A client with hepatic cirrhosis and severe ascites undergoes a therapeutic paracentesis, resulting in the removal of 4.5 liters of peritoneal fluid. Thirty minutes after the procedure, the client's heart rate increases from 84 to 118 bpm, and blood pressure decreases from 128/74 to 92/56 mm Hg. Which action should the nurse implement first to mitigate the risk of a life-threatening complication?
- Initiate the administration of a prescribed intravenous albumin infusionCevap
- BElevate the head of the bed to a high-Fowler's position and dangle the client's legs
- CAnalyze the client's most recent arterial blood gas results for signs of respiratory alkalosis
- DPerform deep abdominal palpation starting at the puncture site to assess for internal hemorrhage
Cevap
The nurse should immediately initiate the administration of prescribed intravenous albumin to expand intravascular volume and prevent hypovolemic shock.
The rapid removal of large volumes of ascitic fluid during a paracentesis significantly alters intra-abdominal pressure. This change often causes a rapid, compensatory shift of fluid from the intravascular space back into the peritoneal cavity or splanchnic vascular bed. This complication, known as post-paracentesis circulatory dysfunction, manifests clinically as hypovolemia (evidenced by tachycardia and hypotension). Intravenous albumin is a hypertonic colloid that increases intravascular oncotic pressure. Administering it pulls fluid back into the blood vessels, effectively restoring circulating volume and preventing life-threatening hypovolemic shock.
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Post-paracentesis circulatory dysfunction and intravascular volume replacement
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