Self-management of chronic abd ascites

Elena Ignatiev

Practice Problem: Ascites is a common chronic complication of cirrhosis; however, no standardized self-monitoring education process is established for educating cirrhotic patients to manage their ascites in the outpatient setting. The aims were to develop a standardized education process using a symptom self-monitoring guide and evaluate clinician satisfaction following implementation of the guide for patient symptom control.

Supporting Literature: Studies conducted in patients with chronic conditions have shown self-monitoring protocols improve symptom management. Additionally, prior studies acknowledged that patients’ knowledge of cirrhosis and its complications improved following educational interventions. Guideline based therapy for ascites includes sodium restriction, diuretics, therapeutic paracentesis and transjugular intrahepatic portosystemic shunt.

Project Implementation: Guided by the theory of Self-Care of Chronic Illness, a standardized script and Ascites Control Tracker guide, guide tailored to ascites symptom self-monitoring, were developed. Nurses were instructed on the use of the guide and then used the self-monitoring guide to educate patients/caregivers. Clinicians were surveyed pre- and post-educational intervention regarding their satisfaction with patient education.

Outcomes: Pre- and post-intervention surveys were evaluated for percent change in clinicians satisfaction regarding patient education; satisfaction increased by 41%.

Clinical Implications for Practice: Standardized patient education and the minimal time requirement to complete that education answer a national call to implement self-monitoring in chronically ill patient populations to improve patient outcomes. Recommendations for next steps are additional evaluation of the self-monitoring guide and its effect on patient satisfaction, impact on hospital admissions, and frequency of outpatient paracentesis.