Question

The nurse is supervising a student caring for the patient with a nephrostomy tube. Which action by the student needs immediate follow-up? A. The dressing with a small amount of drainage around the nephrostomy tube is changed. B. The amount of urine from the nephrostomy tube is measured and documented. C. The nephrostomy tube is clamped close to the skin with a large hemostat. D. The patient is given an analgesic for surgical pain.

Short answer

The action by the student that needs immediate follow-up is C. The nephrostomy tube is clamped close to the skin with a large hemostat.

Step-by-step solution

Analyzing the Choices

Go through each of the choices (A to D), understanding what each action implies and their possible impact on the patient.

Categorizing the Choices

Categorize the choices into those that are part of standard care for a patient with a nephrostomy tube and those that are against standard care. Actions included in standard care: A. Changing a dressing with a small amount of drainage, B. Measuring and documenting the amount of urine from the nephrostomy tube, D. Administering analgesics for surgical pain. These actions reflect appropriate care. The action that is against standard care: C. Clamping the nephrostomy tube close to the skin using a large hemostat. This can lead to increased pressure in the kidney, potentially causing damage

Identify the Action that Needs Immediate Follow-Up

The action that needs immediate follow-up or correction is the one that poses a risk to the patient. In this case, C. Clamping the nephrostomy tube close to the skin with a large hemostat needs immediate follow-up and should be corrected.

Key concepts

Nephrostomy Tube Care

Nephrostomy tubes are a critical component in managing certain kidney issues, particularly when there's a need to drain urine directly from the kidney due to an obstruction or other problems. It's vital to understand how to care for these tubes to ensure patient safety and promote healing. Some standard practices in nephrostomy tube care include:

• Regularly changing the dressing, especially if there's some drainage.
• Carefully measuring and documenting the urine output from the nephrostomy tube, as this provides important information about kidney function.
• Avoiding actions that increase pressure on the kidney, such as overly clamping the tube, which can lead to serious damage.

Clamping the tube close to the skin or using improper tools can cause pressure buildup, risking kidney injury. Hence, following recommended procedures and avoiding actions that can cause harm is crucial in nephrostomy tube care.

Student Nurse Supervision

Supervising student nurses is an essential part of their education, helping them to build confidence and competence in clinical practices. When working with a patient who has a nephrostomy tube, it is essential for supervising nurses to:

• Ensure that students understand the importance of maintaining sterility when handling the nephrostomy tube and its site.
• Guide students to accurately document the amount and characteristics of urine output, which is crucial for evaluating patient health.
• Help students recognize incorrect practices, such as using a large hemostat to clamp the tube, which can be harmful.

Close supervision allows students to learn and practice clinical skills safely while protecting the patient's well-being.

Patient Safety

Patient safety is integral to all nursing care, especially when dealing with complex procedures like managing nephrostomy tubes. To maintain patient safety:

• Avoid clamping the nephrostomy tube as this can create dangerous pressure on the kidney and lead to complications.
• Ensure proper pain management through safe administration of analgesics, which helps the patient remain comfortable and cooperative.
• Regularly assess the tube and site for any signs of infection, ensuring ongoing protection against potential health threats.

By prioritizing these safety measures, nurses can drastically reduce the risk of adverse events, ensuring patients receive the highest standard of care.

Clinical Decision-Making

Effective clinical decision-making involves considering all actions' impacts on patient outcomes, particularly in complex scenarios like those involving nephrostomy tubes. In this setting, decisions must:

• Be grounded in solid clinical knowledge and adhere to standard operating procedures.
• Consider the direct implications of each action on the patient's health, such as the potential harm of incorrect tube handling.
• Weigh the need for immediate intervention, for instance, identifying and correcting the misuse of medical tools like hemostats immediately.

Incorporating sound judgment and knowledge, clinical decision-making ensures both student nurses and patients navigate medical care effectively and safely.