Ascites Nursing Diagnosis: A Comprehensive Guide for Healthcare Professionals

Ascites, the pathological accumulation of fluid within the peritoneal cavity, is a significant clinical manifestation often indicative of underlying systemic disease. While various conditions can precipitate ascites, liver cirrhosis stands out as the predominant etiology, accounting for over half of all diagnosed cases. The intricate pathophysiology of ascites involves a cascade of events initiated by increased portal pressure and elevated nitric oxide levels, leading to vasodilation, hormonal imbalances, compromised renal function, and ultimately, the translocation of fluid into the peritoneal space.

This article provides an in-depth exploration of ascites from a nursing perspective, focusing on the critical aspects of nursing diagnosis, assessment, interventions, and care planning. Designed for nurses and healthcare professionals, this guide aims to enhance understanding and improve patient care for individuals experiencing ascites.

Understanding Ascites: Etiology and Pathophysiology

What is Ascites?

Ascites is defined by the abnormal buildup of fluid in the peritoneal cavity, the space within the abdomen that houses organs like the liver, stomach, and intestines. This fluid accumulation is not a disease in itself but rather a symptom of an underlying medical condition. The development of ascites is often linked to a complex interplay of physiological changes, primarily driven by portal hypertension.

In the context of liver cirrhosis, the scarred and fibrotic liver tissue obstructs blood flow through the portal vein, leading to increased pressure within the portal venous system (portal hypertension). This hypertension triggers a cascade of events, including:

• Vasodilation: Elevated portal pressure and increased nitric oxide levels cause splanchnic vasodilation (dilation of blood vessels in the abdominal organs).
• Hormonal Imbalances: Vasodilation leads to a decrease in effective circulating blood volume, activating vasoconstrictor hormones like renin-angiotensin-aldosterone system (RAAS) and antidiuretic hormone (ADH).
• Renal Dysfunction: Hormonal imbalances and renal hypoperfusion contribute to sodium and water retention by the kidneys.
• Fluid Shift: The combination of increased hydrostatic pressure in portal capillaries and decreased oncotic pressure (due to reduced albumin synthesis by the diseased liver) forces fluid out of the blood vessels and into the peritoneal cavity, resulting in ascites.

Understanding this pathophysiological process is crucial for healthcare professionals to effectively manage and care for patients with ascites.

Common Causes of Ascites

While liver cirrhosis is the most common cause, ascites can arise from a range of medical conditions. Identifying the underlying cause is paramount for targeted treatment and management. Key causes of ascites include:

• Liver Cirrhosis: The most frequent cause, resulting from chronic liver diseases such as alcoholic liver disease, viral hepatitis (Hepatitis B and C), and non-alcoholic fatty liver disease (NAFLD).
• Heart Failure: Congestive heart failure, particularly right-sided heart failure, can lead to systemic venous congestion and fluid accumulation, including ascites.
• Cancer: Malignancies, especially those involving the peritoneum (peritoneal carcinomatosis), liver cancer, ovarian cancer, and other abdominal cancers, can cause ascites.
• Kidney Disease: Nephrotic syndrome and end-stage renal disease can result in fluid retention and ascites due to protein loss and impaired fluid balance.
• Pancreatitis: Severe acute or chronic pancreatitis can sometimes lead to ascites due to pancreatic fluid leaks and inflammation.
• Tuberculosis: Peritoneal tuberculosis is an infectious cause of ascites, particularly prevalent in regions with high TB incidence.
• Ovarian Lesions: Benign or malignant ovarian tumors can, in rare cases, be associated with ascites (Meigs’ syndrome).
• Other Conditions: Less common causes include Budd-Chiari syndrome (hepatic vein obstruction), constrictive pericarditis, and severe malnutrition.

