TIME SPECIFIC CONTENT TEACHING LEARNING A.V.

EVALUATION
S.N. OBJECTIVE ACTIVITY ACTIVITY

1. 1min Introduce INTRODUCTION: Lecture Listening LCD What do you

the  Paracentesis is a form of body fluid sampling procedure, Cum mean by the
paracentasis generally referring to peritoneocentesis in which the discussion paracentesis?
peritoneal cavity is punctured by a needle to sample
peritoneal fluid.
 The procedure is used to remove fluid from the peritoneal
cavity, particularly if this cannot be achieved with
medication.
 The most common indication is ascites that has
developed in people with cirrhosis.
2. 1min Define the DEFINITION: Lecture Listening LCD Define the
paracentesis According to dictionary: Cum paracentesis?
1. Paracentesis was again performed several times, and a discussion
tumors was perceived to have formed in the lower part of the
abdomen.

According to oxford dictionary:

1. Definition of paracentesis - the perforation of a cavity of
the body or of a cyst or similar outgrowth, especially with a
hollow needle to remove fluid or gas.

3. 1min purposes of Purposes of paracentasis: Cum listening chart What is aim of

paracentesis discussion paracentesis?
 To relieve pressure on the abdominal and chest organs if Lecture
a transuded collects as a result of renal, cardiac or liver
diseases.
 To study chemical, bacteriological and cellular
composition of the peritoneal fluid for the diagnosis of
diseases.
 To drain an exudates in peritonitis.
4. 1min List out the Preparation of Articles: Lecture Listening articles
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preparation Cum
Of articles A covered sterile tray containing: demonstra
tion
1. Sponge holding forceps to clean the skin
2. Syringe (5  ml) with needles to give local anesthesia
3. Syringe (20 ml) with lour lock for aspiration of fluid
4. Three-way adaptor and tubing.
5. Trocar and cannula or aspiration needles
6. B.P. handle with blades to make a small skin incision for
the introduction of trocar and cannula.
7. Suturing needles (if incision is made)
8. Small bowls to take cleaning lotions
9. Dissecting forceps – toothed 1, non toothed
10. Specimen bottles
11. Sterile dressing towels or slits
12. Cotton balls, gauze pieces, and cotton pad.
13. Gloves, gown and mask

An unsterile tray containing:

1. Mackintosh and towels
2. Kidney tray and paper bag
3.Spirit, iodine, tr. Benzoic etc
4. Lignocaine 2 percent
5. Apron for the doctor
6. Drainage receptacle to collect the fluid
7. Pint measures to measure the fluid
8. Low stool to raise the drainage receptacle and adjust the
height
Surgical dressing set:-
  Spirit,
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  Savlon,
  Butadiene,
  Gauze pieces,
  Gauze pads,
  Transfer forceps,
  Cotton balls,
  Artery forceps

5. 3min Explain the GENERAL INSTRUCTIONS: Lecture Listening LCD What is general
General Cum instruction of
instruction 1. Give adequate explanations to win the confidence and co- discussion paracentesis?
operation of the client. Client’s co-operation is very
necessary, for the prevention of injury to the adjacent
organs.
2. Strict aseptic technique should be followed to prevent
introduction of infection into the peritoneal cavity.
3. Ask the client to void 5 minutes before the procedure to
prevent injury to the bladder. Catheterize the client if any
doubt exists.
4. Keep the client warm and comfortable to prevent chills.
5. Be prepared to treat shock. Shock can be prevented by:

a. Withdrawing the fluid slowly. Apply clamps on

the tubing

b. Withdrawing small quantity of fluid at a time.

c. Applying pressure on the abdomen with many tailed

bandage and tightening it from above downwards as the
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fluid is drained.

d. Keeping the client warm.

e. Observing the vital signs continuously during the

procedure
6. The drainage receptacle should be raised on the stool. The
greater the vertical distance between the tapping needle and the
end of the tubing in the drainage receptacle, the greater is the pull
on the fluid in the cavity and more quickly the cavity is drained
and the client may go into a state of shock.

7. Use a tapping needle trocar of smaller gauge possible. This

will reduce the puncture wound as small as possible and thereby
reduce the chances of fluid leaking from the peritoneal cavity
after the procedure is over.

8. The flow of fluid can be controlled by the application of

clamps on the tubing.

9. The nurse should remain with the client throughout the

procedure to observe the client’s general condition. Changes in
colour, pulse, respiration, blood pressure etc. should be noted and
reported to the doctor immediately. These are the indications that
the client is going into vascular shock and collapse.

10. Repeated aspirations of the ascetic fluid result in

hypoproteinaemia. The client should be given plasma proteins if
he develops such a condition

6. 2min Explain the Preparation of the Client: Lecture Listening Articles How to prepare
preparation Cum the client?
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of client discussion
1. Explain the procedure to the client and his relatives to obtain
their understanding, co-operation and acceptance of the
treatment.
2. Get a written consent from the client or his relatives.
3. Prepare the skin as for a surgical procedure.
4. Record the blood pressure, pulse, respiration and weight of the
client on the nurse’s record before sending the client to the
operation room. This may be used to compare the similar data
obtained during or after the procedure and to determine the effect
of the procedure on the client.
5. Empty the bladder just before the procedure to prevent injury
to the distended bladder. When there is doubt, catheterize the
bladder.

6. Protect the client from chills by keeping him warm. Cover the
client with a blanket. Close the windows and doors to prevent
draught. Put off the fan.

