CPD practice profile
Ascites A CPD article reminded Lucy Ward of the causes and effects of ascites and the holistic care required for these patients
Hypertension
In a diseased liver, the structure of the liver changes; it atrophies and looks shrunken because of the formation of scar tissue. Increases in endothelin lead to vasoconstriction. As a result, pressure rises in the portal vein, leading to portal hypertension. Nitric oxide then causes vasodilaton because of the portal hypertension, increasing blood
NURSING STANDARD
Complications
PHOTOTAKE
Ascites is the accumulation of fluid in the peritoneal cavity. It can be caused by liver disease, tuberculosis, peritoneal infection, pancreatic disease and malignancies. In the emergency assessment unit where I work, many patients are admitted with ascites, mainly as a result of chronic liver disease or malignancy. Ascites occurs in 60% of patients with liver disease, and the presence of ascites reduces survival to approximately two years. Ascites causes discomfort and is a sign that the liver is compensating for damage and can no longer perform its functions effectively. The CPD article provided a good overview of the pathophysiology of the liver. The liver is highly vascular, with 1,500mL of blood being perfused through it every minute. It receives 75% of its blood supply from the portal vein, which delivers nutrient and toxin-rich blood from the stomach, spleen, umbilicus and intestines. The endothelial cells lining the blood vessels in the healthy liver produce endothelin and nitric oxide, which regulate vasoconstriction and vasodilation of local blood vessels.
blood volume. Eventually, the retained fluid in the swollen blood vessels starts to leak into the lymphatic system. The lymphatic system cannot cope with the increased volume of fluid and it starts to leak into the peritoneal cavity, forming ascites. The CPD article highlighted the psychological needs of patients with ascites, including depression and reduced quality of life. It also suggests how nurses can support patients or help with referrals. For example, referral to a counselling team may help patients to adjust to loss of independence and deterioration in health.
flow to the liver and pressure in the portal vein. The kidneys activate the renin-angiotensin-aldosterone system to increase blood supply to the kidneys. However, vasodilation of the abdominal vessels continues, and blood pressure in the kidneys continues to fall. The kidneys reabsorb sodium and water to increase
This practice profile is based on NS729 Fullwood D, Purushothaman A (2014) Managing ascites in patients with chronic liver disease. Nursing Standard. 28, 23, 51-58.
Ascites causes significant patient discomfort, in addition to various complications including shortness of breath and reduced appetite. As a nurse, it is important to be able to assess for ascites and start treatment in a timely fashion to limit complications. After reading the CPD article, I have a much better understanding of the complications of ascites, and why a patient may be fluid-restricted in some cases, or commenced on a non-added salt diet. I also understand that ascites increases a patient’s risk of infection, respiratory and renal problems. In addition, I am more aware of addressing the psychological effects of ascites on patients NS Lucy Ward is a staff nurse at Jersey General Hospital in St Helier, Jersey
Write your own practice profile You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a practice profile. Turn to page 49 for this week’s article and on page 60 you can find out how to present and submit your practice profile.
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 may 28 :: vol 28 no 39 :: 2014 59
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Ascites A CPD article reminded Lucy Ward of the causes and effects of ascites and the holistic care required for these patients
Hypertension
In a diseased liver, the structure of the liver changes; it atrophies and looks shrunken because of the formation of scar tissue. Increases in endothelin lead to vasoconstriction. As a result, pressure rises in the portal vein, leading to portal hypertension. Nitric oxide then causes vasodilaton because of the portal hypertension, increasing blood
NURSING STANDARD
Complications
PHOTOTAKE
Ascites is the accumulation of fluid in the peritoneal cavity. It can be caused by liver disease, tuberculosis, peritoneal infection, pancreatic disease and malignancies. In the emergency assessment unit where I work, many patients are admitted with ascites, mainly as a result of chronic liver disease or malignancy. Ascites occurs in 60% of patients with liver disease, and the presence of ascites reduces survival to approximately two years. Ascites causes discomfort and is a sign that the liver is compensating for damage and can no longer perform its functions effectively. The CPD article provided a good overview of the pathophysiology of the liver. The liver is highly vascular, with 1,500mL of blood being perfused through it every minute. It receives 75% of its blood supply from the portal vein, which delivers nutrient and toxin-rich blood from the stomach, spleen, umbilicus and intestines. The endothelial cells lining the blood vessels in the healthy liver produce endothelin and nitric oxide, which regulate vasoconstriction and vasodilation of local blood vessels.
blood volume. Eventually, the retained fluid in the swollen blood vessels starts to leak into the lymphatic system. The lymphatic system cannot cope with the increased volume of fluid and it starts to leak into the peritoneal cavity, forming ascites. The CPD article highlighted the psychological needs of patients with ascites, including depression and reduced quality of life. It also suggests how nurses can support patients or help with referrals. For example, referral to a counselling team may help patients to adjust to loss of independence and deterioration in health.
flow to the liver and pressure in the portal vein. The kidneys activate the renin-angiotensin-aldosterone system to increase blood supply to the kidneys. However, vasodilation of the abdominal vessels continues, and blood pressure in the kidneys continues to fall. The kidneys reabsorb sodium and water to increase
This practice profile is based on NS729 Fullwood D, Purushothaman A (2014) Managing ascites in patients with chronic liver disease. Nursing Standard. 28, 23, 51-58.
Ascites causes significant patient discomfort, in addition to various complications including shortness of breath and reduced appetite. As a nurse, it is important to be able to assess for ascites and start treatment in a timely fashion to limit complications. After reading the CPD article, I have a much better understanding of the complications of ascites, and why a patient may be fluid-restricted in some cases, or commenced on a non-added salt diet. I also understand that ascites increases a patient’s risk of infection, respiratory and renal problems. In addition, I am more aware of addressing the psychological effects of ascites on patients NS Lucy Ward is a staff nurse at Jersey General Hospital in St Helier, Jersey
Write your own practice profile You can gain a certificate of learning by reading a Nursing Standard CPD article and writing a practice profile. Turn to page 49 for this week’s article and on page 60 you can find out how to present and submit your practice profile.
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 may 28 :: vol 28 no 39 :: 2014 59
Downloaded from rcnpublishing.com by ${individualUser.displayName} on Jun 25, 2014. For personal use only. No other uses without permission. Copyright © 2014 RCN Publishing Ltd. All rights reserved.
