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Soru

Zorluk: KolayReduction of Risk Potential

A 58-year-old client with end-stage cirrhosis and severe ascites is scheduled to undergo a bedside paracentesis. Which of the following nursing actions is the priority to reduce the risk of a serious complication during this procedure?

  1. Assisting the client to empty their bladder immediately before the procedure.Cevap
  2. B
    Positioning the client flat in a supine position to maximize fluid shifting.
  3. C
    Palpating the client's abdomen deeply before auscultating to locate the fluid pockets.
  4. D
    Delegating the collection of baseline vital signs to the unlicensed assistive personnel.

Cevap

Assisting the client to empty their bladder immediately before the procedure.
A full bladder can extend upward into the abdominal cavity, placing it in the direct path of the paracentesis needle. Having the client void immediately prior to the procedure decompresses the bladder, dropping it down into the pelvis. This fundamental nursing action significantly reduces the risk of an accidental, life-threatening bladder perforation.

Adım Adım Çözüm

1
Analyze the anatomical risks associated with a paracentesis.
The procedure involves inserting a trocar into the abdominal cavity. A distended bladder extends upward into this space.
Understanding the anatomical relationship between the bladder and the abdominal cavity identifies the primary puncture risk.
2
Determine the optimal intervention to mitigate this risk.
Emptying the bladder reduces its size and keeps it safely within the pelvis.
A decompressed bladder is protected from accidental puncture by the paracentesis needle, directly reducing a major procedural complication.

Anahtar Kavram

Paracentesis Safety and Risk Reduction
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Konular

Reduction of Risk Potential

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