Ascites

Definition

Ascites is the pathologic accumulation of serous fluid in the peritoneal cavity, usually secondary to portal hypertension, hypoalbuminemia, or peritoneal disease. It is a hallmark of decompensated cirrhosis.

Causes

• Cirrhosis (most common)
• Heart failure
• Nephrotic syndrome
• Peritoneal carcinomatosis
• Tuberculous peritonitis

Assessment

Abdominal distention, increased abdominal girth, shifting dullness on percussion, fluid wave, umbilical protrusion, dyspnea from diaphragmatic compression, weight gain.

Nursing Interventions

Monitor daily weight, abdominal girth (measure at same level each day), and strict I&O. Restrict sodium (2 g/day) and sometimes fluids. Administer diuretics (spironolactone with furosemide) and albumin as ordered. Position in semi-Fowler’s to ease breathing. For paracentesis, ensure the patient voids immediately before the procedure, monitor vital signs, and watch for hypotension after large-volume drainage (>5 L). Albumin may be given.

NCLEX Relevance

Classic cue of cirrhosis. Know pre-paracentesis nursing priorities and signs of spontaneous bacterial peritonitis (SBP).