Therapeutic Paracentesis: Worst-Case Scenarios (Nursing)

00:01 Now here's how a worst-case scenario method can help you.

00:04 This is how I recommend students study concepts when they're preparing for exams, the NCLEX and practice.

00:12 Now the goal be that you start filling these out for other diagnoses, but let me walk you through it for paracentesis.

00:18 Look at that first column.

00:20 It says diagnosis or procedure.

00:23 So the diagnosis or procedure we're talking about is a paracentesis.

00:27 Remember that drains fluid from the peritoneum.

00:30 Okay, so that's our diagnosis WCS stands for bleeding.

00:35 Okay so the worst case scenario one of them is bleeding after a paracentesis.

00:41 The third column says how would you recognize it? What are the signs and symptoms that you would see, well as a nurse, I may notice that the patient is making some kind of unusual complaints.

00:53 So the patient may complain of increased pain.

00:56 How does that tie back to bleeding? Well bleeding is going to cause abdominal pain.

01:01 The drainage, you might notice on the dressing that the drainage is increasing that could be a sign of bleeding or the patient may complain of increased shortness of breath.

01:13 Okay. These are all ominous signs.

01:16 Now what do I do about it? That's that fourth column.

01:20 Well monitor her Vital Signs closely is important, but I've got a second one there that's kind of confusing.

01:26 I mean that's always frustrating on a question because sometimes when you say call the health care provider they say it's passing the buck in the wrong answer.

01:33 Sometimes they say, Oh no, that's the right answer.

01:36 How do you know the difference? It's all about scope of practice.

01:40 So if I think this patient is bleeding and why do I think they're bleeding? Well, because they had a paracentesis and they're telling me they have increased pain there's changes in their vital signs, and collects expecting me to recognize these are signs and symptoms of the worst case scenario of bleeding.

01:59 Can I fix bleeding as a nurse? No.

02:02 That is outside of my scope of practice.

02:05 I'm going to want to have a current set of vital signs when I contact the health care provider, but I can't fix this without the healthcare provider that's within their scope of practice.

02:17 So see how using this charting system this method of organizing information in this manner will help you recognize this is how we write test questions in nursing school.

02:29 If I'm asking you what could you do first, you're going to want to monitor the vital signs you're going to want to assess that figure out where the patient is you have this information from them.

02:38 You're going to check and see if their symptomatic yet.

02:41 If the question asks me what's most important that I do, it's the second option notify the healthcare provider.

02:49 So just a little insight on how test questions are written and how you can work it putting the information in your brain in an organized manner so you can retrieve it when you need it.

03:01 Now bleeding was one case scenario.

03:03 Let's do another one hypotension.

03:06 Now what might the patient say to me, we're still talking about paracentesis, but I know I'm going to watch them for signs of bleeding and I know I'm going to watch them for hypotension or low blood pressure.

03:16 The patient may say something, I feel really dizzy, their blood pressure might be trending downward and downward and downward and when it goes down the heart rate goes up.

03:28 So what are the interventions and at that last column? I'm going to monitor vital signs closely.

03:34 And again, I'm going to notify the healthcare provider to let them know that, hey this blood pressure is dropping, so we've got some fluid shifting issues.

03:43 I'm going to need to know what's the next best step to keep this patient safe.