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

Ascites Is A Special Case In The Medical Geriatric Ward breast feeding EssayBackgroundI think ascites is a particular case in this Medical Geriatric ward, because I saw this only one case of ascites in this four weeks pr telephone numbericum. And it is my first time that dread uncomplaining with ascites. Therefore, I interest and choose this case for studying the treat care of ascites.In this jibe patient care study, I will talk active the information and relevant clinical data about this case, the pathophysiology of ascites, the nursing assessment, care plan within patient hospitalize period 20-21/09/2010, plan for future management, and what I learn from this case.Case presentationPatient X is 72-year-old male. He lives in old age home, chair bound for activities of daily living. He is dependent super Social Security Assistance, exsmoker and exdrinker. He was admission to Accident Emergency at 20/09/2010. He complained that increased abdominal distension for 2 twenty-fo ur hourss, poor appetite, precipitancy of breath. Physcial condition conscious, SaO2 95% under room air, afebrile, chest clear, no ankle edema. His primary diagnosis is cirrhosis and gross ascites. He has chronic renal impairment, diabetes mellitus, dipsomaniac cirrhosis of liver, and chronic ascites. Last time admitted from 05-07/09/2010 for ascites, therapeutic abdominal tap was through with(p) and 1.3L ascites fluid was removed.Ascites is an accumulation of extracellular fluid in the peritoneal nether region abnormally. It is the most common major complication of portal hypertension following liver cirrhosis. Blocking the blood flow through the liver sinusoids to hepatic veins and vena cava lead to increased pressure in the portal venous system.It results in plasma leaks out directly from the liver capsule and the congested portal vein into the peritoneal cavity. In addition, hepatocellular damage reduces the livers might to synthesize normal amounts of albumin, which may deteriorate by leakage of protein in ascites. The evidence of hypoalbuminemia shows in the blood establish that the albumin was 24g/L, which is a low level. Adlosterone offernot activate by liver to stimulate the kidneys to retain sodium and water due to hepatocellular damage. Thus, sodium and water are unperturbed retention, and the volume of peritoneal cavity fluid grows continue.In this case, the medical management can be performed to patient X should be paracentesis or abdominal tap. This procedure involves using a thin needle to pull ascites fluid from the abdomen (George Longstreth, 2009). Large-volume paracentensis repeated make in combination with Albumin conducted intravenously, which can repress a sudden drop in blood flow in the arteries and to replace each liter of removed ascitic fluid. The physician prescribed IV administration of Albumin 40g later on tapping and 30g. 10500ml milk like in color of ascites fluid was removed. If ascites is recurrent, therapeutic abdominal tap may need to be done every two weeks or more frequently, and need to remove up to 10 liters ascites fluid (Cirrhosis Ascites). Ascitic fluid analysis also done earlier for provides a sample of fluid for analysis, which help 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 locate fluid in the peritoneal cavity. The result did not show dilated bowel.A low sodium and protein diet with restriction of fluids 1L per day. oedema in the form of ascites brings about shallow breathing and impaired gas exchange, as a result of respiratory compromise. We need to Promote and maintain an legal breathing pattern, Arterial blood gas analysis and pulse oximetry monitor every four hours were ordered. Potassium- sparing diuretic Frusemide tablet 40mg twice a day was prescribed.Nursing assessmentIn abdominal assessment, inspect for skin integrity (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 sounds and bruits.Then perform percussion of the abdomen abdominal percussion is aimed at detecting fluid in the ascites, volatilised distension, and masses within the abdomen. Percuss lightly on abdomen according to auscultation site at each abdominal guardant. The sound will be tiresome if the ascites is presence. Measure the abdominal girth circumference. Assess 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 judging (R. Abdomen), 2008).Nursing diagnosisExcess fluid volume and deficient fluid volume related to fluid shifts secondary to portal hypertension, hypoalbuminemia. It is a combination of volume riddle for patient with ascites.The anticipate outcomes of this care plan are that a normal balance of fluid in the peritoneal cavity will be well-kept as evidenced by normal serum albumin levels, without of hypovolemia, decreased 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 and nonsteroidal anti-inflammatory drugs may inhibit prostaglandin synthesis and impair sodium excretion by the kidney. Thus, it needs to avoid admin istering them. Weight the client and measure the patients abdominal girth daily. Closely monitor the patient after paracentesis procedure. To plug the client has tolerated the procedure well, check the vital signs frequently. Check the dressing carefully to ensure that there are no losing excessive amounts of fluid. Use a sack 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 extract relief of feelings of faulty breathing pattern as a result of no mulctness 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 supported with pillows. It can facilitate breathing and relieves the pressure performing on diaphragm. Monitor the clients respiratory status (crackles a nd increased respirations) for the development of atelectasis or pneumonia to identifies fluid in lungs. Encourage the patient to deep breathe and cough. Use an bonus spirometer to maintain and monitor the respiratory function. If the cough does not loosen to expectorate reparatory secretion, patient can receive ultrasound treatmentFor improving gas exchange, administer oxygen and blood products as ordered.Teach the patient some breathing techniques, such as pursed-lip breathing to overcome poor breathing patterns (Lynda juall carpenito-moyet).To evaluation the outcome, treatments of ascites change the client to breath with minimal 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 keep or increase body pitch to an ideal weight and consume sufficient nutrients. Identify deficiencies in daily intake.F or 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. Offer 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 few large ones, because even distribution of intake can help to prevent feeling full and ensures affluent nutritional intake. Determine food preferences and selected low or no protein and low salt (no more than 1500 mg/day of sodium). If possible, encourage the patients relative to bring permitted foods from home. block constipation to reduce abdominal pressure and fullness. Administer Lactulose liquid 20mal three times a day as phy sician ordered.Plan for management after discharge, patient x should back to the old age home and have follow 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. development 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 Make sure patient can have a complete care after discharge.Word count 1452Black, J. M. Hawks, J. H. (2009). Medical-Surgical nursing Clinical management for positive outcomes. Missouri Saunders.George F. Longstreth MDhttp//www.healthline.com/adamcontent/ascitesixzz11s5PVSziHead-To-Toe Assessment (R. Abdomen)(Head-To-Toe Assessment (R. Abdomen), 2008)(Cirrh osis Ascites).http//www.healthcentral.com/ency/408/guides/000075_11.html