Risk Factors for Ascites

Several factors increase the likelihood of developing ascites, primarily those that predispose individuals to liver damage and related complications:

• Liver Cirrhosis: As the leading cause, any condition leading to cirrhosis is a major risk factor.
• Excessive Alcohol Use: Chronic alcohol abuse is a significant contributor to liver cirrhosis and subsequent ascites.
• Viral Hepatitis: Chronic infections with Hepatitis B and Hepatitis C viruses can cause liver damage and cirrhosis.
• Non-alcoholic Steatohepatitis (NASH): Fatty liver disease, often associated with obesity and diabetes, can progress to NASH and cirrhosis.
• Cancer in Abdominal Organs: Malignancies in the liver, ovaries, colon, and other abdominal organs increase ascites risk.
• Portal Vein Thrombosis: Blockage of the portal vein can elevate portal pressure and contribute to ascites.
• Kidney Failure: Chronic kidney disease and nephrotic syndrome predispose to fluid retention.

Understanding these risk factors enables healthcare professionals to identify individuals at higher risk and implement preventive measures or early interventions.

Nursing Assessment for Ascites: Subjective and Objective Data

A comprehensive nursing assessment is the cornerstone of effective care for patients with ascites. This assessment involves gathering both subjective data (patient’s reported symptoms and history) and objective data (physical examination findings and diagnostic results).

Subjective Data: Review of Health History

Obtaining a thorough health history is crucial for understanding the patient’s condition and identifying potential contributing factors.

General Symptoms

Begin by asking the patient about their symptoms. Common complaints associated with ascites include:

• Abdominal Distention: Patients often describe a noticeable increase in abdominal size or a “swollen belly.”
• Abdominal Pain or Discomfort: Discomfort can range from mild fullness to more pronounced abdominal pain or heaviness. (Abdominal pain nursing diagnosis)
• Increased Abdominal Pressure: A sensation of pressure or tightness in the abdomen is frequently reported.
• Weight Gain: Rapid weight gain, despite potentially reduced appetite, is a hallmark of fluid retention.
• Early Satiety: Feeling full quickly after starting to eat due to abdominal distention.
• Bloating: A subjective feeling of abdominal fullness and gas.
• Loss of Appetite (Anorexia): Reduced desire to eat, often linked to abdominal discomfort and fullness.
• Nausea: Feeling sick to the stomach, sometimes with vomiting. (Nausea nursing diagnosis)
• Indigestion: Symptoms of discomfort after eating, such as heartburn or upset stomach.
• Constipation: Difficulty passing stools, which can be exacerbated by abdominal pressure and reduced mobility. (Constipation nursing diagnosis)
• Shortness of Breath (Dyspnea): Fluid accumulation can push on the diaphragm, restricting lung expansion and causing breathlessness. (Shortness of breath nursing diagnosis)
• Generalized Edema (Anasarca): Swelling in other parts of the body, such as legs, ankles, and feet, indicating systemic fluid overload.
• Fatigue: Feeling unusually tired or weak. (Fatigue nursing diagnosis)
• Sense of Heaviness: A feeling of weight or dragging sensation in the abdomen.

Determining Causative Factors

Inquire about the patient’s medical history to identify potential underlying causes of ascites. Ask about conditions such as:

• Liver Disease: History of liver cirrhosis, hepatitis (viral or alcoholic), or non-alcoholic fatty liver disease (NAFLD). (Liver cirrhosis nursing diagnosis)
• Heart Conditions: History of heart failure or other cardiac issues. (Heart failure nursing diagnosis)
• Cancer History: Previous diagnoses of cancer, particularly abdominal or pelvic malignancies. (Cancer nursing diagnosis) (Colon cancer nursing diagnosis)
• Kidney Disease: History of kidney failure, nephrotic syndrome, or dialysis. (Kidney failure nursing diagnosis)
• Pancreatitis: Prior episodes of pancreatitis. (Pancreatitis nursing diagnosis)
• Tuberculosis Exposure: History of tuberculosis or exposure to TB. (Tuberculosis nursing diagnosis)
• Diabetes: History of type 2 diabetes, which is linked to NAFLD and cirrhosis. (Type 2 diabetes nursing diagnosis)
• Hypercholesterolemia: High cholesterol levels, also associated with NAFLD.
• Peritonitis: Past infections of the peritoneum.
• Chronic Alcohol Use: Assess the patient’s history of alcohol consumption.
• IV Drug Use: History of intravenous drug use, which increases the risk of viral hepatitis. (IV drug use nursing diagnosis) (Substance abuse nursing diagnosis)
• Obesity: Assess for obesity, a risk factor for NAFLD and NASH. (Obesity nursing diagnosis)
• Malnutrition: Severe malnutrition can, paradoxically, contribute to ascites in some cases. (Malnutrition nursing diagnosis)

