A staff education nurse is evaluating a group of nurses during a new employee orientation on the use of proper body mechanics when lifting. Which of the following images indicates the appropriate use of ergonomic principles?

 

A. Perform the Credés maneuver: The Credés maneuver involves applying manual pressure over the bladder to promote voiding. This technique is contraindicated in clients with continuous bladder irrigation post-TURP, as it can disrupt the surgical site and increase the risk of bleeding or trauma.

B. Maintain the irrigation solution rate: Pink-tinged urine is an expected finding in the immediate postoperative period following TURP. Maintaining the prescribed irrigation rate helps prevent catheter obstruction from clots, ensures continuous drainage, and reduces the risk of bladder distention and further bleeding.

C. Replace the indwelling urinary catheter: Catheter replacement is unnecessary when urine is draining and pink-tinged, indicating minor bleeding rather than obstruction or malfunction. Routine replacement could introduce infection and trauma.

D. Warm the irrigation solution: Warming the solution is generally not required unless the client experiences discomfort from cold fluid. It does not address the normal postoperative pink-tinged urine and does not influence clot prevention.

Rationale for correct choices

• Spontaneous abortion: The client is at 10 weeks gestation with vaginal bleeding, abdominal cramping, and an open cervix, which are classic findings associated with spontaneous abortion. The presence of cervical dilation indicates that pregnancy loss is actively occurring or imminent. These findings distinguish spontaneous abortion from other early pregnancy complications.

• Cervical dilation: Cervical dilation during early pregnancy is a key indicator of pregnancy loss. In spontaneous abortion, the cervix opens as products of conception begin to pass. This finding provides objective evidence that the pregnancy is not being maintained.

Rationale for incorrect choices

• Molar pregnancy: Molar pregnancy is associated with excessively high hCG levels, uterine enlargement greater than gestational age, and symptoms such as severe nausea or hyperemesis. The client’s hCG level is appropriate for gestational age and does not suggest trophoblastic overgrowth. Cervical dilation is not a defining feature of molar pregnancy.

• Ectopic pregnancy: Ectopic pregnancy typically presents with unilateral pelvic pain, possible shoulder pain, and often no cervical dilation. Vaginal bleeding may occur, but the cervix usually remains closed. Additionally, ectopic pregnancies often have lower-than-expected hCG levels.

• Lower abdominal cramping: Abdominal cramping is a common symptom in many early pregnancy complications and is not specific to spontaneous abortion. While it supports uterine activity, it does not independently confirm pregnancy loss. Cervical dilation provides stronger diagnostic evidence. Cramping alone is insufficient as the primary indicator.

• hCG levels: The client’s hCG level is within the expected range for 10 weeks gestation. Abnormally high levels would suggest molar pregnancy, while low or slowly rising levels might suggest ectopic pregnancy or nonviable gestation. In this case, hCG does not explain the acute findings.