A nurse is caring for a client.

Exhibits

Based on the information in the EHR, which of the following actions should the nurse take? Select all that apply.

A. Performing the procedure independently. This is the best indicator of readiness for discharge. The client’s partner must demonstrate the ability to perform tracheostomy suctioning correctly and safely without direct supervision. Proper technique includes using sterile equipment, maintaining appropriate suction pressure (80120 mmHg), limiting suction duration to 1015 seconds per pass, and allowing adequate oxygenation between passes to prevent hypoxia. Independent performance ensures the caregiver can manage airway clearance at home.
B. Verbalizing all steps in the procedure. While verbalizing the steps demonstrates understanding, it does not confirm the ability to perform suctioning correctly. Practical application is necessary to ensure competency in technique, infection control, and recognizing complications such as hypoxia or airway trauma.
C. Attending a class given about tracheostomy care. Education is essential, but attending a class alone does not confirm skill mastery. Handson practice and independent demonstration are required to ensure safe and effective tracheostomy management.
D. Asking appropriate questions about suctioning. Asking questions reflects engagement and willingness to learn, but it does not indicate that the caregiver can independently perform the procedure. Proper discharge readiness requires demonstrated competency through handson practice.

A. Progressive increase in platelet production. In DIC, platelet levels decrease rather than increase due to widespread consumption of platelets in abnormal clot formation. This depletion leads to an increased risk of bleeding.
B. Immediate sodium and fluid retention. DIC primarily affects coagulation and does not directly cause significant sodium or fluid retention. Fluid shifts may occur due to capillary leakage and organ dysfunction, but these are secondary effects rather than primary findings.
C. Excessive thrombosis and bleeding. This is correct. DIC is a disorder of widespread clotting followed by excessive bleeding. Small clots form throughout the vascular system, consuming clotting factors and platelets, leading to an inability to control bleeding in later stages. Clients may experience petechiae, purpura, oozing from IV sites, and internal organ damage due to ischemia.
D. Increased clotting factors. In DIC, clotting factors are depleted due to their excessive use in forming clots. This depletion contributes to the inability to clot properly, resulting in hemorrhage as the disorder progresses.