Identifying Risk Factors

Explore the patient’s lifestyle and medical history to identify specific risk factors for ascites:

• Liver Cirrhosis: History of any condition leading to cirrhosis.
• Viral Hepatitis: History of hepatitis B or C infection.
• Excessive Alcohol Use: Long-term heavy alcohol consumption.
• Non-alcoholic Steatohepatitis (NASH): Presence of fatty liver disease.
• Cancer in Abdominal Organs: Known malignancies in the abdomen.
• Portal Vein Thrombosis: History of blood clots in the portal vein.
• Kidney Failure: Pre-existing kidney dysfunction.

Objective Data: Physical Assessment

The physical examination is crucial for detecting and assessing ascites.

Abdominal Girth Measurement

• Procedure: Measure the circumference of the abdomen at the level of the umbilicus using a measuring tape. Ensure consistent landmarking for subsequent measurements.
• Significance: Serial measurements of abdominal girth are valuable for monitoring fluid accumulation over time and assessing treatment effectiveness. An increase in girth suggests worsening ascites.

Vital Signs Monitoring

Monitor vital signs regularly, as fluid accumulation can impact cardiovascular function:

• Blood Pressure: May be elevated in cases of fluid overload, but can also be low in advanced liver disease due to vasodilation.
• Heart Rate: Tachycardia (increased heart rate) may occur as the body attempts to compensate for fluid shifts. Bounding pulses can also be present with fluid overload.
• Temperature: Fever may indicate infection of the ascitic fluid (spontaneous bacterial peritonitis).

Physical Examination Findings

A detailed physical examination should include the following:

• General Appearance: Note any weight gain, overall edema (anasarca), and signs of discomfort.
• Gastrointestinal System:
  • Inspection: Observe for abdominal distention, a firm abdomen, and an inverted umbilicus (pushed inward due to swelling). Bulging flanks when the patient is lying supine are another visual sign.
  • Percussion: Percuss the abdomen to assess for tympany (hollow sound) over the umbilicus (due to gas-filled intestines) and dullness (thud-like sound) over the flanks and sides (indicating fluid).
  • Palpation: Gently palpate the abdomen to assess for firmness and tenderness.
• Cardiovascular System (if ascites is suspected to be due to heart failure):
  • Jugular Venous Distension (JVD): Visible distention of the jugular veins in the neck, indicating increased central venous pressure.
• Respiratory System (if ascites is suspected to be due to heart failure):
  • Dyspnea and Orthopnea: Shortness of breath, especially when lying flat (orthopnea), and pulmonary congestion (rales or crackles on auscultation) may be present due to fluid overload.
• Lymphatic System:
  • Peripheral Edema: Assess for edema in the extremities, particularly the lower legs and ankles.
• Genitourinary System:
  • Scrotal Edema: Swelling of the scrotum in males may occur.
• Integumentary System (if ascites is due to advanced liver disease):
  • Spider Angioma: Small, spider-like blood vessels visible on the skin.
  • Jaundice: Yellowing of the skin and sclera (whites of the eyes) due to bilirubin buildup.
  • Palmar Erythema: Redness of the palms of the hands.
  • Muscle Wasting: Loss of muscle mass, particularly in the extremities (temporal wasting, thin extremities).
  • Gynecomastia: Enlargement of breast tissue in males.

