ATI Therapeutic Procedure form Paracentesis PDF

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Summary

ATI Therapeutic Procedure form Paracentesis from the clinicals weekly patient assigned to provide care and report assignment...

Description

ACTIVE LEARNING TEMPLATE:

Therapeutic Procedure

Abdeljalek STUDENT NAME Alejandra _____________________________________ Paracentesis PROCEDURE NAME ____________________________________________________________________

REVIEW MODULE CHAPTER Lippincott ___________

Description of Procedure Performed to obtain samples of ascitic fluid for diagnostic and therapeutic purposes by insertion of a trocar and cannula through the abdominal wall May be performed using image guidance In four-quadrant tap, aspirates fluid from each quadrant of the abdomen to verify abdominal trauma and the need for surgery

Indications To determine the cause of ascites To detect abdominal trauma To remove accumulated ascitic fluid

Outcomes/Evaluation Normal Results: Fluid is odorless and clear to pale yellow. Abnormal Results: Milk-colored fluid may indicate chylous ascites. Bloody fluid may indicate a tumor, hemorrhagic pancreatitis, or perforated intestine or duodenal ulcer. Cloudy or turbid fluid may indicate peritonitis or an infectious process. RBC count above 100/μ L suggests neoplasm or tuberculosis. RBC count above 100,000/μ L suggests intra-abdominal trauma. WBC count above 300/μ L with more than 25% neutrophils suggests spontaneous bacteri peritonitis or cirrhosis. A high percentage of lymphocytes suggests tuberculous peritonitis or chylous ascites. A protein ascitic fluid-serum ratio of 0.5 or greater may suggest a malignancy or tuberculous or pancreatic ascites. Protein levels rise above 3 g/dL in malignancy and above 4 g/dL in tuberculosis. Albumin gradient between ascitic fluid and serum greater than 1 g/dL indicates chronic hepatic disease. Gram-positive cocci usually indicate primary peritonitis; gram-negative organisms indicate secondary peritonitis. Fungi may indicate histoplasmosis, candidiasis, or coccidioidomycosis.

Potential Complications Bleeding, hemorrhage Infection Bladder trauma Shock Perforated intestine Inferior epigastric artery puncture Anterior cecal wall hematoma Iliac vein rupture

ACTIVE LEARNING TEMPLATES

CONSIDERATIONS

Nursing Interventions (pre, intra, post) Pre- Make sure that the patient has sign an appropriate consent form. Note and report allergies. No dietary restrictions are required. Intra- Perform hand hygiene. Confirm the patient's identity using at least two specific patient identifiers. Obtain baseline vital signs, weight, and abdominal girth measurement. Assist the patient into the supine position. Post- Give IV infusions and albumin. Monitor vital signs and intake and output. Observe the puncture site and drainage for bleeding and infection. Obtain the patient's daily weight and daily abdominal girth measurement. Observe the patient for hematuria, which may indicate bladder trauma. Monitor serum electrolyte (especially sodium) and protein levels.

Client Education If the patient has severe ascites, inform the patient that the procedure will relieve discomfort and make breathing easier. Explain who will perform the test and where it'll be done. Inform the patient that a local anesthetic will be administered. Explain that a blood sample may be taken for analysis. Tell the patient that there are no dietary restrictions. Tell the patient that the test takes 45 to 60 minutes.

Nursing Interventions If the patient can't tolerate being supine, raise the head of the bed slightly. The practitioner prepares and drapes the puncture site using sterile technique. Immediately before starting the procedure, the procedure team takes a time-out to verify the correct patient, procedure, and site. Local anesthetic is injected. The needle or trocar and cannula are inserted, usually 1″ or 2″ (2.5 to 5 cm) below the umbilicus, or in each quadrant of the abdomen. Fluid specimens are aspirated. Specimens are placed in appropriately labeled containers. The trocar or needle is removed, and a dressing is applied. Label the specimens appropriately and send them to the laboratory.

THERAPEUTIC PROCEDURE

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