Examkin

Soru

Zorluk: OrtaBasic Care and Comfort

A client is admitted to the nursing unit directly after undergoing a percutaneous liver biopsy. To reduce the risk of internal bleeding and ensure safety, what is the most appropriate position for the practical nurse to place this client?

  1. Resting on the right side with a small towel roll under the puncture siteCevap
  2. B
    Resting on the left side with a supportive pillow placed behind the back
  3. C
    Lying flat on the back with the lower extremities elevated on pillows
  4. D
    Sitting upright in bed at a 60-degree angle with the knees slightly bent

Cevap

Resting on the right side with a small towel roll under the puncture site
Positioning the client on the right side (where the liver is located) applies direct, continuous pressure to the liver capsule and the biopsy puncture site. This use of body weight, often augmented by a rolled towel, acts as a tamponade to promote hemostasis and minimize the risk of severe internal hemorrhage.

Adım Adım Çözüm

1
Analyze the client's recent diagnostic procedure.
The client had a percutaneous liver biopsy, which involves puncturing a highly vascular organ.
Understanding the nature of the procedure highlights the primary complication to prevent, which is severe bleeding.
2
Identify the goal of immediate post-procedure positioning.
The primary goal is to apply direct, continuous pressure to the puncture site to promote clotting (hemostasis).
External pressure acts as a mechanical barrier against bleeding from the internal wound.
3
Determine the optimal anatomical position to achieve this goal.
Placing the client on the right side compresses the liver against the chest wall. Adding a towel roll directly under the right costal margin maximizes this pressure.
The liver is located on the right side of the abdomen; therefore, right lateral positioning uses the client's own body weight to tamponade the bleeding.

Anahtar Kavram

Post-Procedure Positioning and Hemorrhage Prevention
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Konular

Basic Care and Comfort

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