What is the initial nursing intervention when a patient’s wound eviscerates during a turn?

When a patient experiences wound evisceration, the primary concern is to protect the exposed organs and prevent further complications such as infection or tissue damage. Applying a warm, moist normal saline sterile dressing is the correct initial nursing intervention because it helps to keep the exposed tissues hydrated and minimizes the risk of desiccation. The moisture provided by the saline also serves to create a barrier against contamination until surgical intervention can be performed.

This intervention is crucial in maintaining a moist environment, which is beneficial for healing and protects the eviscerated organs from exposure to the external environment. It also helps in soothing the tissue and reducing the risk of further injury or irritation from environmental factors.

In contrast, positioning the patient in high Fowler's position could lead to added pressure on the wound and does not address the immediate need to protect the eviscerated organs. Administering fluids may be necessary later to prevent shock, but it does not address the immediate peril of exposed tissues. Replacing the dressing with sterile fluffy pads, while a necessary action, is not the priority before ensuring that the exposed area is kept moist and protected.