Gastrointestinal System Disorders Q 234

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A 52-year-old man was referred to the clinic due to increased abdominal girth. He is diagnosed with ascites by the presence of a fluid thrill and shifting dullness on percussion. After administering diuretic therapy, which nursing action would be most effective in ensuring safe care?

  

    A. Measuring serum potassium for hyperkalemia

    B. Assessing the client for hypervolemia

    C. Measuring the client's weight weekly

    D. Documenting precise intake and output

    

    

Correct Answer: D. Documenting precise intake and output.

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For the client with ascites receiving diuretic therapy, careful intake and output measurement are essential for safe diuretic therapy. Diuretics lead to fluid losses, which if not monitored closely and documented, could place the client at risk for serious fluid and electrolyte imbalances. The most common adverse effect for any diuretic is mild hypovolemia, which can lead to transient dehydration and increased thirst. When there is an over-treatment with a diuretic, this could lead to severe hypovolemia, causing hypotension, dizziness, and syncope.

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Option A: Hypokalemia, not hyperkalemia, commonly occurs with diuretic therapy. Hypokalemia and metabolic alkalosis can occur with both loop and thiazide diuretics but are more common with loop diuretics. Loop agents increase distal Na+ delivery at macula densa and cause volume depletion, both of which indirectly activate the RAAS pathway.

Option B: Because urine output increases, a client should be assessed for hypovolemia, not hypervolemia. Acid-base disorders usually accompany the electrolyte derangement due to their close association with their reabsorption in the renal tubules. Metabolic disturbances can lead to derangement of glucose, uric acid, or lipid levels with certain diuretics and are individually discussed.

Option C: Weights are also an accurate indicator of fluid balance. However, for this client, weights should be obtained daily, not weekly. Diuretic treatment calls for careful assessment of extracellular fluid volume, urine output, electrolyte levels in plasma and urine, body weight, acid-base status, serum glucose, and BP regularly with particular emphasis on patients with cardiovascular, hepatic, renal, or metabolic disorders and in the elderly individuals.

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