A community health nurse is working with a family that is struggling to adapt following the loss of a family member. Which of the following actions should the nurse take first?

“It is important that our child avoids placing anything inside the cast.”: This reflects an understanding. Inserting objects inside the cast can cause injury, skin breakdown, or infection, and should be avoided.

“We should notify the provider if the cast becomes loose over time.”: This reflects an understanding. A loose cast could lead to inadequate immobilization or further injury. Parents should report any loosening to the provider.

“We should prop the casted arm on pillows for the next 24 hours.”: This needs reinforcement. The cast should be elevated to reduce swelling, but it should not be kept elevated for 24 hours continuously. Parents should be taught to elevate the arm in intervals and monitor for signs of increased swelling or discomfort.

“We need to be very careful about how we handle the cast for the first 2 days while it dries.”: This reflects an understanding. It is important to handle the cast with care while it is drying to prevent deformities or indentations in the cast that could interfere with proper healing.

A. Place the client in an upright position leaning over a bedside table – This position allows for optimal access to the pleural space and facilitates gravity-assisted drainage of pleural fluid.

B. Inform the client they will be sedated for the procedure – Thoracentesis is typically performed under local anesthesia, not sedation, unless the client has specific complications or needs.

C. Obtain informed consent from the client – Thoracentesis is an invasive procedure, and informed consent is required to ensure the client understands the risks, benefits, and alternatives.

D. Explain that a needle will be inserted in the pleural space to withdraw fluid – Providing a clear explanation of the procedure helps reduce anxiety and ensures the client understands what to expect.

E. Administer a cough suppressant to the client prior to the procedure – A cough suppressant can help prevent the client from coughing during the procedure, reducing the risk of complications such as needle displacement or injury.

F. Inform the client that they will need to fast 4 hr prior to the procedure – Fasting is not required for a thoracentesis. This procedure is usually performed with the client awake and does not involve general anesthesia.