Treatment for a patient with ascitis secondary to hepatic failure should include all of the following except?

RAK Nursing Officer - 2019

Medical Surgical Nursing

Medium

Appeared in: RAK Nursing Officer - 2019

Explanation

'Withholding diuretics' because it is the intervention that should NOT be done.
Diuretic therapy is a fundamental component of managing ascites in patients with hepatic failure.
The goal is to promote the excretion of excess sodium and water that has accumulated due to portal hypertension and hormonal changes (hyperaldosteronism).
Commonly used diuretics are spironolactone (an aldosterone antagonist) and furosemide (a loop diuretic).
Withholding this essential therapy would lead to worsening ascites, increased patient discomfort, and a higher risk of complications like spontaneous bacterial peritonitis (SBP).

Option B: This is a correct and essential part of ascites management. Restricting dietary sodium to about 2 grams per day helps to reduce the body's tendency to retain fluid.
Option C: This is a correct intervention. Patients with cirrhosis are often in a catabolic state and malnourished. A high-calorie, adequate-protein diet is necessary to maintain nutritional status and muscle mass.
Option D: This is a correct intervention for specific situations. Paracentesis is performed to relieve symptoms in patients with large-volume or tense ascites, or when ascites is resistant to diuretic therapy.

Clinical Relevance

Nursing practice connection: Use the key finding related to Management of ascites in hepatic failure to guide bedside assessment, documentation, and the next nursing action.
Nurses play a vital role in monitoring patients with ascites by tracking daily weights, measuring abdominal girth, and maintaining strict intake/output records to assess treatment effectiveness.
Monitoring for side effects of diuretic therapy is critical, including electrolyte imbalances (hyponatremia, hyperkalemia with spironolactone, hypokalemia with furosemide), dehydration, and renal dysfunction (elevated creatinine).
Patient education on a low-sodium diet is a key nursing responsibility to ensure compliance and successful long-term management.

How to Approach the Question

First, identify the core subject of the question: the treatment of ascites in hepatic failure.
Recognize the keyword 'EXCEPT'. This means you are looking for the option that is NOT a standard or correct treatment.
Evaluate each option against your knowledge of ascites management.
Option A: 'Withholding diuretics'. Is this standard? No, diuretics are a primary treatment.
Option B: 'Restricting dietary sodium'. Is this standard? Yes, it's a first-line intervention.
Option C: 'Providing a high calorie diet'. Is this standard? Yes, nutritional support is crucial.

Concept Tested & Keywords

Concept Tested: Management of ascites in hepatic failure
Stem keywords: ascites, hepatic failure, treatment
Lead-in keywords: except
Negative lead-in flag: The question asks for the exception in the treatment plan.

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E6 Medicine Harrison 22e Part 2 p. 619-621

E6 Medicine Davidson Principles Practice 24e p. 884-886