Sharon has cirrhosis of the liver and develops ascites. What intervention is necessary to decrease the excessive accumulation of serous fluid in her peritoneal cavity?
A. Restrict fluids.
B. Encourage ambulation.
C. Increase sodium in the diet.
D. Give antacids as prescribed.
Correct Answer: A. Restrict fluids
Restricting fluids decrease the amount of body fluid and the accumulation of fluid in the peritoneal space. Restrict sodium and fluids as indicated. Sodium may be restricted to minimize fluid retention in extravascular spaces. Fluid restriction may be necessary to correct dilutional hyponatremia.
Option B: Encourage bed rest when ascites is present; may promote recumbency-induced diuresis. Measure abdominal girth. Reflects accumulation of fluid (ascites) resulting from loss of plasma proteins/fluid into peritoneal space. Excessive fluid accumulation can reduce circulating volume, creating a deficit (signs of dehydration).
Option C: Monitor serum albumin and electrolytes (particularly potassium and sodium). Decreased serum albumin affects plasma colloid osmotic pressure, resulting in edema formation. Reduced renal blood flow accompanied by elevated ADH and aldosterone levels and the use of diuretics (to reduce total body water) may cause various electrolyte shifts/imbalances.
Option D: Administer salt-free albumin/plasma expanders as indicated. Albumin may be used to increase the colloid osmotic pressure in the vascular compartment (pulling fluid into vascular space), thereby increasing effective circulating volume and decreasing the formation of ascites.
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