The nurse is caring for a client who has undergone surgery to drain a pancreatic pseudocyst with placement of a pancreatic drainage tube. Which nursing intervention prevents complications from this procedure?

Question

a. Positioning the client in a right side-lying position
b. Applying a skin barrier around the drai-nage tube site
c. Clamping the drainage tube for 2 hours every 12 hours
d. Irrigating the drainage tube daily with 30 mL of sterile normal saline

Answer 1

B
The nurse assesses the skin around the drainage tube for redness or skin irritation, which can be severe from leakage of pancreatic enzymes. The nurse applies a skin barrier such as Stomahesive around the drainage tube to prevent excoriation. A side-lying position may be more comfortable for the client. The drainage tube should not be clamped or irrigated without specific orders.