Fundamentals of Nursing Q 454



A client with pleural effusion is scheduled to have a thoracentesis. The nurse on duty will assist the client to which position during the procedure?
  
     A. Lying in bed on the unaffected side with the head of the bed elevated about 45°.
     B. Forward side-lying position with head of bed flat.
     C. Lying in bed on the affected side with the head of the bed elevated about 45°.
     D. Supine position with both arms extended.
    
    

Correct Answer: A. Lying in bed on the unaffected side with head of bed elevated about 45°.

During thoracentesis, to facilitate removal of pleural fluid from the pleural space, position the client sitting on the edge of the bed, leaning over a bedside table with the feet supported on a stool, or lying in bed on the unaffected side with head of bed elevated about 45°.

Option B: Patient lies between supine and prone with legs flexed in front of the patient. Arms should be comfortably placed beside the patient, not underneath. However, the head of the bed should be elevated to facilitate drainage of pleural fluid from the pleural space.
Option C: The patient should lie on the unaffected side. The patient is moved to the extreme side of the bed, the ipsilateral hand is placed behind the head, and a towel roll is placed under the contralateral shoulder. This measure facilitates dependent drainage and provides good access to the posterior axillary space.
Option D: Patients who are alert and cooperative are most comfortable in a seated position, leaning slightly forward and resting the head on the arms or hands or on a pillow, which is placed on an adjustable bedside table. This position facilitates access to the posterior axillary space, which is the most dependent part of the thorax. Unstable patients and those who are unable to sit up may be supine for the procedure.