The nurse's outcome for the patient is, "Patient self-administers subcutaneous heparin before discharge.". What does the nurse include in patient teaching?
a. Expect large areas of bruising around the injection site.
b. Promote heparin absorption by massaging the injection site.
c. Choose one large area for consistent he-parin absorption.
d. Inject heparin into the abdomen but avoid the umbilical area.
D
The nurse instructs the patient to inject heparin into the abdomen and avoid the area around the umbilicus because it is surrounded by dense tissue that delays absorption. The nurse instructs the patient to expect small areas of bruising around the injection site; to avoid massaging the site because it increases absorption and promotes bruising; and to choose various sites, reminding the patient that bruising occurs and the patient may want to keep the areas covered.
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The treatment team meets with a client for the first time and determines, with the client's input, a nursing diagnosis, goal, and steps to reach this goal
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