the catheter over four to six hours. Fluid replacement is required to prevent cardiovascular complications. Patients need to have their bloods monitored for any electrolyte imbalances and renal impairment. Reading this article has improved my understanding of the aetiology and treatment of ascites as well as potential complications. I now feel more confident about providing evidence-based care NS Abby Morrow-Barnes is a staff nurse at Warwick Hospital, South Warwickshire NHS Foundation Trust
Write your own reflective account You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a reflective account. Turn to page 49 for this week’s article and on page 62 you can find out how to present and submit your reflective account.
Visit the RCN Learning Zone The RCN Learning Zone is a FREE online service to help RCN members with their continuing professional development and professional portfolio management. The RCN Learning Zone can be found at www.rcn.org.uk/members/learningzone.php
NURSING :: voluses 29 no 10 :: permission. 2014 61 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 14, 2015. For personal november use only. No5other without Copyright © 2015 RCNi Ltd. All rights reserved.
CPD reflective account The pressure of large volumes of fluid can compress the bowel and reduce blood supply to the abdominal organs. Reduced gut function and renal perfusion are possible consequences. This explains why most patients with ascites have poor appetites.
Treatment
Ascites A CPD article gave Abby Morrow-Barnes a better understanding of the causes and treatment of ascites I have looked after patients with ascites and those who have had large-volume paracentesis. This article has increased my understanding of ascites and helped to improve my nursing care. In liver disease, the flow of the blood to the liver and blood pressure in the blood vessels alter, leading to ascites – the accumulation of fluid in the peritoneal cavity which can cause abdominal distention. Its presence marks the transition from the liver being able to compensate for limited damage, to a liver that can no longer perform its functions. Once ascites is present, the prognosis for a patient with liver disease is poor. I now understand why most patients with ascites have chronically low blood pressure. The liver atrophies as it becomes damaged by disease, and the blood delivered to the liver starts to meet resistance. Pressure then rises in the portal vein. This in turn causes a rise in endogenous vasodilators,
blood being redirected away from major organs and an increased blood flow to the liver. The kidneys then activate the renin-angiotensin-aldosterone system to increase blood volume. Sodium and water are continuously reabsorbed from the loop of Henle, increasing blood volume, but the blood pressure remains inadequate. Fluid accumulating in the peritoneal cavity reduces the space available for lung expansion and can lead to shortness of breath. The stomach can also be compressed, leading to reduced appetite, and nausea and vomiting.
This reflective account is based on NS729 Fullwood D, Purushothaman A (2014) Managing ascites in patients with chronic liver disease. Nursing Standard. 28, 23, 51-58.
Treatment for patients with ascites aims to reduce sodium intake and increase renal sodium excretion. Diuretics are used in conjunction with salt restriction to increase the excretion of sodium via the kidneys. Patients should be monitored frequently. Bed rest with legs elevated is advocated and is likely to reduce peripheral oedema. Large-volume paracentesis is the insertion of a catheter into the peritoneal cavity to drain the fluid, and is the first line therapy in patients with large or grade 3 ascites. The fluid is drained continuously via the catheter over four to six hours. Fluid replacement is required to prevent cardiovascular complications. Patients need to have their bloods monitored for any electrolyte imbalances and renal impairment. Reading this article has improved my understanding of the aetiology and treatment of ascites as well as potential complications. I now feel more confident about providing evidence-based care NS Abby Morrow-Barnes is a staff nurse at Warwick Hospital, South Warwickshire NHS Foundation Trust
Write your own reflective account You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a reflective account. Turn to page 49 for this week’s article and on page 62 you can find out how to present and submit your reflective account.
Visit the RCN Learning Zone The RCN Learning Zone is a FREE online service to help RCN members with their continuing professional development and professional portfolio management. The RCN Learning Zone can be found at www.rcn.org.uk/members/learningzone.php
NURSING :: voluses 29 no 10 :: permission. 2014 61 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 14, 2015. For personal november use only. No5other without Copyright © 2015 RCNi Ltd. All rights reserved.
