Nursing 212

Health Differences Across the Lifespan 2 Study Guide • Correct position for liver biopsy is recumbent with right upper abdomen exposed; insert biopsy needle between the 6th and 7th ribs; immediately before needle insertion, have the patient inhale and exhale deeply and then hold breath at end of expiration until needle is inserted. • After biopsy assist patient to right-side-lying position with a pillow placed under the right costal margin. • Observe for signs and symptoms of shock and pneumothorax. • Position client on the right lateral side for 2 hours for hemostasis. Paracentesis: • Used for severe ascites and is an invasive procedure that drains fluid from the abdomen with a needle; fluid is often sent for culture. • Ensure client is sitting in a straight back chair with bowel and bladder empties prior to procedure; maximum amount of fluid to be aspirated at one time is 3 liters. • Proper position for paracentesis is upright with feet resting on a support so that the puncture site will be readily visible • After paracentesis, observe for signs of vascular collapse • The patient is requested to urinate before the procedure; alternately, a Foley catheter is used to empty the bladder • The patient is positioned in the bed with the head elevated at 45-60 degrees to allow fluid to accumulate in lower abdomen; after cleaning the side of the abdomen with an antiseptic solution, the physician numbs a small area of skin and inserts a large-bore needle with a plastic sheath 2 to 5 cm (1 to 2 in) in length to reach the peritoneal (ascitic) fluid; the needle is removed, leaving the plastic sheath to allow drainage of the fluid • The fluid is drained by gravity, a syringe or by connection to a vacuum bottle; if fluid drainage is more than 5 liters, patients may receive intravenous serum albumin (25% albumin, 8g/L) to prevent hypotension (low blood pressure) • After the desired level of drainage is complete, the plastic sheath is removed and the puncture site bandaged; plastic sheath can be left in place with a flow control valve and protective dressing if further treatments are expected to be necessary • Procedure generally is not painful and does not require sedation; patient is usually discharged within several hours following post-procedure observation provided that blood pressure is otherwise normal and the patient experiences no dizziness Esophageal Varices Esophageal varices develop from increased portal pressure, and are distended and tortuous vessels that can rupture secondary to coughing, sneezing, vomiting, or ingestion of foods high in roughage. Bleeding can be abrupt and painless. Ruptured esophageal varices are considered a medical emergency. Signs and symptoms include hematemesis, ascites, anorexia, nausea and vomiting, fatigue and weakness, peripheral edema, dysphagia, and melena. If bleeding is abrupt, there will be severe hematemesis and signs of hypovolemic shock (tachycardia, hypotension).

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