Mr. McClaren is a 48-year-old man who is admitted to the emergency department (ED) with abdominal pain and general weakness. He reports that he drinks “one bottle of scotch whisky every week for the past one year, and one to two cans of beer during the weekends.” For the past three months, his condition has started to deteriorate. His wife claims that “he has not been eating well for the past three months”. Mr. McClaren reports he has passed dark red stool on three occasions – the last one being just one day before coming to ED. On examination, Mr. McClaren has an enlarged abdomen with tenderness upon palpation. He also presents with the following clinical manifestations: peripheral edema, pale yellow skin color, dry mucus membranes and body weakness. The physician suspects that Mr. McClaren has hepatic cirrhosis. His vital sign findings include: Temperature 37.8 Celsius, BP 94/52, Pulse 110, Oxygen saturation 94%. From your nursing classes, you know that some of the treatments Mr. McClaren may receive are paracentesis, ultrasound and CT scan of the abdomen, as well as vitamin K administration.
Mr. McClaren is going to undergo a paracentesis to relieve the ascites. What are 3 nursing considerations you need to make for a patient undergoing a paracentesis?
Ans) Paracentesis:
- Inserting a needle or trocar through the abdominal wall into
the peritoneal cavity
- Relief of abdominal ascites pressure
- Once drained, fluid is sent to the lab for culture.
Nursing consideration during Paracentesis:
- - Determine patient's readiness for procedure
- Assess pertinent labs
- Verify that consent has been signed
- Gather equipment
- Have patient void before or insert a catheter
- Position patient upright, either on EOB or in high fowlers
- Review baseline vitals, weight, and abdominal girth
- Administer sedation as prescribed
- Administer IV bolus fluid or albumin, prior or after to restore
fluid balance.
Nurses responsibilities during a paracentesis:
- Monitor vital signs
- Adhere to standard precautions
- Label lab specimens and send them to the lab
- Monitor amount of drainage
- Notify provider of any complications
Nurses responsibilities after a paracentesis:
- Maintain pressure at insertion site for several minutes and apply
a bandage
- Check vital signs, record weight, and measure abdominal
girth
- Continue to monitor site and vitals
- Monitor temp every 4 hours for 48 hours
- Assess I&O every 4 hours
- Administer medications as prescribed
- Administer IV fluids or albumin as prescribed
- Assist patient into a comfortable position with HOB elevated to
promote lung expansion
- Document color, odor, consistency, and amount of fluid removed,
location of insertion site, evidence of leakage, manifestation of
hypovolemia, or changes in mental status
- Continue monitoring labs
Education that should be provided for a patient after a
paracentesis:
- Avoid alcohol
- Maintain a low sodium diet
- Monitor puncture site for bleeding or leakage of fluid
- Report changes in mental status due to change in electrolyte
balance
- Change positions slowly to decrease risk of falls due to
hypovolemia.
Mr. McClaren is a 48-year-old man who is admitted to the emergency department (ED) with abdominal...
Mr. McClaren is a 48-year-old man who is admitted to the emergency department (ED) with abdominal pain and general weakness. He reports that he drinks “one bottle of scotch whisky every week for the past one year, and one to two cans of beer during the weekends.” For the past three months, his condition has started to deteriorate. His wife claims that “he has not been eating well for the past three months”. Mr. McClaren reports he has passed dark...
A nurse is working on the medical-surgical unit of the hospital and is starting her shift for the day. One of her patient’s, Mr. W, is in the hospital for exacerbation of symptoms related to cirrhosis. Mr. W is a 55-year-old patient who has a history of alcohol use disorder, having abused alcohol for 33 years; he also suffers from atrial fibrillation and gastroesophageal reflux disease, and he is a smoker. He was admitted to the hospital last evening for...
Mr. Jimenez is a 61-year-old Spanish-speaking man who presented to the emergency room with his wife. His wife also speaks Spanish but does understand some English. Mr. Jimenez complains of nausea and vomiting for the last two days and symptoms of confusion. His blood glucose is 796 mg\deciliter. He has a past medical history of coronary artery disease (CAD) and hypertension (HTN). He has smoked one pack per day of cigarettes for the last 35 years as well as drinking...
John Smith is a 65-year-old retiree who is admitted to your unit from the emergency department (Ed). On arrival, you note that he is trembling and nearly doubled over with severe abdominal pain. John indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid back as a deep, sharp, boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to...
Mr John Norden is a 56 yr old man admitted to the ward with abdominal pain this morning. He has a history of frequent constipation, managed at home with a high fibre diet. Mr Norden tells you during the nursing assessment that he has not opened his bowels for the past four days. How to write a progress note about giving suppository and movicol.
Mr. Cruz is a 34 year old Mexican man who went to the Emergency Department (ED) because of several days of upper respiratory track symptoms. A chest x-ray revealed a small lung nodule of unknown significance. He was felt to have a viral syndrome and was given an appointment to follow-up in the pulmonary clinic in 10 days for further evaluation of the nodule. After missing his initial and two rescheduled appointments, one of the nurses called him home to...
John Smith is a 65-year-old retiree who is admitted to your unit from the emergency department (Ed). On arrival, you note that he is trembling and nearly doubled over with severe abdominal pain. John indicates that he has severe pain in the right upper quadrant (RUQ) of his abdomen that radiates through to his mid back as a deep, sharp, boring pain. He is more comfortable walking or sitting bent forward rather than lying flat in bed. He admits to...
J.G., a 69-year-old man, was seen in the emergency department (ED) 2 days ago, diagnosed (Dx) with alcohol intoxication, and released after 8 hours to his brother’s care. He was brought back to the ED 12 hours ago with an active gastrointestinal (GI) bleed and is being admitted to ICU; his diagnosis is upper GI bleed and alcohol intoxication. You are assigned to admit and care for J.G. for the remainder of your shift. According to the ED notes, his...
John Mathis, a 73-year-old male, is treated in the emergency department (ED) for an infected wound on his right foot. John states he was walking barefoot and stepped on something sharp that cut his foot. He treated it with topical antibiotics, but it appears red and inflamed, with purulent drainage. John is admitted to the medical-surgical unit for inpatient wound care treatment. As part of the admission interview, the nurse asks Mr. Mathis and his wife how they would like...
Derik Miller, a 25-year-old man, hops into the emergency department (ED) with complaints of right ankle pain. He states that he was playing basketball and stepped on another player’s foot, inverting his ankle. You note swelling over the lateral malleolus down to the area of the fourth and fifth metatarsals, and pedal pulses are 3+ bilaterally. His vital signs (VS) are 124/76, 82, 18. He has no allergies and takes no medication. He states he has had no prior surgeries...