What should the nurse monitor for in a client with cirrhosis of the liver?

In clients with cirrhosis of the liver, abdominal ascites is a significant and common condition that arises due to the accumulation of fluid in the abdominal cavity. This occurs as a result of increased pressure in the portal venous system (portal hypertension) and alterations in protein metabolism that can lead to hypoalbuminemia, causing fluid to leak from the blood vessels into the abdominal space.

Monitoring for abdominal ascites is crucial as it can lead to discomfort, difficulty breathing if the diaphragm is pressed upon, and increased risk for infection, such as spontaneous bacterial peritonitis. Recognizing changes in abdominal girth or the presence of a tense or distended abdomen can help the healthcare team intervene appropriately to manage ascites, which may include diuretics, dietary changes, or therapeutic paracentesis to relieve pressure.

In contrast, increased appetite is unlikely in someone with liver cirrhosis due to metabolic changes and potential complications, while bowel incontinence is not a typical direct effect of cirrhosis. A skin rash could occur but is less specific and not a primary complication of cirrhosis compared to the development of ascites. This is why monitoring for abdominal ascites is critical in managing patients with cirrhosis effectively.