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Difficulty: MediumBasic Care and Comfort

A client who underwent a subtotal thyroidectomy earlier today calls for assistance due to muscle aching in the neck and shoulders. The practical nurse enters the room to adjust the client's position for optimal comfort and safety. Which of the following positioning methods should the nurse implement?

  1. Elevate the head of the bed to 30 to 45 degrees and support the head with pillows to keep the neck in a neutral position.Answer
  2. B
    Place the client in a flat, supine position to reduce gravitational pressure on the neck and promote deep sleep.
  3. C
    Position a small rolled towel horizontally beneath the client's cervical spine to gently extend the neck and relieve muscle spasms.
  4. D
    Raise the head of the bed to a full 90-degree angle and encourage the client to actively stretch their neck from side to side.

Answer

The nurse should elevate the head of the bed to a semi-Fowler's position (30 to 45 degrees) and use pillows to support the client's head and neck in strict neutral alignment.
Following a thyroidectomy, placing the client in a semi-Fowler's position (head of the bed elevated 30 to 45 degrees) with the head and neck supported in a neutral position is the essential standard of care. The elevation promotes venous return and decreases surgical site edema, which is critical for protecting the airway. The supportive pillows provide comfort while preventing neck extension or flexion, which could pull on the suture line, cause severe pain, or trigger bleeding.

Step-by-Step Solution

1
Assess the client's current position and comfort level, noting the recent subtotal thyroidectomy.
Recognize that the client is at high risk for airway obstruction resulting from postoperative edema or hemorrhage.
Swelling in the anterior neck tissues can quickly compress the trachea, making airway protection the top clinical priority.
2
Elevate the head of the bed to an angle of 30 to 45 degrees (semi-Fowler's position).
Gravitational pull naturally promotes venous drainage away from the client's head and neck.
Decreasing venous pressure minimizes incisional edema and bleeding, thereby protecting the airway and enhancing overall comfort.
3
Place supportive pillows or sandbags closely on both sides of the client's head and neck.
The cervical spine is securely maintained in a neutral, aligned position without flexing or hyperextending.
Neutral alignment prevents undue tension on the fresh suture line, prevents wound dehiscence, and helps minimize the muscle spasms commonly experienced after this surgery.

Key Concept

Proper postoperative positioning following a thyroidectomy requires semi-Fowler's elevation and neutral neck alignment to prevent airway compromise, reduce edema, and protect the surgical incision.
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Topics

Basic Care and Comfort

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