Ascites Detection Maneuvers

Several physical examination maneuvers can aid in detecting ascites. It’s recommended to use at least two maneuvers, as no single test is perfectly sensitive or specific:

• Bulging Flanks: Observe if the patient’s flanks protrude outwards when lying supine. A positive finding suggests fluid accumulation.
• Flank Dullness: Percuss the abdomen, noting the sound over the umbilicus (tympany) and the flanks (dullness). In ascites, dullness will be present in the flanks due to fluid.
• Shifting Dullness: Percuss the abdomen while the patient is supine, outlining areas of tympany and dullness. Then, have the patient turn to a lateral decubitus position (lying on their side) and repeat percussion. In ascites, the area of dullness will shift to the dependent side (lower side), while tympany shifts upwards as the fluid moves with gravity.
• Fluid Wave: Have the patient or an assistant place the ulnar edge of their hand firmly along the midline of the abdomen to prevent transmission of a skin wave. Tap one flank sharply with your fingertips, and simultaneously palpate the opposite flank with your other hand. If ascites is present, you may feel a fluid wave or impulse transmitted to your palpating hand.

Fluid Intake and Output Tracking

Accurate monitoring of fluid intake and output is essential for assessing fluid balance.

• Intake: Document all oral and intravenous fluid intake.
• Output: Record urine output and any other fluid losses (e.g., drainage from paracentesis).
• Balance: Calculate the fluid balance to assess fluid retention or deficit.

Diagnostic Procedures for Ascites

Diagnostic procedures are crucial for confirming the presence of ascites, determining its cause, and ruling out other conditions.

Ascitic Fluid Analysis (Paracentesis)

• Diagnostic Abdominal Paracentesis: This procedure involves inserting a needle into the abdominal cavity to withdraw ascitic fluid for analysis. It is the most efficient method for determining the cause of ascites.
• Fluid Appearance: Ascitic fluid is typically clear or straw-colored (yellow-tinged). Cloudy or turbid fluid may suggest infection.
• Fluid Culture: A sample of ascitic fluid can be sent for culture to detect bacteria or other pathogens, especially if spontaneous bacterial peritonitis (SBP) is suspected. Cytology can also be performed to look for cancer cells.

Ascitic Fluid Investigation

Analysis of the ascitic fluid provides valuable diagnostic information:

• Cell Count: Includes total nucleated cell count and polymorphonuclear neutrophils (PMN) count. Elevated PMN count (>250 cells/mm³) is suggestive of SBP.
• Bacterial Culture and Gram Stain: To identify bacterial infections.
• Serum-Ascites Albumin Gradient (SAAG): Calculated by subtracting the ascitic fluid albumin level from the serum albumin level. A high SAAG (≥1.1 g/dL) typically indicates portal hypertension as the cause of ascites (e.g., cirrhosis, heart failure), while a low SAAG suggests other causes (e.g., malignancy, tuberculosis, nephrotic syndrome).
• Total Protein: Helps differentiate between transudative (low protein, often seen in cirrhosis and heart failure) and exudative (high protein, seen in infection and malignancy) ascites.
• Glucose, LDH, Amylase, Bilirubin: These tests can provide further clues to the etiology of ascites.

Radiology Tests

Radiological imaging can help detect ascites and identify underlying conditions:

• Chest X-ray: In severe ascites, a chest x-ray may show elevation of the diaphragm and pleural effusions (fluid around the lungs).
• Ultrasound: Abdominal ultrasound is a highly sensitive and accurate test for detecting ascites. It can visualize even small volumes of fluid (as little as 5 mL). Ultrasound can also guide paracentesis procedures.
• CT Scan: Computed tomography (CT) scans of the abdomen and pelvis are more detailed imaging studies that can diagnose ascites and may reveal underlying malignancies or other structural abnormalities.

Alt text: A medical professional performs an abdominal paracentesis procedure on a patient to drain ascitic fluid, with equipment and sterile drapes visible.

Nursing Interventions for Ascites: Managing Fluid and Risk Factors

Nursing interventions for ascites are focused on managing fluid retention, addressing underlying causes, and preventing complications.

Managing Fluid Retention

The primary goal of managing ascites is to reduce fluid accumulation and alleviate associated symptoms.

