When preparing a client for a liver biopsy which instruction would the nurse provide to the client

Most ultrasound procedures do not require advance preparation. The exceptions are listed below:

For any study, if your doctor gave you an order, please bring it with you.

Abdominal Ultrasound and Abdominal Ultrasound with Doppler

(Liver, spleen, gallbladder, kidneys, pancreas, abdominal aorta, biliary system)

• (Exam time: 30 min; visit time about 1-1/2 hours)
• Adults: Do not eat or drink eight hours before exam.
• Children: Do not eat or drink four hours before study or skip one meal.
• Take medications with a small sip of water.
• If you are diabetic, please take your insulin.

Pelvic Ultrasound

(Uterus, ovaries, fallopian tubes, urinary bladder)

• (Exam time: 30 min; visit time about 1-1/2 hours)
• Our protocol is to include transvaginal ultrasound for females.
• Eat normally.
• One hour before your exam, drink 32 ounces of water.
• Do not empty your bladder before your exam.

Bladder Ultrasound

• For both male and female patients, one hour before your exam, drink 32 ounces of water.

Prostate-Transrectal Ultrasound

• Two hours before your exam, do a cleansing with a Fleet enema #1.
• Follow preparations for prostate ultrasound

Transvaginal Ultrasound

• Drink 32 ounces of any liquid one hour before the exam. Do not urinate before the exam so you arrive for at the exam with a full bladder.

Hysterosonogram

• No unprotected sexual relations during the first 10 days of your menstrual cycle.

Ultrasound breast biopsy

• You must be off aspirin, blood thinners and vitamin E for seven days prior to your biopsy.

Liver biopsy / paracentesis / thoracentesis / prostate biopsy

• Do not eat or drink after midnight the day before your biopsy.
• You must be off aspirin, blood thinners and vitamin E for seven days before your biopsy.

The S. Mark Taper Foundation Imaging Center provides a full range of advanced imaging, both radiology and cardiology, as well as interventional radiology and interventional tumor (oncology) treatments to the greater Los Angeles area, including Beverly Hills, Encino, Mid-Cities, Sherman Oaks, Silver Lake, Studio City, Toluca Lake and West Hollywood.

Because many illnesses affect body alignment and mobility, you must be able to safely care for these clients in order to be an effective nurse. These topics are also important on the NCLEX- RN® exam. The successful test taker must correctly answer questions about impaired mobility and positioning.
Immobility occurs when a client is unable to move about freely and independently. To answer questions on positioning, you need to know the hazards of immobility, normal anatomy and physiology, and the terminology for positioning.
Many graduate nurses are not comfortable answering these questions because:

• They don’t understand the “whys” of positioning.
• They don’t know the terminology.
• They have difficulty imagining the various positions.

If you have difficulty answering positioning questions, the following strategy will assist you in selecting the correct answer.

• Step 1

  Decide if the position for the client is designed to prevent something or promote something.

• Step 2

  Identify what it is you are trying to prevent or promote.

• Step 3

  Think about anatomy, physiology, and pathophysiology (“A&P”).

• Step 4

  Which position best accomplishes what you are trying to prevent or promote?

Does this sound a little confusing? Hang in there. Let’s walk through a question using this strategy.

Before you read the answers, let’s go through the four steps outlined above.
Step 1. By positioning the client after a liver biopsy, are you trying to prevent something or promote something? Think about what you know about a liver biopsy. You position a client after this procedure to prevent something.
Step 2. What are you trying to prevent? The most serious and important complication after a percutaneous liver biopsy is hemorrhage.
Step 3. Think about the principles of anatomy, physiology, and pathophysiology. What do you do to prevent hemorrhage? You apply pressure. Where would you apply pressure? On the liver. Where is the liver? On the right side of the abdomen under the ribs.
Step 4. How should the client be positioned to prevent hemorrhage from the liver, which is on the right side of the body? Look at your answer choices.
(1)  Supine. If you lay the client flat on his back, no pressure will be applied to the right side. Eliminate.
(2)  Right side-lying. If you lay the client in a right side-lying position, will pressure be applied to the right side? Yes. Keep it in for consideration.
(3)  Left side-lying. No pressure is applied to the right side. Eliminate.
(4)  Semi-Fowler’s. If you lay the client on his back with head partially elevated, no pressure is applied to the right side. Eliminate.
The correct answer is (2). Some students select (3) because they don’t know normal anatomy and physiology. Some students select (4) because semi-Fowler’s position is used for a lot of reasons.
Let’s look at another question.

Let’s go through the steps.
Step 1. By positioning the client after an angiogram, are you trying to prevent something or promote something? You are trying to promote something.
Step 2. What are you trying to promote? Adequate circulation of the right leg.
Step 3. Thinkabouttheprinciplesofanatomy,physiology, and pathophysiology. What promotes adequate circulation in the right leg? Keeping the leg at or below the level of the heart so blood flow is not constricted.
Step 4. How will the client be positioned after an angiography to prevent constriction of vessels and keep the right leg at or below the level of the heart? Look at the answer choices.
(1) “Semi-Fowler’s with the right leg bent at the knee.” The head of the bed is elevated 30–45 degrees in this position. The leg is lower than the heart. If the right leg is bent at the knee, this could constrict arterial blood flow. Eliminate.
(2)  “Side-lying with a pillow between the knees.” Use of a pillow in this position could create pressure points in the right leg. You don’t want the knees bent. Eliminate.
(3)  “Supine with the right leg extended.” In this position, the leg is at the level of the heart. Circulation will not be constricted because the leg is straight. Keep for consideration.
(4)  “High Fowler’s with her right leg elevated.” The head of the bed is elevated 60–90 degrees in this position. Elevating the leg promotes venous return. Eliminate.
The correct answer is (3). The client is on bed rest for 8–12 hours in a supine position after an angiogram.
If you didn’t know the specific positioning needed after an angiogram, you can apply your knowledge to select the correct answer by just thinking about it.

Even if you didn’t memorize what position to use before, during, and after a procedure, think about the question for a moment. You can figure out what position is needed.
You cannot figure out the correct position if you do not know what the terms (such as supine or Fowler’s) mean.
You cannot figure out a correct position if you do not know anatomy and physiology. If you think the liver is on the left side of the body, you are in trouble!
You cannot figure out a correct position if you do not know what you are trying to accomplish. If you couldn’t remember that a complication after a liver biopsy is hemorrhage, you will simply be taking a random guess at the correct answer.
If you think in images, you should form a mental image of each position. Picture yourself placing the client in each position, and then see if the position makes sense. Let’s try another question using the strategies for positioning.

When preparing a client for liver biopsy The nurse explains that during the test the client will be placed in which position?

What should I do before a liver biopsy?

What is the procedure for a liver biopsy?

Why do you lay on the right side after a liver biopsy?