A patient with portal hypertension secondary to chronic liver cirrhosis was admitted in the surgical ward....

A patient with portal hypertension secondary to chronic liver cirrhosis was admitted in the surgical ward. The patient presented with emaciated body build, distended abdomen with prominent veins, and jaundice. The doctor ordered paracentesis and the following laboratory tests prior the procedure: Prothrombin time (PT), Activated Partial Thromboplastin Time (APTT), Total Protein, Albumin-Globulin ratio, AST, ALT.

List down two (2) nursing diagnoses and create a hypothetical FDAR for the patient.

Why is there a need to check the PT and APTT levels of the patient prior paracentesis?

What is the rationale behind the order of checking the Total Protein, Albumin-Globulin ratio?

Enumerate the following regarding the nursing role in assisting with paracentesis:

Position of choice

Site of insertion

At least three (3) nursing considerations.

Expert Solution

1 Nursing diagnosis are ascites and jaundice. FDAR for patient include the vitals monitoring, paracentesis to releive the ascites ,monitoring while doing paracentesis. Inform any complications timely to the physician.

2.PT and APTT indicate integrity of coagulation pathway. If it is abnormal there is a chance of severe bleeding after paracentesis. Hence it is very important to do PT and APTT before paracentesis.

3.Total protein and albumin globulin ratio indicates the proper functioning of liver and if it is reduced it may be the cause of ascites. Hence if the patient is having hypoalbuminemia, then intravenously albumin should be given.

4.Position for paracentesis : patient can be positioned in supine with hip and knee flexed.

Site for paracentesis : can be done on right flank.

Nurse should assist the physician while doing paracentesis, monitor the vitals, give psychological support to the patient and have a rapid response if any complications arise and assist the physician to manage the same.

Nightingale answered 2 years ago

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