Treat the Underlying Cause

The most effective approach to managing ascites is to treat the underlying medical condition responsible for its development. This may involve:

• Liver Disease Management: For cirrhosis, treatment focuses on managing the underlying liver disease (e.g., antiviral therapy for hepatitis, alcohol abstinence, management of NAFLD).
• Heart Failure Management: For heart failure-related ascites, treatment involves managing heart failure with medications, sodium restriction, and fluid management.
• Cancer Treatment: If ascites is due to malignancy, cancer treatment (e.g., chemotherapy, radiation, surgery) is the primary focus.

Minimize Ascitic Fluid Volume

Strategies to reduce ascitic fluid volume include:

• Sodium Restriction: Limiting sodium intake is crucial to reduce fluid retention. The recommended sodium intake for patients with ascites is typically less than 2,000 mg per day. Advise patients to avoid processed foods, restaurant meals, and added salt. Potassium-containing salt substitutes should be used with caution, as they can elevate potassium levels, especially in patients taking certain diuretics.
• Diuretics: These medications help the kidneys excrete excess fluid and sodium. Common diuretics used for ascites include:
  • Spironolactone (potassium-sparing): Often the first-line diuretic, as it counteracts the effects of aldosterone, which promotes sodium retention in liver disease.
  • Furosemide (potassium-wasting): May be added to spironolactone for more potent diuresis. Monitor potassium levels carefully when using furosemide.
• Therapeutic Paracentesis: Large-volume paracentesis involves removing a significant amount of ascitic fluid (several liters) to provide symptomatic relief from abdominal distention and discomfort. It is often used for patients with tense ascites or refractory ascites (ascites that does not respond to diuretics).
• Indwelling Peritoneal Catheter: For patients with recurrent or refractory ascites requiring frequent paracentesis, an indwelling peritoneal catheter (e.g., PleurX catheter) may be placed to allow for easier drainage of fluid at home.
• Transjugular Intrahepatic Portosystemic Shunt (TIPS): TIPS is a procedure used for patients with refractory ascites who are not candidates for liver transplantation. It involves creating a shunt (connection) between the portal vein and hepatic vein within the liver to reduce portal hypertension and fluid buildup.

Antibiotics

If ascites is complicated by spontaneous bacterial peritonitis (SBP), antibiotics are necessary to treat the infection.

Managing Risk Factors and Preventing Recurrence

In addition to managing fluid retention, nurses play a vital role in educating patients about lifestyle modifications to manage risk factors and prevent ascites recurrence.

Weight Monitoring

• Daily Weight: Instruct patients to monitor their weight daily and report significant weight gain (e.g., >2 pounds in a day or >5 pounds in a week) to their healthcare provider.
• Significance: Weight gain can be an early indicator of fluid accumulation.

Alcohol Avoidance

• Education: Emphasize the importance of complete alcohol abstinence for patients with liver disease, as alcohol worsens liver damage and increases the risk of ascites.
• Support: Provide resources and support for patients struggling with alcohol dependence.

NSAID Avoidance

• Education: Advise patients to avoid nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, as they can impair kidney function, worsen sodium retention, and reduce the effectiveness of diuretics in patients with cirrhosis. Acetaminophen (paracetamol) is generally considered safer for pain relief in these patients, but should still be used cautiously and under medical guidance.
• Alternatives: Discuss alternative pain management strategies with the healthcare provider.

Safe Sex Practices

• Education: Educate patients about safe sex practices to reduce the risk of contracting viral hepatitis (Hepatitis B and C), which can lead to cirrhosis and ascites.

Fluid Intake Restriction

• Guideline: Fluid restriction may be necessary in patients with hyponatremia (low sodium levels in the blood). In such cases, daily fluid intake may be limited to less than 1 liter per day, as prescribed by the physician. Fluid restriction is not routinely recommended for all patients with ascites unless hyponatremia is present.

