00:00
A client diagnosed with alcoholic cirrhosis and ascites undergoes a paracentesis.
00:07
Following the procedure, which assessment finding is a priority for followup?
Okay, 2 sentences, but a lot of work to be done here before we look at the answer
choices. So I now have a client diagnosed with 2 things, alcoholic cirrhosis and
cirrhosis means liver damage. Right? And this liver damage was caused by
excessive alcohol for what their body could handle. So this is liver damage caused
by excessive alcohol compared to what their body could handle. Why am I hanging
on this point? Because alcoholic is a descriptor word. In this case, it may or may
not play a big deal, but you always want to take a look at those descriptor words
because they can change that. Right? If I'm talking about hepatitis, toxic hepatitis
would be inflammation of my liver or something going on in my liver caused by
something I ingested. That's very different than viral hepatitis because that is easily
spread to another person. But toxic hepatitis is not spread to another person. It's a
problem that I ingested something and that damaged my liver. So, descriptor words
matter. So, somebody with alcoholic cirrhosis and ascites. So I know that that is,
they've got all this excess fluid in their belly and we do a whole video series on
why somebody with liver damage ends up with ascites. Now, they undergo a
procedure. It's called a paracentesis, paracentesis. Anytime this is done, a needle is
actually placed through the abdominal wall and fluid is drawn out. So, that's what a
paracentesis is, we're looking to pull excess fluid off this patient's abdominal wall
because they have this build-up of fluid because their liver is not doing well. So,
following the procedure, which is a paracentesis, which assessment finding is a
priority for follow-up? Well, when we see that, we're always thinking "I'm going to
look for the top priority" meaning I need to eliminate the 3 other options that are
either not connected to this procedure of paracentesis or they're not as severe as the
final correct answer. So you've got 4 options, write down the numbers 1, 2, 3, and
4, no words, just write the numbers down on your scratch paper. As you're going
through the question, ask would this be a priority after a paracentesis, yes or no?
Would this be a priority after a paracentesis, yes or no? And don't forget why for
every evaluation. Then, cross through the answer choices, make sure you feel
confident about your answer but the one that's remaining, say why you think it's
the right answer then restart the video and come back we'll go for the walk through
together. Okay, welcome back. Do you commit to your answer? Let's take a look.
03:09
Now we have just 4 assessments. Right? So I look at the assessments, hypotension,
I don't like that. That's going to be a perfusion problem but I'm going to have to see
if it's at all attached or connected to a paracentesis. Elevated SGOT or AST. Well,
that's a sign of liver damage, that's not good. Some fluid leakage from the puncture
site, I'm not comfortable with that, and bacterial cells and a urinalysis. Now by
the time I move through all those answer choices, if I'm not being really diligent
and intentional about saying "Would this be a priority after a paracentesis?" I could
end up getting tripped up by a silly answer like number 4 because there is no
connection to bacterial cells and a urinalysis and a paracentesis but sometimes
when I get stressed and you're going through questions and things are going on
in your mind your mind is kind of worrying, you're going to think like "Oh, hey
bacterial cells and urinalysis that's a bad thing. I think we should follow up on
that." But it doesn't have anything to do with the topic of the question. And that's
where students can struggle. So, number 4, you're out. Right? You're not a priority
for followup for someone having a paracentesis. Now, I don't like fluid leaking
from the puncture site. That doesn't seem like a good idea. I don't want their liver
to be damaged but I also have hypotension. All 3 of these answer choices are they
connected to paracentesis? 3 yes, 2 could be, 1. 1, what would hypotension have to
do with paracentesis? When we picture what that is, you're pulling fluid volume
off. So anytime I change the status of some of these fluid volume status in their
body, you are at a risk for dropping their blood pressure. Okay, so that does have a
connection. So anytime you do an esis, a paracentesis, a diuresis, if you are doing
anything that causes fluid volume shifting and sticking a needle in somebody's
belly and pulling out fluid you are shifting fluid outside their body, that's going to
cause a change inside their body too. Anytime you have a fluid volume status
change or shifting, you're risking what we call officially circulatory collapse.
05:31
What that means is their blood pressure is going to tank. Because this is really
complicated in here, keeping all your squishiness in the right spots and out of the
others. So hypotension, I'm leaving in. Now, I'm going to compare it to the other
two. Elevated SGOT or AST. Well, they already told me that's an elevated liver
gig, that's liver test and somebody with cirrhosis is already going to have
elevated SGOT especially if it's bad enough that you got the big barrel belly full of
acidic fluids. So, 2 is not a higher priority than number 1. Number 3, some fluid
leakage from the puncture site. You know, my brain goes to what I like a fountain?
like it's all these stuff just like phew. No, don't make a movie, that's being
Spielberg. Don't make a movie. So, number 3 is not a bigger risk than number 1
because it just says some fluid is leaking from the puncture site. Am I going to
keep an eye on it? Absolutely. If I've got a little bit, not a big deal. I'm going to
watch that dressing like a hulk because I'm the nurse but I am watching if this
patient has low blood pressure. In fact, this is what always made me nervous when
I help with the paracentesis or a thoracentesis in the lungs, but I know their blood
pressure can drop. The more fluid they pull off, the more sensitive the patient is,
the bigger the drop in blood pressure can be. So that's why whoever is doing the
procedure, whatever physician or practitioner is doing that procedure, we'll make
some very calculated decisions on the patient's hemodynamic stability, how much
fluid they can take off and still maintain that stability. The reason we do this kind
of paracentesis is because with all these fluid in their abdomen, their lungs are like
up here, "I can't breathe" because it's pushing on their lungs. So, just making that
internal cavity that much less. So that's why we do it is for patient comfort. They'll
also run cultures and things on it, but anytime you cause a fluid volume shift like
guys, this is notebook material, just needs to go in your notebook. Any esis,
diuresis, paracentesis, thoracentesis, anything where you're causing fluid volume
shifting in someone's body puts them at a risk for that circulatory system to tank or
hypotension. Now, we've got a perfusion problem. So that's what you want to take
with you to other questions. If you didn't know what SGOT was, make sure you get
that in your notes. Know that we don't want fluid leakage but you can see when
you compare it to low blood pressure, number 1 is a bigger deal and it has a
connection, a very clear connection to paracentesis. Number 4, yeah we don't like
that but it does not have any connection to paracentesis. So good work, spend the
time, reflect to see what needs to go down in your notebook, what notes would you
learn about yourself on this question. Maybe there's a strategy you need to adjust to
remember .Why do you think you got it right? Why do you think you got it wrong?
What do you want to do differently on your next question? That's the heavy lifting.
08:38
Keep going, you can do this, and join us for more questions.