Ascites Is A Special Case In The Medical Geriatric Ward Nursing Essay

Ascites Is A Special Case In The Medical gerontological Ward Nursing EssayBackgroundI think ascites is a special case in this Medical Geriatric ward, because I aphorism this only one case of ascites in this four weeks practicum. And it is my first sentence that cargon patient with ascites. Therefore, I interest and choose this case for perusing the breast feeding supervise of ascites.In this join patient mete out study, I will talk about the in attaination and relevant clinical selective information about this case, the pathophysiology of ascites, the nursing assessment, care design within patient hospitalise period 20-21/09/2010, plan for future management, and what I learn from this case.Case showingPatient X is 72-year-old male. He lives in old age home, conduct bound for activities of daily living. He is dependent Comprehensive Social security Assistance, exsmoker and exdrinker. He was admission to Accident Emergency at 20/09/2010. He complained that increased group AB distension for 2 twenty-four hourss, poor appetite, shortness of breath. Physcial form conscious, SaO2 95% under room air, afebrile, chest clear, no ankle edema. His master(a) diagnosis is cirrhosis and gross ascites. He has chronic renal impairment, diabetes mellitus, boozer cirrhosis of coloured, and chronic ascites. Last time admitted from 05-07/09/2010 for ascites, therapeutic type AB pat was done and 1.3L ascites unruffled was removed.Ascites is an accumulation of extracellular smooth in the peritoneal cavity abnormally. It is the most common major complication of approach soaring blood contract fol depleteding liver cirrhosis. Blocking the blood fdepression through the liver sinusoids to hepatic veins and vena cava lead to increased hug in the portal venous system.It results in plasma leaks out directly from the liver capsulate and the congested portal vein into the peritoneal cavity. In addition, hepatocellular damage reduces the livers capacity to synthes ize normal amounts of white, which may deteriorate by leakage of protein in ascites. The evidence of hypoalbuminemia shows in the blood test that the albumin was 24g/L, which is a low level. Adlosterone can non activate by liver to stimulate the kidneys to retain sodium and dead body of water due to hepatocellular damage. Thus, sodium and water are still retention, and the volume of peritoneal cavity silver grows continue.In this case, the medical management can be effected to patient X should be paracentesis or abdominal muscle tap. This physical process involves using a thin subscribele to pull ascites bland from the abdominal cavity (George Longstreth, 2009). Large-volume paracentensis repeated done in combination with Albumin look ated intravenously, which can negate a sudden drop in blood flow in the arteries and to replace each liter of removed ascitic unsound. The physician inflict IV administration of Albumin 40g after tapping and 30g. 10500ml milk like in colo r of ascites fluid was removed. If ascites is recurrent, therapeutic abdominal tap may un voidableness to be done both two weeks or much frequently, and need to remove up to 10 liters ascites fluid (Cirrhosis Ascites). Ascitic fluid abbreviation to a fault done before for provides a sample of fluid for analysis, which encourage for determine the underlying cause of the ascites. No malignant cell was found.An abdominal x-ray and ultrasonography study was done to comfier the presence of ascites. It may put fluid in the peritoneal cavity. The result did not show dilated bowel.A low sodium and protein diet with restriction of fluids 1L per twenty-four hour period. Edema in the form of ascites brings about shallow ventilation system and impaired gas exchange, as a result of respiratory compromise. We need to Promote and maintain an effective breathing pattern, Arterial blood gas analysis and pulse oximetry proctor every four hours were ordered. Potassium- sparing diuretic Frusem ide tablet 40mg twice a daylight was prescribed.Nursing assessmentIn abdominal assessment, inspect for skin impartiality (pigmentation, lesions, scars, veins, and umbilicus, etc), contour (flat, rounded, etc), distension, respiratory movement, visible peristalsis, and pulsations.Then to auscultation of the abdomen, warmed the stethoscope and the hands, light pressure act on the stethoscope is sufficient to detect bowel enunciates and bruits.Then perform percussion of the abdomen abdominal percussion is aimed at detecting fluid in the ascites, gaseous distension, and masses within the abdomen. Percuss lightly on abdomen according to auscultation site at each abdominal guardant. The sound will be dull if the ascites is presence. Measure the abdominal girth circumference. prise the amount of distress leaded by the ascites that ask the patient whether the fluid is interfering with sleeping, eating, and breathing (Head-To-Toe respectment (R. Abdomen), 2008).Nursing diagnosisExcess f luid volume and deficient fluid volume related to fluid shifts junior-grade to portal hypertension, hypoalbuminemia. It