The nurse is removing the client's staples from an abdominal incision when the client sneezes and the incision splits open, exposing the intestines. Which of the following actions... The nurse is removing the client's staples from an abdominal incision when the client sneezes and the incision splits open, exposing the intestines. Which of the following actions should the nurse take next?
Understand the Problem
The question describes a scenario where a patient's abdominal incision has opened, exposing the intestines, while a nurse is removing staples. It asks what the nurse's immediate next action should be.
Answer
Cover the abdominal organs with sterile dressings moistened with sterile normal saline.
The next action the nurse should take is to cover the abdominal organs with sterile dressings moistened with sterile normal saline.
Answer for screen readers
The next action the nurse should take is to cover the abdominal organs with sterile dressings moistened with sterile normal saline.
More Information
When an abdominal incision eviscerates, the priority is to protect the exposed organs from contamination and drying. Sterile saline helps maintain tissue viability.
Tips
A common mistake is to prioritize calling the surgeon or the resuscitation team before protecting the exposed organs. While those steps are important, they come after ensuring the patient's immediate safety and preventing complications like infection or tissue damage.
Sources
- Solved The nurse is removing the incision staples for a | Chegg.com - chegg.com
- A client who had an appendectomy for a perforated appendix ... - coursehero.com
- Medical-Surgical Nursing Test Bank: Adrenal Cortex & Substances - coursesidekick.com
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