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Soru

Zorluk: KolayReduction of Risk Potential

A client arrives at the cardiac step-down unit after a diagnostic cardiac catheterization accessed through the right femoral artery. Which intervention must the nurse implement to reduce the risk of hemorrhage at the access site?

  1. Remind the client to maintain the right leg in a straight position.Cevap
  2. B
    Elevate the head of the bed to a high-Fowler's angle.
  3. C
    Encourage the client to bend the right knee frequently to prevent stiffness.
  4. D
    Position the client on the left side with both hips sharply flexed.

Cevap

Remind the client to maintain the right leg in a straight position.
Following a femoral artery cardiac catheterization, keeping the affected extremity straight is critical. This position minimizes tension and bending at the groin access site, allowing a stable clot to form and preventing severe hemorrhage or hematoma.

Adım Adım Çözüm

1
Identify the procedure and the specific access site.
The client underwent a cardiac catheterization via the right femoral artery.
The anatomical location of the arterial puncture dictates specific post-procedure mobility restrictions.
2
Determine the primary physiological risk associated with this access site.
The femoral artery is a large vessel under high pressure, making hemorrhage and hematoma formation the greatest immediate risks.
Recognizing the high risk of bleeding guides the selection of protective nursing interventions.
3
Select the nursing intervention that directly prevents stress on the puncture site.
Keeping the right leg completely straight minimizes movement and flexion at the groin.
Maintaining the leg straight prevents disruption of the developing clot and reduces the risk of arterial bleeding.

Anahtar Kavram

Post-procedure positioning to prevent hemorrhage following femoral access
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Konular

Reduction of Risk Potential

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