Which nursing interventions are significant for a child with cirrhosis who is at risk for bleeding? Select all that apply
a. Guaiac all stools
b. Provide a safe environment
c. Administer multivitamins with vitamins A, D, E, and K
d. Inspect skin for pallor and cyanosis
e. Monitor serum liver panels
A, B, C
Feedback
Correct Identification of bleeding includes stool guaiac testing, which can detect if
blood is present in the stool; protecting the child from injury by providing
a safe environment; administering vitamin K to prevent bleeding episodes;
and avoiding injections.
Incorrect A skin assessment would likely reveal jaundice. Pallor and cyanosis are
associated with a cardiac problem. These may be late signs of a significant
bleeding episode, but not significant in the prevention stage of the nursing
process. Monitoring serum liver panels is important but would not provide
information on coagulation status or risk factors associated with bleeding.
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