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Zorluk: OrtaBasic Care and Comfort

A practical nurse receives a client who just returned to the nursing unit following a diagnostic lumbar puncture. To prevent a common post-procedure complication and promote client comfort, which positioning action should the nurse implement?

  1. A
    Assist the client into a side-lying position with the knees flexed to the chest.
  2. Maintain the client in a flat, supine position for several hours.Cevap
  3. C
    Elevate the head of the bed to a high-Fowler's position immediately.
  4. D
    Position the client in a semi-Fowler's position with the legs elevated on pillows.

Cevap

The client should be maintained in a flat, supine position for several hours following a lumbar puncture.
Following a lumbar puncture, the client must remain flat in a supine position for a prescribed period, usually 4 to 8 hours. This neutral, horizontal alignment prevents the leakage of cerebrospinal fluid (CSF) from the puncture site, which is the primary cause of severe, debilitating spinal headaches.

Adım Adım Çözüm

1
Identify the procedure the client just underwent.
The client had a diagnostic lumbar puncture.
Different diagnostic procedures require specific postoperative positioning to prevent complications.
2
Determine the primary post-procedure complication associated with a lumbar puncture.
The main complication is a post-dural puncture headache (spinal headache) caused by cerebrospinal fluid (CSF) leakage.
Understanding the physiological risk guides the choice of nursing interventions.
3
Select the appropriate positioning to prevent this complication.
Keeping the client flat and supine helps maintain equalized pressure in the central nervous system, minimizing CSF leakage.
Gravity causes more CSF to leak from the puncture site if the head is elevated.

Anahtar Kavram

Post-procedure Positioning for Lumbar Puncture
Tahmini Süre:1m 0s
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Konular

Basic Care and Comfort

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