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Difficulty: MediumReduction of Risk Potential

While assuming care for a client with advanced hepatic cirrhosis who recently underwent a large-volume paracentesis, the nurse evaluates the client's current status. The procedure notes indicate that 44 liters of ascitic fluid were removed. Which assessment finding is the most critical indicator of a developing physiological complication that requires immediate intervention?

  1. A steady increase in heart rate from 8686 to 114114 bpm combined with a narrowing pulse pressureAnswer
  2. B
    Arterial blood gas values demonstrating a pH of 7.427.42, PaCO 2_2 of 3838 mm Hg, and HCO 3−_3^- of 2424 mEq/L
  3. C
    The client maintaining a semi-Fowler's position to support optimal diaphragmatic excursion
  4. D
    A documented oral temperature of 99.0∘F99.0^\circ\text{F} (37.2∘C37.2^\circ\text{C}) accompanied by a report of mild procedural fatigue

Answer

A steady increase in heart rate from 86 to 114 bpm combined with a narrowing pulse pressure
The correct answer identifies classical early compensatory signs of hypovolemic shock. Large-volume paracentesis frequently causes profound intravascular fluid shifts into the peritoneal space. The body compensates for this sudden loss of circulating volume by increasing the heart rate (tachycardia) and increasing peripheral vascular resistance, which manifests as a narrowing pulse pressure. This critical finding demands immediate medical intervention to prevent severe physiological deterioration.

Step-by-Step Solution

1
Analyze the procedural risks associated with the client's history.
Large-volume paracentesis (removal of significant amounts of fluid, such as 44 liters) can lead to profound and rapid fluid shifts in clients with compromised liver function.
Removing ascitic fluid abruptly decreases intra-abdominal pressure, causing vasodilation and shifting fluid out of the intravascular space (third-spacing).
2
Evaluate the assessment findings against potential physiological complications.
Tachycardia (heart rate increasing to 114114 bpm) and a narrowing pulse pressure are classical early compensatory signs of hypovolemic shock.
The body attempts to compensate for the sudden decrease in circulating intravascular volume by increasing the heart rate and constricting peripheral vessels.
3
Prioritize the findings to determine the most critical indicator.
The hemodynamic instability takes immediate precedence over normal ABGs, therapeutic positioning, and expected mild post-procedural fatigue.
Unrecognized and untreated hypovolemic shock can rapidly progress to vital organ ischemia and cardiovascular collapse, demanding immediate interventions such as IV albumin administration.

Key Concept

Post-Paracentesis Hemodynamic Monitoring and Shock Recognition
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Topics

Reduction of Risk Potential

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