A patient comes in emergency with cirrhosis of liver and DVT, venous ulcer on medial malleolus due to varicose vein with active bleeding. What will be the first priority intervention?

1. A

   Apply tourniquet to stop arterial bleeding

2. B

   Apply tourniquet to stop arterial and venous bleeding

3. C

   Elevate the limb with compression bandage

4. D

   Inform to the duty doctor

Appeared in: NORCET 5 Prelims - Sept 2023 (Shift-2)

Explanation

Listen in Hindi

• The immediate priority in managing active bleeding from a venous ulcer is to stop the blood loss.
• Elevating the limb above the level of the heart uses gravity to decrease hydrostatic pressure in the veins, which reduces blood flow to the wound.
• Applying a compression bandage provides direct, sustained pressure on the bleeding site, which is the most effective method to facilitate hemostasis (clot formation).
• This combination of elevation and compression is the standard, evidence-based first-line treatment for venous hemorrhage.

Why Other Options Were Wrong

• Option A: This is incorrect because the bleeding is from a venous ulcer, not an artery. Applying a tourniquet is an inappropriate and potentially harmful intervention for venous bleeding.
• Option B: Applying a tourniquet is incorrect for venous bleeding. It would obstruct venous return without necessarily stopping the bleed, leading to increased congestion, pressure, and potential for severe tissue ischemia.
• Option D: Informing the doctor is a necessary step, but it is not the first priority. The nurse's immediate duty is to perform life-saving interventions. Bleeding must be controlled first to stabilize the patient.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Priority nursing interventions for acute bleeding from a peripheral venous ulcer in acute care settings.
• A nurse's ability to rapidly identify the type of bleeding (venous vs. arterial) and initiate the correct first-line intervention is critical to prevent significant blood loss and hypovolemic shock.
• This scenario highlights the nursing principle of 'act first, report later' in an emergency. The nurse must stabilize the patient before notifying the physician.
• Patient comorbidities like cirrhosis can impair clotting ability, making any active bleed more serious and harder to control. Prompt and correct action is therefore even more crucial.

How to Approach the Question

• First, identify the question type. This is a 'priority' question, asking for the most important initial action.
• Analyze the clinical scenario to find the immediate life-threat. Here, it is 'active bleeding'.
• Characterize the problem further. The source is a 'venous ulcer', which dictates the type of intervention needed.
• Recall the standard protocol for venous bleeding: elevation and direct pressure (compression).
• Evaluate the options against this protocol. Options A and B (tourniquet) are incorrect for venous bleeding. Option D (inform doctor) is a secondary action.
• Select the option that directly addresses and controls the life-threatening problem according to protocol, which is elevating the limb and applying a compression bandage.

Concept Tested & Keywords

• Concept Tested: Priority nursing interventions for acute bleeding from a peripheral venous ulcer.
• Stem keywords: cirrhosis of liver, DVT, venous ulcer, active bleeding, first priority
• Lead-in keywords: first priority
• Clinical cues: The cue 'active bleeding' indicates a circulatory emergency requiring immediate intervention.
• Clinical cues: The term 'venous ulcer' specifies the source of bleeding, guiding the choice of intervention away from arterial-focused measures.

Question ID

QMkYw7JVFWqQES_DKI2uxb

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 81-83

E6 Medicine Harrison 22e Part 2 p. 85-87