A nurse is caring for an adult client with end-stage cirrhosis who recently underwent an u… — NCLEX-RN

A nurse is caring for an adult client with end-stage cirrhosis who recently underwent an ultrasound-guided bedside paracentesis with the removal of $4.5 \text{ liters}$ of ascitic fluid. Prior to the procedure, the client's vital signs were blood pressure $126/82 \text{ mmHg}$ and heart rate $86 \text{ bpm}$ .

Thirty minutes post-procedure, the client reports feeling slightly dizzy. The current assessment reveals the following data:

Parameter	Current Value
Blood Pressure	$92/74 \text{ mmHg}$
Heart Rate	$118 \text{ bpm}$
Respiratory Rate	$20 \text{ breaths/min}$
$SpO_2$	$96\%$ on room air
Arterial $pH$	$7.32$
$PaCO_2$	$31 \text{ mmHg}$
$HCO_3^-$	$15 \text{ mEq/L}$

Which action should the nurse take next to reduce the risk of severe physiological compromise?

A
Continue routine monitoring, as the widened pulse pressure indicates an expected hemodynamic response to fluid removal.
B
Apply supplemental oxygen to treat the underlying respiratory acidosis shown on the morning laboratory results.
Initiate the prescribed intravenous infusion of 25% human albumin.Answer
D
Elevate the head of the bed to a high Fowler's position to maximize diaphragmatic excursion.

Answer

The correct action is to initiate the prescribed intravenous infusion of 25% human albumin to prevent paracentesis-induced circulatory dysfunction.

The removal of a large volume of ascitic fluid rapidly decreases intra-abdominal pressure, leading to splanchnic vasodilation and a massive shift of intravascular fluid into the peritoneal space. This phenomenon, known as paracentesis-induced circulatory dysfunction (PICD), causes severe hypovolemia. The client's narrowing pulse pressure (

92 - 74 = 18 \text{ mmHg}

) and tachycardia (

118 \text{ bpm}

) are classic early compensatory signs of hypovolemic shock. Administering a hypertonic colloid, such as 25% human albumin, increases intravascular oncotic pressure, pulling fluid back into the vascular space and effectively mitigating the risk of cardiovascular collapse.

Step-by-Step Solution

Analyze the vital sign changes from baseline.

The blood pressure has dropped significantly to

92/74 \text{ mmHg}

, the pulse pressure has narrowed to

18 \text{ mmHg}

(

92 - 74 = 18

), and the heart rate has increased to

118 \text{ bpm}

Recognizing early hemodynamic trends is essential for detecting the onset of compensatory hypovolemic shock.

Interpret the arterial blood gas (ABG) values.

The ABG indicates a metabolic acidosis (

pH

7.32

HCO_3^-

15

) with partial respiratory compensation (

PaCO_2

31

), not a respiratory acidosis.

Accurate ABG interpretation prevents implementing inappropriate interventions, such as attempting to correct a nonexistent respiratory problem.

Evaluate the physiological impact of large-volume fluid removal.

The rapid removal of

4.5 \text{ liters}

of fluid drastically decreases intra-abdominal pressure, causing splanchnic vasodilation and a massive intravascular fluid shift.

Understanding the fluid dynamics of a large-volume paracentesis highlights the immediate risk for profound hypovolemia.

Select the priority risk-reduction intervention.

Administering a hypertonic colloid, such as 25% human albumin, is selected to restore intravascular volume.

Albumin provides the necessary oncotic pressure to pull fluid back into the vascular space, stabilizing hemodynamics and preventing cardiovascular collapse.

Key Concept

Paracentesis-Induced Circulatory Dysfunction (PICD)

Question

Answer

Step-by-Step Solution

Key Concept

Common Mistakes

Topics

More questions from this topic