A nurse is preparing to administer a chemotherapeutic agent via intraperitoneal therapy. In which position should the nurse plan to place the client before administering this therapy?

1. A

   Supine

2. B

   Semi-fowler's

3. C

   Trendelenburg's

4. D

   Dorsal recumbent

Appeared in: DHS 2018 shift 1st

Explanation

• Intraperitoneal (IP) chemotherapy involves instilling antineoplastic agents directly into the peritoneal cavity.
• The Semi-Fowler's position, with the head of the bed elevated 30-45 degrees, is used for the initial instillation.
• This position utilizes gravity to direct the chemotherapeutic fluid into the lower abdomen and pelvic cavity, a common site for residual disease.
• After the initial instillation is complete, the patient is repositioned frequently to ensure the medication coats all surfaces of the peritoneum.

Why Other Options Were Wrong

• Option A: The supine position (lying flat) does not use gravity to facilitate the flow of the chemotherapeutic agent into the pelvic cavity.
• Option C: The Trendelenburg position (head down, feet up) would cause the fluid to pool near the diaphragm, which is the opposite of the goal for initial instillation.
• Option D: The dorsal recumbent position (lying on back with knees bent) does not provide the necessary gravitational pull to direct the fluid into the pelvis.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Client positioning for intraperitoneal chemotherapy administration in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• Correct positioning is a critical nursing responsibility that directly impacts the efficacy of IP chemotherapy by ensuring the drug reaches the target areas.
• Nurses must perform vigilant respiratory assessments during and after IP chemotherapy, as the large volume of instilled fluid can increase intra-abdominal pressure and compromise diaphragmatic excursion, leading to shortness of breath.
• What if? If the patient develops acute shortness of breath during the infusion, the nurse's first action should be to slow or stop the infusion and raise the head of the bed to a higher Fowler's position to relieve pressure on the diaphragm, then notify the provider.

How to Approach the Question

• Identify the core procedure: Administering intraperitoneal (IP) chemotherapy.
• Understand the goal of the initial step: To instill fluid into the peritoneal cavity so it initially pools in the lower abdomen and pelvis.
• Apply the principle of gravity: To make fluid flow downwards into the pelvis, the patient's upper body must be elevated relative to the pelvis.
• Evaluate the options based on this principle: Semi-Fowler's elevates the head, Trendelenburg's lowers the head, and Supine/Dorsal Recumbent are flat.
• Conclude that Semi-Fowler's is the only position that uses gravity to achieve the initial goal of pelvic pooling.
• Differentiate between positioning for instillation versus positioning for distribution, recognizing that other positions like Trendelenburg's are used later.

Concept Tested & Keywords

• Concept Tested: Client positioning for intraperitoneal chemotherapy administration
• Stem keywords: intraperitoneal therapy, chemotherapeutic agent, administer, position
• Lead-in keywords: plan to place

Question ID

QzLUTELFIwXl-6ErVaHSnX

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor pp. 208-210, 211-213

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 1 p. 106-108