Ascites Nursing Care Plans: Addressing Key Nursing Diagnoses

Based on the nursing assessment, several nursing diagnoses may be relevant for patients with ascites. Nursing care plans help prioritize interventions and guide care delivery. Common nursing diagnoses and associated care plan components include:

Excess Fluid Volume

Nursing Diagnosis: Excess Fluid Volume related to compromised regulatory mechanisms, portal hypertension, lower plasma colloidal osmotic pressure, sodium and water retention, excessive sodium/fluid intake, and dependent venous pooling.

As evidenced by: Increased abdominal girth, abdominal pain/discomfort, bloating, increased blood pressure, weight gain, edema, weakness/fatigue, bounding pulse, tachycardia, and neck vein distention.

Expected Outcomes:

• Patient will demonstrate a decrease in abdominal girth.
• Patient will report a decrease in abdominal pain/discomfort.
• Patient will maintain blood pressure within acceptable limits (e.g., >90/60 mmHg) and heart rate between 60-100 beats/min.

Assessments:

1. Monitor vital signs: Increased heart rate and blood pressure may be observed due to portal hypertension and fluid overload.
2. Assess contributing and causative factors: Identifying the underlying cause of fluid volume excess is essential for effective management.
3. Monitor abdominal girth: Provides objective data on fluid accumulation and treatment response.

Interventions:

1. Restrict sodium and fluid intake as appropriate: Sodium restriction minimizes fluid retention. Fluid restriction may be necessary if hyponatremia is present.
2. Prepare for/assist with paracentesis: Therapeutic paracentesis provides symptomatic relief. Explain the procedure and maintain aseptic technique.
3. Administer medications: Administer diuretics (spironolactone, furosemide) and albumin as prescribed. Albumin may help prevent fluid re-accumulation after paracentesis.
4. Educate on monitoring for fluid gain: Instruct patients on daily weight monitoring and to report significant weight gain or symptoms of fluid overload.

Alt text: A nurse measures the abdominal girth of a patient with ascites using a measuring tape around the patient’s abdomen at the level of the umbilicus.

Imbalanced Nutrition: Less than Body Requirements

Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements related to disease process, inflammation, food/taste aversion, inadequate intake, early satiety, abdominal distention, altered metabolism, abdominal discomfort, and increased energy expenditure.

As evidenced by: Abdominal cramping, abdominal pain, muscle wasting, constipation, bloating, hypoactive bowel sounds, nausea, and lack of appetite.

Expected Outcomes:

• Patient will identify nutritional requirements and make appropriate food choices.
• Patient will report an increase in appetite and demonstrate improved muscle mass (or prevent further muscle wasting).

Assessments:

1. Assess the patient’s nutritional status: Use methods like mid-arm muscle circumference (MAMC) and triceps skinfold (TSF) to assess nutritional status, as body weight can be misleading due to fluid accumulation.
2. Assess laboratory values for nutrient deficiencies: Monitor for deficiencies in macronutrients and micronutrients (e.g., magnesium, zinc, folate, B vitamins, vitamins A, D, E, K).
3. Assess for any barriers to eating: Identify factors hindering adequate nutrition, such as taste changes, appetite suppression, early satiety, and abdominal discomfort.

Interventions:

1. Refer the patient to a dietitian: A dietitian can develop a personalized meal plan to address nutrient deficits.
2. Encourage a high-protein diet and restrict sodium intake: Recommend a protein intake of 1.2-1.5 g/kg/day and sodium restriction (around 2 grams per day).
3. Incorporate branched-chain amino acids (BCAAs): BCAAs may improve liver function, nutritional status, and quality of life in malnourished patients with cirrhosis.
4. Encourage small, frequent meals and snacks: Smaller, more frequent meals are better tolerated due to abdominal distention and early satiety.
5. Provide late-evening snacks: A late-evening snack with complex carbohydrates and protein can help prevent muscle proteolysis.

Ineffective Breathing Pattern

Nursing Diagnosis: Ineffective Breathing Pattern related to increased abdominal pressure and decreased lung expansion.

As evidenced by: Nasal flaring, tachypnea, orthopnea, fatigue, shortness of breath/dyspnea, respiratory depth changes, and alterations in ABGs.

