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Zorluk: KolayReduction of Risk Potential

A nurse is finalizing the plan of care for a client who is scheduled to undergo a bedside percutaneous liver biopsy. Identify the actions the nurse must implement to minimize the client's risk for procedure-related complications. (Select all that apply.)

  1. Verify that the client's most recent prothrombin time and platelet count are within acceptable parameters.Cevap
  2. Instruct the client to exhale and hold their breath when the biopsy needle is inserted.Cevap
  3. C
    Assist the client into a left lateral position immediately following the procedure.
  4. D
    Perform deep abdominal palpation every 15 minutes post-procedure to assess for hematoma formation.
  5. Maintain the client on strict bed rest for the prescribed duration following the biopsy.Cevap

Cevap

The correct interventions are verifying coagulation parameters, instructing the client on the exhalation and breath-holding technique, and enforcing post-procedure bed rest.
The correct actions involve reducing bleeding and puncture risks. Verifying coagulation studies ensures the client's blood can clot normally. Having the client hold their breath after exhaling elevates the diaphragm, protecting the lungs. Maintaining bed rest ensures the newly formed clot at the puncture site is not disrupted.

Adım Adım Çözüm

1
Analyze the physiological risks associated with a percutaneous liver biopsy.
The primary risks are hemorrhage (due to the liver's high vascularity) and pneumothorax (due to the liver's proximity to the diaphragm and lungs).
Understanding the potential complications dictates which preventive actions are necessary.
2
Evaluate the pre-procedure and intra-procedure options for safety.
Checking coagulation labs (PT, platelets) mitigates bleeding risk. Having the client hold their breath after exhaling elevates the diaphragm, mitigating pneumothorax risk.
These actions directly address and reduce the most common severe complications.
3
Evaluate the post-procedure options for safety and recovery.
Bed rest stabilizes the clot. Conversely, deep palpation can destroy the clot, and left-sided positioning fails to apply necessary pressure to the liver.
Post-procedure care must focus on maintaining hemostasis at the puncture site.

Anahtar Kavram

Reduction of Risk Potential: Liver Biopsy Complications
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