The patient is admitted with pancreatitis and has severe ascites. In caring for this patient, the nurse should:
a. monitor the patient's blood pressure and evaluate for signs of dehydration.
b. restrict intravenous and oral fluid intake because of fluid shifts.
c. avoid the use of colloid IV solutions in managing the patient's fluid status.
d. only use crystalloid fluids to prevent IV lines from clotting.
A
In patients with severe acute pancreatitis, some fluid collects in the retroperitoneal space and peritoneal cavity. Patients sequester up to one third of their plasma volume. Initially, most patients develop some degree of dehydration and, in severe cases, hypovolemic shock. Fluid replacement is a high priority in the treatment of acute pancreatitis. The IV solutions ordered for fluid resuscitation are usually colloids or lactated Ringer's solution; however, fresh frozen plasma and albumin may also be used. IV fluid administration with crystalloids at 500 mL/hr is at times required to maintain hemodynamic status. Often, vigorous IV fluid replacement at 250 to 300mL/hr continues for the first 48 hours or a volume adequate to maintain a urine output of greater than or equal to 0.5 mL/kg body weight per hour. Fluid replacement helps to maintain perfusion to the pancreas and kidneys, reducing the potential for complications.
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