Question

The nurse is caring for a client who has undergone a biopsy of the right kidney. Following the biopsy, the nurse can help reduce the risk of bleeding by: A. Applying a pressure dressing and placing the client in supine position B. Applying an occlusive dressing and placing the client in left Sims position C. Applying a moisture proof barrier and placing the client in right Sims position D. Applying a pressure dressing and placing the client in prone position

Short answer

Answer: The best method to minimize bleeding risk after a right kidney biopsy is to apply a pressure dressing to control bleeding and place the client in the right Sims position to apply pressure on the right kidney.

Step-by-step solution

Understand the Kidney Biopsy Procedure

A kidney biopsy involves the removal of a small piece of kidney tissue for diagnostic purposes. The medical professional inserts a needle through the skin and into the kidney to obtain the sample. As with any invasive procedure, there is a risk of bleeding due to tissue damage and blood vessel penetration.

Evaluate the Dressing Options

After a kidney biopsy, the dressing options to consider are: - Pressure dressing (A & D) - Occlusive dressing (B) - Moisture proof barrier (C) A pressure dressing is tightly wrapped around the biopsy site to apply pressure and limit blood flow, which can be effective in controlling bleeding. An occlusive dressing is air and water-tight, preventing contaminants from entering the wound. Moisture-proof barrier serves a similar purpose as an occlusive dressing by protecting the biopsy site from external contaminants. However, neither occlusive dressing nor moisture-proof barrier is specifically designed to control bleeding.

Evaluate the Client Position Options

Next, let's evaluate the different client positions suggested in the exercise: - Supine position (A) - Left Sims position (B) - Right Sims position (C) - Prone position (D) Since the biopsy was performed on the right kidney, having the client in a position that places pressure on the right kidney can help reduce the risk of bleeding. The supine position (A) means that the client is lying on their back, not applying direct pressure on either kidney. The Sims positions (B & C) are lateral positions, with the client lying on their left side (B) or right side (C). Placing the client in the right Sims position (C) applies pressure on the right kidney. The prone position (D) places the client on their stomach, which may also apply pressure to the right kidney.

Select the Best Solution

Based on the dressing options and client positions, the best solution to minimize bleeding risk after a right kidney biopsy is: C. Applying a pressure dressing to control bleeding and placing the client in the right Sims position to apply pressure on the right kidney, which can help reduce the risk of bleeding. Although the prone position (D) may also apply pressure to the right kidney, a pressure dressing is the most effective dressing to control bleeding, as compared to the moisture barriers provided in the other options.

Key concepts

Kidney Biopsy Post-Care

After a kidney biopsy, meticulous post-care is critical to ensure patient safety and recovery. A kidney biopsy is an invasive procedure where a small tissue sample is taken from the kidney for diagnostic testing. An inherent risk of this procedure is bleeding due to the penetration of blood vessels. To mitigate this risk, specific post-care steps must be followed.

One of the primary interventions includes the application of a pressure dressing. This type of dressing is designed to apply targeted pressure to the biopsy site, helping to control and minimize bleeding by compressing the tissue and closing off small blood vessels. It is crucial that the dressing is applied firmly but not so tightly as to cut off circulation.

The patient's positioning is also an integral part of post-procedure care. Incorrect positioning can lead to increased bleeding risk or discomfort. For a biopsy performed on the right kidney, the right Sims position is preferred because it applies gentle pressure to the biopsy site, assisting in hemostasis. Keeping the site elevated can contribute to reducing swelling and pain. Monitoring for signs of bleeding, pain level, and other complications is a continuous responsibility of the nursing staff.

Nursing Interventions

Nursing interventions are actions taken by nurses to enhance patient outcomes. Post-biopsy care involves a variety of such interventions designed to prevent complications such as bleeding, infection, and pain. These interventions may include monitoring the patient's vital signs, administering prescribed medications, providing wound care, and educating the patient.

• Vital Sign Monitoring: Regular checks are necessary to swiftly identify any signs of hemorrhage or shock.
• Pain Management: Analgesics may be administered as prescribed, and the patient's pain levels should be monitored to ensure comfort.
• Wound Care: It involves not only the application of the correct type of dressing but also monitoring for signs of infection and proper healing.
• Education: Providing patients with information about what to expect after the procedure, signs of complications, and when to seek medical attention is vital for recovery.

Nurses must also carefully document all interventions and patient responses to form a comprehensive picture of the patient's recovery trajectory.

Clinical Decision Making

Clinical decision making in nursing is the process by which nurses use critical thinking to evaluate and decide on the best actions to meet patient care goals. It integrates the best available evidence, clinical expertise, and patient preferences. In the context of kidney biopsy post-care, decision making is key to minimizing complications.

For instance, in deciding between various dressings and positions post-biopsy, a nurse must consider factors such as the biopsy site, the potential for bleeding, and the patient's overall health status. The selection of a pressure dressing and the right Sims position in the provided scenario was made with the intent to apply direct pressure to the right kidney to control bleeding. This shows a nuanced understanding of how clinical decisions should aim to balance patient comfort, the potential for adverse outcomes, and the healing process.

An effective nursing decision-making process will also involve the assessment of patient responses, adapting plans as needed, and collaborating with the multidisciplinary healthcare team to ensure the highest quality of patient care.