7. Change the client’s garments with hospital dress. Put on loose

gowns. The upper garments may be pinned up to prevent its
falling over the abdomen during the procedure.

8. Bring the client to the edge of the bed to prevent over

reaching. Place him in a Fowler’s position supported with a back
rest and pillows
9. Maintain privacy with screens and drapes. Drape the client
exposing the abdomen only.

10. Protect the bedding with a mackintosh and towel.

11. Place a many tailed bandage under the client to apply over
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the abdomen during the procedure in order to maintain the intra-

abdominal pressure.  This will help to prevent shock and collapse
as the fluid is drained from the abdominal cavity.

12.The nurse should remain with the client throughout the

procedure encouraging him to co-operate and diverting his
attention away from the procedure. She should note the color,
pulse, respiration and blood pressure during the procedure to
detect the early signs of shock and collapse

7. 1min Explain the Site and Positioning of the Client for an Abdominal Lecture listening LCD What is site and
site and Paracentesis Cum Positioning of
position of discussion the client for an
the client abdominal
The primary object of selecting a site is to avoid injury to the paracentesis ?
urinary bladder and other abdominal organs. A common site is
the midway between the symphysis pubis and the umbilicus on
the midline. An another site may be a point two-third along a line
from the umbilicus to the anterior superior iliac spine.

The client is positioned in Fowler’s position supported by back

rest and pillows near the edge of the bed

8. 2min Demonstrati PROCEDURE: Lecture Articles Explain the

on Cum Listening demonstration
Of the The abdominal paracentesis is done under strict aseptic Discussion And of the
procedure techniques. If it is done for diagnostic purposes, the fluid Demonstr paracentasis?
of the withdrawn by a large syringe may be sufficient. If the procedure a-tion
paracentasi- is done for relieving pressure symptoms, a trocar and cannula are
s used. After catheter is passed through the cannula into the
peritoneal cavity for the removal of fluid. After enough fluid is
withdrawn, the cannula is removed and opening is sealed.giving
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a local anaesthesia, a small skin incision is made at the site

selected and the trocar and cannula are enough fluid is
withdrawn, the cannula is removed and opening is
sealed.introduced. After the trocar and cannula are in position the
trocar is removed and the cannula is attached to the tubing that
reaches the drainage receptacle. Occasionally, a soft catheter is
passed through the cannula into the peritoneal cavity for the
removal of fluid. After
9. 2min Explain the After Care of the Client: listening LCD What need the
after care of Lecture after care of
client 1. As soon as the needle is removed, a sterile dressing and a Cum the client?
pressure bandage is applied at the puncture site to prevent discussion
leakage of fluid

2. The abdominal bandage is tightened to maintain intra-

abdominal pressure.

3. Check the client’s general condition after the procedure. Any

change in the color, pulse, respiration and blood pressure should
be reported immediately. The vital signs are checked half hourly
for two hours; then hourly for 4 hours followed by 4 hourly for
24 hours.

4. The specimen collected should be sent to the laboratory with

labels and requisition form.

5. Examine the dressing at the puncture site frequently for any

leakage. Re-enforce the dressing if leakage is present.

6. Serum proteins are estimated to detect hypoproteinaemia. If

hypoproteinaemia is present, plasma proteins are administered.
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7. Record the procedure on the nurse’s record with date and time.
Note the amount and character of the fluid drained, its color,
effects of treatment on the client (both desired and undesired
effects) and the general condition of the client during and after
the treatment.

10. 1min Explain the Nursing management:- Lecture listening LCD What is
nursing   Check for the physician’s order, Cum nursing
manageme- Discussion Management
  Explain to procedure to patient and patient relatives what
nt of
to be going to done,
paracentsis?
 Take written consent from patient and patient relatives,
 Shave and Skin prepare should be done,
 Record the patient vital e,g. Temperature,B.P,pulse,Spo2,
  Provide privacy,
  Maintain I. V, line, if any emergency to give fluids and
medications,
  Paint abdomen with Betadine,
  Assist to Doctor, giving needed articles, such as cotton
swabs, sterile towels, etc…
  Needle should be inserted z-track technique,
  Monitor patient during procedure,
  Observe for fluid color,
  Measure fluid quantity,
  Send test tube for diagnostic tests,
  After finishing the procedure, seal the punctured wound
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with sterile dressing,

  Fasten the abdominal binder tightly, from the top to
bottom,

11. 1min Explain the Complications: Listening Listening What is

complicatio Cum complication
n 1. Hypovolaemia leading to shock and collapse. discussion of the
paracentesis?
2. Infection (peritonitis)

3. Injury to the blood vessels and other abdominal organs.

4. Renal failure due to reduced systemic circulation

5. Hypoprotenaemia as a result of repeated tapping

12. 1min Summarize SUMMARRY:

the Let summarize the topic -paracentasis .in this topic we have Listening Listening
Topic demonstrate ,discussion and learned about the introduction, Cum
paracentesis definition, purposes, equipment, general instruction, procedure discussion
,after procedure care,complication.

13 1min Conclude CONCLUSION: Listening listening

the topic  Paracentesis is a form of body fluid sampling procedure, Cum
paracentesis generally referring to peritoneocentesis in which the discussion
peritoneal cavity is punctured by a needle to sample
peritoneal fluid.
 TIME SPECIFIC CONTENT TEACHING LEARNING A.V. EVALUATION
S.N. OBJECTIVE ACTIVITY ACTIVITY
 TIME SPECIFIC CONTENT TEACHING LEARNING A.V. EVALUATION
S.N. OBJECTIVE ACTIVITY ACTIVITY