When performing a surgical dressing change of a client's ...

[ericka1]

When performing a surgical dressing change of a client's abdominal dressing, the nurse notes an increase in the amount of drainage and separation of the incision line. The underlying tissue is visible to the nurse.
 
  The priority nursing action at this time is to: 1. Apply a povidone-iodine (Betadine)soaked sterile dressing.
  2. Leave the incision exposed to the air to dry the area.
  3. Apply a sterile dressing soaked with normal saline.
  4. Irrigate the wound, and apply a dry sterile dressing.

Question 2

The client newly diagnosed with gout has been prescribed allopurinol (Zyloprim). The nurse would be concerned if the client was also currently taking:
 
  1. Digoxin (Lanoxin)
  2. Adenosine (Adenocard)
  3. Warfarin (Coumadin)
  4. Ergonovine maleate (Ergotrate)

[shoemake]

Answer to Question 1

3

Rationale: Wound dehiscence is the separation of wound edges at the suture line. Signs and symptoms include increased drainage and the exposure of underlying tissues. These usually occur 6 to 8 days after surgery. The client should be instructed to remain quiet and to avoid coughing or straining. The client should be positioned to prevent further stress on the wound. Sterile dressings soaked with sterile normal saline should be used to cover the wound. The physician must be notified after applying this initial dressing to the wound.

Answer to Question 2

3

Rationale: Allopurinol (Zyloprim) is an antigout medication that may increase the effect of oral anticoagulants. Warfarin sodium is an anticoagulant and, if this medication was prescribed for the client, the nurse should verify the prescription. The dosage of warfarin may need to be decreased. Digoxin is a cardiac glycoside. Adenosine is an antidysrhythmic. Ergonovine maleate (Ergotrate) is an antimigraine medication.

[ericka1]

Thanks

[shoemake]

Welcome