Report uncontrolled bleeding, an expanding hematoma, or saturated dressing at the site.
Before you read
Test yourself first: 3 questions
Question 1 of 3
A pressure injury reveals full-thickness skin loss with visible subcutaneous fat, but bone, tendon, and muscle are NOT exposed. Slough may be present. How should the nurse stage this wound?
Answer: B. Stage 3 pressure injuries involve full-thickness skin loss with visible adipose (fat) tissue; slough and/or eschar may be present but do not obscure the depth. Bone, tendon, and muscle are not exposed. Exposed muscle or bone would indicate Stage 4.
Question 2 of 3
A client is diagnosed with aplastic anemia. The nurse understands this disorder involves what underlying problem?
Answer: A. Aplastic anemia is bone marrow failure in which the marrow stops producing all blood cell lines, causing pancytopenia: anemia, leukopenia, and thrombocytopenia. This places the client at risk for fatigue, infection, and bleeding simultaneously.
Question 3 of 3
A nurse documents a pressure injury showing full-thickness skin loss with visible subcutaneous fat. Slough may be present, but no bone, tendon, or muscle is exposed. Which stage is appropriate?
Answer: B. A Stage 3 pressure injury involves full-thickness skin loss in which adipose (fat) tissue is visible in the wound. Slough or eschar may be present without obscuring the depth, and undermining or tunneling may occur. Because deeper structures (muscle, tendon, bone) are not exposed, it is not Stage 4. Stage 2 does not involve fat.
Keep the streak going with more questions like these, each with a full rationale.
What is bone marrow biopsy?
A local anesthetic is used, but the patient feels brief pressure and a pulling sensation during aspiration. Memory aid: pressure to the site is the key post-procedure action to prevent bleeding.
Key points to remember
- The posterior iliac crest is the most common site; the sternum may be used for aspiration only in adults.
- Patients with low platelets or clotting disorders are at higher risk for bleeding after the procedure.
- The patient feels brief sharp pain or a pulling sensation when marrow is aspirated despite local anesthesia.
- Firm pressure followed by a pressure dressing to the site controls bleeding afterward.
- Bleeding and infection at the site are the primary post-procedure complications.
- The specimen evaluates cellularity, cell lines, and abnormal cells for diagnosis.
Nursing priorities
- Verify informed consent and review platelet count and coagulation studies before the procedure.
- Position the patient prone or side-lying to expose the iliac crest.
- Apply firm direct pressure to the site, then a pressure dressing after the needle is removed.
- Monitor the site for bleeding, swelling, or hematoma and assess pain afterward.
- Administer prescribed analgesics and monitor for signs of infection.
Labs & values
Patient teaching
- You will feel pressure and a brief sharp or pulling feeling when the marrow is drawn.
- Keep the dressing dry and intact, and watch the site for bleeding once home.
- Mild soreness for a day or two is normal; take pain medicine as directed.
- Report fever, increasing pain, or bleeding that soaks the dressing.
Red flags: report now
- Report uncontrolled bleeding, an expanding hematoma, or saturated dressing at the site.
- Report fever, increasing pain, redness, or drainage suggesting infection.
- Report signs of shock such as hypotension and tachycardia.
- Never remove pressure too early in a patient with thrombocytopenia.
References
Clinical references for this topic
