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Difficulty: MediumReduction of Risk Potential

A client with hepatic cirrhosis and severe ascites has just completed a bedside paracentesis, during which 5 liters of fluid were drained. Shortly after the procedure, the nurse observes that the client's heart rate has increased from a baseline of 82 to 118 beats per minute, and capillary refill time is delayed at 4 seconds. The current blood pressure is 98/64 mm Hg. To address the most likely developing complication, which action should the nurse take?

  1. Initiate the prescribed intravenous infusion of albumin.Answer
  2. B
    Reposition the client into a high Fowler's position.
  3. C
    Document the vital signs as an expected physiological response to fluid removal.
  4. D
    Administer the prescribed oral loop diuretic to continue mobilizing third-spaced fluid.

Answer

The nurse should initiate the prescribed intravenous infusion of albumin to prevent or treat paracentesis-induced circulatory dysfunction.
Following a large-volume paracentesis (typically defined as the removal of more than 4 to 5 liters of fluid), the sudden decrease in intra-abdominal pressure can lead to splanchnic vasodilation and a rapid shift of fluid from the intravascular space into the peritoneal cavity. This fluid shift causes severe intravascular hypovolemia, evidenced in this client by tachycardia, delayed capillary refill, and decreasing blood pressure. Administering an intravenous colloid, such as albumin, increases intravascular oncotic pressure. This draws fluid back into the blood vessels, stabilizing hemodynamics and preventing life-threatening hypovolemic shock.

Step-by-Step Solution

1
Analyze the client's post-procedure assessment data, including tachycardia, delayed capillary refill, and borderline low blood pressure.
The findings indicate decreased intravascular volume and poor tissue perfusion.
These are classic compensatory signs of impending hypovolemic shock.
2
Connect the physiological findings to the recent large-volume paracentesis.
The removal of 5 liters of fluid decreased intra-abdominal pressure, leading to splanchnic vasodilation and a massive fluid shift out of the vascular space.
Understanding the mechanism of complication is required to select the correct targeted intervention.
3
Determine the highest priority intervention to stabilize the client's hemodynamics.
An intravascular volume expander, such as a colloid solution, must be administered.
Expanding the intravascular volume directly addresses the core physiological deficit.

Key Concept

Paracentesis-Induced Circulatory Dysfunction (Hypovolemic Shock)
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Topics

Reduction of Risk Potential

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