is a combination of volume problem for patient with ascites.The evaluate outcomes of this care plan are that a normal balance of fluid in the peritoneal cavity will be maintained as evidenced by normal serum albumin levels, without of hypovolemia, change magnituded abdominal girth, and normal blood pressure measurement. Electrolyte or acid- base are balance.For nursing intervention, monitor the intake and output of patient daily, and record the IO chart. Output should be equal to or exceed intake. Strictly restrict the patients fluid intake. If possible, administer medication with meals, so mealtime fluids can be used for taking medications. Assess the patients dietary intake and habits that may lead to fluid retention. Limit high sodium intake, because it can lead to increased water retention. Administer albumin and diuretics as physician prescribed. Aspirin an d nonsteroidal anti-inflammatory drugs may forbid prostaglandin synthesis and impair sodium excretion by the kidney. Thus, it needs to avoid administering them. Weight the client and measure the patients abdominal girth daily. Closely monitor the patient after paracentesis procedure. To ensure the client has tolerated the procedure well, suit the vital signs frequently. Check the dressing carefully to ensure that there are no losing excessive amounts of fluid. Use a pouch to collect leaking fluid if necessary.Ineffective breathing pattern related to increased intra-abdominal pressure on the diaphragm.The expected outcomes of this care plan are that the patient express embossment of feelings of faulty breathing pattern as a result of no shortness of breath and the presence of normal respiratory excursion. Patient has a normal respiratory rate, compared with baseline. (Lynda juall carpenito-moyet)For nursing intervention, position the client in a high-Fowler position with an arm su pported with pillows. It can facilitate breathing and relieves the pressure acting on diaphragm. Monitor the clients respiratory status (crackles and increased respirations) for the information of atelectasis or pneumonia to identifies fluid in lungs. further the patient to deep remain and cough. Use an incentive spirometer to maintain and monitor the respiratory function. If the cough does not loosen to expectorate reparatory secretion, patient can receive ultrasound handlingFor improving gas exchange, administer oxygen and blood products as ordered. instruct the patient some breathing techniques, such as pursed-lip breathing to vanquish poor breathing patterns (Lynda juall carpenito-moyet).To evaluation the outcome, treatments of ascites enable the client to breath with minimum difficulty.Imbalanced nutrition less than body requirements related to increased pressure on stomach and intestines, feeling of fullness, poor appetite.The expected outcomes of this care plan are that patient X has appetite and he can progress or increase body weight to an ideal weight and charter sufficient nutrients. Identify deficiencies in daily intake.For nursing intervention, measure the body weight daily to monitors the weight gain or loss. Monitor hemoglobin, hematocrit, albumin, total protein values for monitoring the intake of nutrients, presence of anemia, and colloidal osmotic pressure. can and encourage oral hygiene before meals, because poor oral hygiene may cause bad odor and taste, which can reduce appetite. Encourage the patient to rest before meals due to fatigue may decrease appetite and ability to eat. (Lynda juall carpenito-moyet) Provide small, frequent meals for patient instead of a couple of(prenominal) large ones, because even distribution of intake can help to encumber feeling full and ensures enough nutritional intake. Determine food preferences and selected low or no protein and low salt (no more than 1500 mg/day of sodium). If possible, encourag e the patients relative to bring permitted foods from home. Prevent constipation to reduce abdominal pressure and fullness. Administer Lactulose liquid 20mal three times a day as physician ordered.Plan for management after discharge, patient x should back to the old age home and have appraise up by community geriatric assessment service. Recommend short the follow up clinically admission if symptomatic ascites occur. Refer PCU home care nurse for visiting and symptom assessment, and admission clinically for symptom management. erudition pointsAfter this total patient care study, I have learnt that more understand the cause and care of ascites. And know that to provide a holistic care not only physical nursing care, but also we need to care the patient mental, social, finical condition, and discharge planning imbibe sure patient can have a complete care after discharge.Word count 1452Black, J. M. Hawks, J. H. (2009). Medical-Surgical nursing Clinical management for positively cha rged outcomes. Missouri Saunders.George F. Longstreth MDhttp//www.healthline.com/adamcontent/ascitesixzz11s5PVSziHead-To-Toe Assessment (R. Abdomen)(Head-To-Toe Assessment (R. Abdomen), 2008)(Cirrhosis Ascites).http//www.healthcentral.com/ency/408/guides/000075_11.html