When assisting with bedside central venous catheter (CVC) ...

[809779]

When assisting with bedside central venous catheter (CVC) placement, which nursing intervention is appropriate? Select all that apply.
 
  a. Don sterile gloves and mask (and possibly gown).
  b. Scrub the insertion site with antibacterial soap for 1 min.
  c. Verify that informed consent has been obtained.
  d. Place the patient in low-Fowler's position.

Question 2

A patient has an area of nonblanchable erythema on his coccyx. The nurse has determined this to be a stage I pressure ulcer. What would be the most important treatment for this patient?
 
  a. Transparent film dressing
  b. Sheet hydrogel
  c. Frequent turn schedule
  d. Enzymatic debridement

[al]

Answer to Question 1

A, C
Maximum barrier sterile technique is used for CVC insertion (sterile gloves, mask, and gown), although some agency policies do not include sterile gown for the nurse. This is an invasive procedure, so informed consent is required. The nurse should confirm that this has been obtained. The scrub is not done with antibacterial soap. The scrub is done with chlorhexidinealcoho l solution or, alternatively, first with 70 alcohol and then with povidone detergent. The patient is placed in Trendelenburg position with a rolled towel between the shoulders for best site access.

Answer to Question 2

C
The patient should be placed on a turn schedule to relieve the pressure. If pressure is not relieved, the wound will worsen. A stage I wound is not open, so a dressing is not warranted. Enzymatic debridement is used to remove slough or eschar in an open wound. A transparent film dressing would protect the area. However, the primary treatment is to relieve the source of pressure.

[809779]

TYSM

[Animal_Goddess]

Excellent