Expected Outcomes:

• Patient will demonstrate an effective respiratory pattern with a respiratory rate of 12-20 breaths/min, normal depth, and absence of cyanosis.
• Patient will report relief from shortness of breath/dyspnea.
• Patient will maintain arterial blood gas (ABG) values within normal limits.

Assessments:

1. Monitor respiratory rate, depth, and effort: Assess for signs of respiratory distress.
2. Assess ABGs: Evaluate respiratory status and response to therapy.

Interventions:

1. Place in semi-Fowler’s position, as appropriate: Elevating the head of the bed eases pressure on the diaphragm and improves breathing.
2. Provide supplemental oxygen, as indicated: Administer oxygen to treat hypoxia or dyspnea.
3. Prepare for TIPS procedure (if indicated): TIPS may be considered for refractory ascites causing significant respiratory compromise.
4. Instruct on lifestyle modifications: Reinforce the importance of low-sodium diet, diuretic adherence, and alcohol cessation to manage ascites and its respiratory effects.

Ineffective Tissue Perfusion

Nursing Diagnosis: Ineffective Tissue Perfusion related to increased abdominal pressure, infection, disease process, and inflammatory process.

As evidenced by: Abdominal distention, hypoactive or absent bowel sounds, nausea and vomiting, loss of peristalsis, bloating, shortness of breath, and pain.

Expected Outcomes:

• Patient will remain free from abdominal pain and distention.
• Patient will verbalize understanding of the treatment regimen and lifestyle modifications to reduce complications.

Assessments:

1. Assess the extent of ascites: Measure abdominal girth and weight to monitor progression.
2. Assess diagnostic values: Review paracentesis results to rule out SBP.
3. Inspect, auscultate, percuss, and palpate the abdomen: Assess bowel sounds and abdominal findings.
4. Assess laboratory values: Monitor albumin levels and other indicators of liver function.

Interventions:

1. Monitor intake and output: Assess fluid balance and response to treatment.
2. Evaluate and monitor weight and abdominal girth: Track ascites progression.
3. Provide supplemental oxygenation via nasal cannula: Ensure adequate oxygenation, especially if respiratory distress is present.
4. Administer diuretics as indicated: Promote fluid excretion and reduce abdominal pressure.
5. Restrict sodium and fluid intake as indicated: Manage fluid retention.

Risk for Infection

Nursing Diagnosis: Risk for Infection related to stasis of body fluid, chronic illness (cirrhosis, heart failure), immunosuppression, and invasive procedures.

As evidenced by: (Risk diagnosis, evidenced by risk factors, not signs and symptoms).

Expected Outcomes:

• Patient will remain free from infection.
• Patient will verbalize strategies to prevent infection.

Assessments:

1. Note the onset of abdominal pain or discomfort: New abdominal pain may indicate SBP.
2. Monitor temperature: Fever may suggest infection.
3. Assess lab values: Monitor WBC count, peritoneal fluid culture, and CRP levels for signs of infection.

Interventions:

1. Maintain sterile technique for invasive procedures: Prevent healthcare-associated infections.
2. Obtain specimens for culture and sensitivities, as indicated: Identify causative pathogens if infection is suspected.
3. Administer antibiotics as appropriate: Treat bacterial infections promptly.
4. Instruct the patient and family on proper handwashing: Emphasize hand hygiene to prevent infection transmission.
5. Instruct on vaccinations: Recommend influenza, pneumococcal, and hepatitis vaccines for immunocompromised patients.

Conclusion

Ascites is a complex clinical manifestation that requires comprehensive nursing care. Nurses play a crucial role in assessing patients, implementing interventions to manage fluid retention and associated symptoms, educating patients about lifestyle modifications, and preventing complications. By understanding the pathophysiology of ascites, conducting thorough assessments, and utilizing appropriate nursing diagnoses and care plans, healthcare professionals can significantly improve the outcomes and quality of life for individuals living with ascites.

References

(To be added, utilizing reputable nursing and medical resources)