Hepatic cirrhosis patient is given diuretic therapy because it will?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015

Medical & Surgical Nursing

Hard

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015

Explanation

In hepatic cirrhosis, the liver's reduced ability to metabolize hormones leads to secondary hyperaldosteronism (excess aldosterone).
Aldosterone is a hormone that signals the kidneys to retain sodium and water, a major cause of fluid overload (ascites and edema) in cirrhosis.
Diuretic therapy, specifically with aldosterone antagonists like spironolactone, is used to directly block the action of aldosterone at the kidney receptors.
By inhibiting aldosterone, these diuretics promote the excretion of sodium and water, thereby reducing fluid accumulation.

Option A: This is incorrect. Osmotic pressure is primarily maintained by plasma proteins like albumin. In cirrhosis, albumin levels are low, which decreases osmotic pressure and contributes to edema. Diuretics do not maintain osmotic pressure.
Option B: Decreasing osmotic pressure would be counterproductive, as it would cause even more fluid to shift from the bloodstream into the tissues, worsening ascites and edema.
Option D: While renin is part of the Renin-Angiotensin-Aldosterone System (RAAS) that leads to aldosterone production, the specific diuretics used for cirrhotic ascites (like spironolactone) act downstream by directly blocking aldosterone's effects, not by inhibiting renin itself.

Clinical Relevance

Nursing practice connection: Use the key finding related to Mechanism of diuretic therapy in hepatic cirrhosis to guide bedside assessment, documentation, and the next nursing action.
A key nursing responsibility is to monitor for hyperkalemia (high potassium), a major side effect of aldosterone antagonists like spironolactone, as they are potassium-sparing.
Nurses must meticulously track daily weights, intake and output, and abdominal girth to assess the effectiveness of diuretic therapy and monitor for excessive fluid loss.
Patient education should emphasize adherence to a low-sodium diet, which potentiates the effect of diuretics and helps manage fluid retention.

How to Approach the Question

First, identify the patient's diagnosis: Hepatic Cirrhosis. This is the central clue.
Next, recall the key pathophysiological changes in cirrhosis related to fluid balance. The two most important are low albumin and high aldosterone levels.
Consider the intervention: Diuretic therapy. Ask yourself how a diuretic would address the fluid problem in cirrhosis.
Evaluate the options based on the pathophysiology. Since high aldosterone is a major cause of fluid retention, a drug that inhibits aldosterone's action would be a logical and direct treatment.
Eliminate options related to osmotic pressure, as that is managed by albumin, not diuretics. Also, eliminate options targeting other parts of the RAAS cascade (like renin) if a more direct mechanism (aldosterone) is available.

Concept Tested & Keywords

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E6 Pharmacology Katzung 16e pp. 420-422, 415-417

E6 Physiology Guyton 4SAE Part 2B p. 88-90