An older client is admitted to an assisted living facility. While reviewing the client's health history, a nurse notes a current diagnosis of iron deficiency anemia. Which precaution should the nurse initiate?

A.Aspiration for blood return is contraindicated when administering subcutaneous heparin because it increases the risk of local tissue trauma and hematoma formation. Pulling back on the plunger can create a vacuum that ruptures small capillaries in the adipose tissue. This mechanical stress leads to unnecessary bruising and may interfere with the predictable absorption of the anticoagulant.

B.Massaging the injection site after heparin administration is strictly avoided as it can cause significant ecchymosis and tissue irritation. Physical manipulation of the site accelerates the spread of the medication into damaged capillaries, potentially leading to a localized hemorrhage. The nurse should avoid any friction or pressure that could disrupt the integrity of the subcutaneous vascular network.

C.The Z-track method is a specific technique reserved for deep intramuscular injections to prevent medication leakage into subcutaneous tissues. It is not used for subcutaneous administration of heparin, which is specifically designed for absorption within the fatty layer. Utilizing this method for heparin would be an incorrect application of parenteral technique and would not mitigate the risk of bruising.

D.Correct administration involves cleansing the skin, inserting the needle into the subcutaneous layer, and injecting the medication without aspiration or subsequent massage. Applying gentle pressure after needle withdrawal helps prevent the leakage of blood or medication from the puncture site. This technique minimizes the risk of hematoma and ensures the anticoagulant is delivered safely into the intended tissue plane.

A.Baked chicken breast prepared without salt is a high-protein, low-sodium option that supports the nutritional needs of a client with liver impairment. It provides essential amino acids necessary for albumin synthesis while avoiding the hidden sodium found in processed meats. This choice helps manage the osmotic pressure needed to reduce ascites and peripheral edema without contributing to further fluid volume excess.

B.Spaghetti with tomato sauce, especially if the sauce is commercially prepared, often contains high levels of sodium used as a preservative and flavor enhancer. High sodium intake in clients with hepatic dysfunction triggers the renin-angiotensin-aldosterone system, leading to significant water retention and worsening of portal hypertension. The nurse should advise the client to choose fresh, unprocessed ingredients to maintain a strict low-sodium profile.

C.A bowl of ice cream contains significant amounts of sugar and saturated fats, which can exacerbate underlying metabolic issues or non-alcoholic fatty liver disease. While it may not be as high in sodium as canned goods, it does not provide the lean protein required for hepatic cellular repair and maintenance of oncotic pressure. The nurse should prioritize nutrient-dense meals that specifically address the sodium restriction and protein requirements.

D.Canned soup is one of the most concentrated sources of sodium in the modern diet, often exceeding 800 mg per serving. Consuming such high levels of salt would cause rapid fluid accumulation in a client with liver impairment, potentially leading to respiratory distress or severe abdominal tension from ascites. The nurse must educate the client to avoid canned or highly processed foods to prevent acute fluid overload.