Question

A client is admitted with cirrhosis of the liver and fluid in the peritoneal cavity. The physician instructs the nurse to prepare the client for a paracentesis. Which intervention would be included in preparation? A. Placing the client in the prone position B. Starting an IV with an 18-gauge needle C. Obtaining a lipid profile D. Assessing that the client empties the bladder

Short answer

Answer: The correct intervention is to assess that the client empties their bladder prior to the procedure.

Step-by-step solution

Understand the context and medical terms

Cirrhosis of the liver is a condition in which the liver does not function properly due to long-term damage. Fluid in the peritoneal cavity is called ascites. A paracentesis is a medical procedure used to remove the excess fluid from the peritoneal cavity. Now let's analyze each option:

Analyze Option A

Placing the client in the prone position means the client lies flat on their abdomen. This position will not be helpful for a paracentesis because it doesn't provide easy access to the area where the needle is inserted to drain the fluid. Also, it creates unnecessary pressure on the abdomen. So, Option A is not correct.

Analyze Option B

Starting an IV with an 18-gauge needle is not necessary for a paracentesis. An 18-gauge needle is typically used for infusing fluids or medications, not for the removal of fluid from the peritoneal cavity. Therefore, Option B is not correct.

Analyze Option C

Obtaining a lipid profile is not relevant for a paracentesis preparation. A lipid profile is a blood test to measure cholesterol and other fat levels in the blood. It does not help in preparing a client for a paracentesis procedure. Thus, Option C is not correct.

Analyze Option D

Assessing that the client empties the bladder is the correct intervention in this case. Emptying the bladder before a paracentesis is essential to minimize the risk of bladder injury during the procedure. As the peritoneal cavity and bladder are in close proximity, an empty bladder can help provide a safer and more accessible site for the paracentesis needle insertion.

Conclusion

In conclusion, the correct intervention to be included in preparing a client for a paracentesis is Option D: Assessing that the client empties the bladder.

Key concepts

Cirrhosis of the Liver

Cirrhosis is a chronic disease that results from the replacement of normal liver tissue with scar tissue, causing the liver to become hard and lumpy. This scarring disrupts the liver's ability to control infections, remove bacteria and toxins from the blood, process nutrients, and synthesize proteins necessary for blood clotting.

Over time, cirrhosis can lead to a variety of health problems, including fluid accumulation in the abdomen, known as ascites, and hepatic encephalopathy, which affects brain function. Long-term alcohol abuse, hepatitis infections, and fatty liver disease are among the leading causes of cirrhosis.

Management involves lifestyle modification, medications to manage symptoms, and routine monitoring for complications. It's critical to recognize that individuals with cirrhosis are often more susceptible to infections and may require specific nursing interventions to manage their overall health effectively.

Ascites and Paracentesis

Ascites is the accumulation of fluid within the peritoneal cavity, often due to advanced liver disease, such as cirrhosis. This condition can lead to discomfort, difficulty breathing, and increased risk of infection. A paracentesis is a procedure in which a needle is inserted through the abdominal wall to remove this excess fluid.

Risks and Considerations

Though paracentesis can provide significant relief, it carries potential risks such as infection or damage to surrounding organs. Therefore, the area must be sterile, and proper precautions must be taken.

Practical Steps for Paracentesis

Before the procedure, patients often need to give informed consent. They must also have certain blood tests to assess clotting ability, and they should empty their bladder to decrease the risk of accidental injury during the needle insertion.

Nursing Intervention

Nursing interventions for patients undergoing paracentesis are aimed at ensuring patient safety and comfort while facilitating a successful procedure.

• Ensuring the patient's bladder is empty is crucial, as a full bladder increases the risk of puncture when the paracentesis needle is inserted.
• Monitoring vital signs before, during, and after the procedure helps detect any immediate complications, such as changes in blood pressure or heart rate that could indicate bleeding or shock.
• Educating the patient about what to expect during the procedure can help alleviate anxiety and promote cooperation.
• Observing for signs of infection or changes in the patient's condition after the paracentesis is also an essential nursing role.

Overall, these interventions are designed to minimize risks and provide a supportive environment for patients facing this treatment.