Introduction to Ascites (Nursing)

00:00 Now we have finally arrived at what we've been talking to.

00:05 Understand about peripheral edema, it's my arms and my legs.

00:09 Now we're going to go beyond that and talk about ascites.

00:13 So look at our picture there.

00:14 You see that let's start on this left side.

00:17 You see the spinal column right? Then you see the organs there. You've got the liver at the top.

00:22 You've got the stomach. You've got the intestines.

00:25 Okay, then you see how it all exits the body when it's done, but the blue fluid there is meant for you to think about ascites.

00:33 That's where ascites hangs out.

00:36 Because ascites is excess or pathological accumulation of serous fluid in the abdomen or the peritoneal cavity.

00:45 So all right here.

00:48 When I'm out at the mall and I'm seeing people in public and I see someone wow, you'll start spotting these people like crazy when you're out in public.

00:57 Resist the urge to ask them about their liver function, but it takes one quick look after you've practiced enough and you seen enough patience, you know, whoa, that person's liver is struggling.

01:08 Have a really funny look to them because they'll have this big belly and then usually pretty spindly arms and legs and a weird hue to their skin sometimes.

01:19 So we're talking about edema and the peripheral edema, you're going to be looking at my legs first and my feet, you're going to looking for swollen tissues or we're talking about ascites.

01:30 That's in my abdominal cavity in my peritoneal cavity and you're going to have this rounded swollen belly.

01:37 Now approximately 50% so just about half of the patients with cirrhosis will develop ascites within ten years of being diagnosed.

01:46 So this is fairly common and it is a sign of progressing disease.

01:51 They'll start with the peripheral edema, but it usually will progress as the liver declines, it can progress and about half of your patients into ascites.

02:01 I can imagine what it's like to live with ascites.

02:04 How does this make you feel about your body image.

02:06 How your clothes fit.

02:08 How hard is it for you to breathe because take a look at that picture.

02:11 Think about someone you know or your experience with being pregnant.

02:16 Our bodies were meant to be just like this when you start putting extra fluid in there, it puts pressure and squishes all those organs.

02:26 Makes it harder for them to breathe.

02:28 They have less energy. They're more tired.

02:30 These are all things as nurses as we want to encourage conversations with them to help them set appropriate goals in moving towards a better level of health.

02:40 So let's talk about the three causes of ascites.

02:43 Now these some weird ones in here that we didn't talk about before so that's why I want you to understand what's different about ascites.

02:50 They have increased lymph production, portal hypertension, and damage to the hepatocytes.

02:57 Okay, we're not just going to leave you with a list, you know, I never do that.

03:00 I want to break these down, but I wanted you to have a beginning shot of what we're talking about.

03:05 Increased lymph, Portal hypertension and damage to the hepatocytes.

03:10 Now before I roll into increased lymph production, I'm just going to let you know this one is still part of the unknown.

03:18 We're not exactly sure how it happens.

03:21 But we do know that it does.

03:22 Remember these three causes of ascites are linked to liver problems or cirrhosis.

03:29 Well, you ready? This next picture isn't really pretty.

03:32 But let's take a look at what ascites looks like.

03:37 Yeah, okay.

03:38 First of all, that's an interesting outfit.

03:40 He's wearing I'm not even going to go there, right? But let's talk about the ascites.

03:45 Notice that the abdomen is swollen.

03:47 Well, you know why we ended up there right? See if you can list all the reasons that can end up with extra fluid in the abdominal and peritoneum.

03:57 So you see that that abdomen is distended.

04:00 The patient will have obvious weight gain, their clothes are going to fit differently, they're going to feel really miserable.

04:07 It's going to be difficult for them to breathe.

04:08 They're going to have less energy.

04:11 But look at that abdominal wall.

04:13 What are those? What are those little squiggles? Well, those can actually be some weird veins, they might be stretch marks, got all kinds of changes externally that you'll be able to see.

04:24 The weirdest one, Is like the belly button will pop out so they may have been innie and now they are an outie.

04:32 If they have severe ascites and if pressure building up there it can cause their original belly button to pop out.

04:39 Kind of like the button on a turkey when it's done at Thanksgiving.

04:43 Now there's abdominal striae we refer to those but let's give them their official name.

04:48 Abdominal striae are stretch marks so they can either be abdominal striae.

04:52 That's the official name and they can also be some distended veins, so when you see a client with severe ascites, look for these signs.

05:01 Look for striae those are stretch marks, look for distended veins, those are further classic signs that we assess when a patient has ascites.