Question

1. How do physicians determine the underlying cause(s) of acid-base disorders? please include the reference(s) to number 1 question.
2. which diagnosis findings in patients with liver cirrhosis include would be nurse question.
a. INR 2.5
B. Pt 15 seconds
c. Bilirubin 5mg d/L
d. Albumin level 6.5g d/L
3. Priority Nursing action for the patient undergoing a paracentesis include? Select all that apply.
a. Obtain informed concent
b. Have the patient bathe
c. Assess vital signs and weight
d.Instruct the patient to lay in a supine position.
e. Have the patient void
4. Upon completion of the procedure, the priority nursing action is to? Select all that apply.
a. Note the amount of fluid and discard all fluid obtained
b. Put an abnormal binder on the patient
c. Apply a clear occlusive dressing to the insertion site
d. Assess vital signs, weigh patient and maintain the client on bed
5. The nurse will monitor the patient for which potential complication?
a. hypertension
b. increased abdominal girth
c. hematuria
d. decreased edema
6. Ascites is the accumulation of fluid where? a. In the liver
b. In the spleen.
c. In the umbilicus
d. In peritoneum

Answer 1

1.Proper evaluation and treatment of acid-base disorders requires a systematic and analytic approach .(1) assess the accuracy of the acid-base values using the Henderson equation, (2) Physical examination (3) calculate the serum anion gap, (4) identify the primary acid-base disturbance and determine whether a simple or mixed disturbance is present, (5) examine serum electrolytes and ABG, and (6) measure urine pH and urine electrolytes and calculate the urine anion and osmolal gaps.

(REF:Kraut & Madias, 2001)

2. a.INR-2.5 -An INR Level of 2.5 is optimal and is inside your therapeutic INR range of 2-3. This means your blood is considered "therapeutic"

b.Pt -15 seconds-Normal prothrombin time is 11-15 seconds,

c.Bilirubin 5mg/dl indicates jaundice and also may be due to cirrhosis

d. Albumin level - 6.5 g/dl - In liver cirrhosis albumin level will be low , so it will be questioned by the nurse

3.a. Obtain informed consent: As paracentesis is an invasive procedure , it is the priority nursing action to be performed.

b.Have patient bath : It is a daily activity

c.Assess vital signs and weight- It is a normal procedure carried out by nurses daily

d.Instruct the patient to lie in supine position- The client is positioned in Fowler’s position supported by back rest and pillows near the edge of the bed during paracentesis

4.a.Note the amount of fluid and discard all fluid obtained- The specimen collected should be sent to the laboratory

b.Put an abnormal binder on the patient-abdominal binder is applied to maintain intra-abdominal pressure but next to occlusive dressing

c.Apply a clear occlusive dressing to the insertion site- As soon as the needle is removed, a sterile dressing and a pressure bandage is applied at the puncture site to prevent leakage of fluid.

d.Assess vital signs, weigh patient and maintain the client on bed - The vital signs are checked half hourly for two hours; then hourly for 4 hours followed by 4 hourly for 24 hours, weight to be checked once when patient is in good condition.

5.a. Hypertension- Hypotension can occur after paracentesis.

b.Increased abdominal girth- After paracentesis the abdominal girth will reduce as some amount of fluid is removed.

c.Hematuria- nurse will monitor the patient for hemorrhagic complications

d.decreased edema-Edema may decrease after paracentesis as some amount of fluid is removed.

6.a.In the liver- Ascites is most often caused by liver scarring. This increases pressure inside the liver's blood vessels. The increased pressure can force fluid into the abdominal cavity, causing ascites.

b.In the spleen- Abdominal malignancy with ascites and peritoneal dialysis and trauma to spleen can lead to fluid accumulation

c.In umbilicus- Serous fluid accumulation in umbiicus is due to any cyst formation.

d.In peritoneum- Ascites is the accumulation of fluid in the peritoneal cavity, usually resulting from cirrhosis