Q1. A patient has advanced cirrhosis of the liver. The patient's spouse asks the nurse why the patient's abdomen is swollen, making it very difficult to fasten their pants. How should the nurse respond to provide the most accurate explanation of the disease process?
- "They must have been eating too many foods with salt in them. Salt pulls water with it."
- "Blood is not able to flow readily through the liver now, and the liver cannot make protein to keep fluid inside the blood vessels."
- "The patient must have forgotten to take their daily water pill."
- "The swelling in the ankles must have moved up closer to their heart so the fluid circulates better."
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Answer: B. "Blood is not able to flow readily through the liver now, and the liver cannot make protein to keep fluid inside the blood vessels."
Portal hypertension and hypoalbuminemia as a result of cirrhosis cause a fluid shift into the peritoneal space causing ascites. In a cardiac or kidney problem, not cirrhosis, sodium can promote edema formation and subsequent decreased urine output. Edema does not migrate upward toward the heart to enhance its circulation. Although diuretics promote the excretion of excess fluid, occasionally forgetting or omitting a dose will not yield the ascites found in cirrhosis of the liver.