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Difficulty: HardBasic Care and Comfort

A client is receiving postoperative care on the medical-surgical unit following a lumbar laminectomy. The client reports mild discomfort from lying flat and requests assistance to turn onto their side. Which of the following techniques should the nurse implement to safely reposition this client?

  1. Obtain assistance from another staff member to logroll the client's entire body as a single unit, keeping a pillow placed between the client's legs.Answer
  2. B
    Gently turn the client's shoulders toward the desired side first, followed immediately by rolling the hips to maintain a continuous, smooth motion.
  3. C
    Elevate the head of the bed to a 45-degree angle to relieve lumbar tension, then instruct the client to use the opposite side rail to pull their torso over.
  4. D
    Place a supportive wedge under the client's knees to relax the back muscles, then slowly pivot the lower extremities to the side while holding the shoulders flat.

Answer

The nurse must obtain assistance to logroll the client as a single unit with a pillow between the legs.
Following spinal surgery such as a lumbar laminectomy, the vertebral column must remain in straight anatomical alignment. Logrolling the client as a single unit prevents any twisting (torsion) or flexion of the spine. Placing a pillow between the legs ensures the hips remain parallel and the spine stays aligned during the lateral movement.

Step-by-Step Solution

1
Identify the surgical procedure and its specific mobility precautions.
The client had a lumbar laminectomy, which requires maintaining strict, neutral spinal alignment.
Postoperative spinal care mandates the prevention of any twisting, flexion, or hyperextension to protect the surgical site and spinal cord.
2
Evaluate the proposed positioning techniques against the required precautions.
Logrolling is the only technique that moves the head, shoulders, and hips simultaneously.
Techniques that involve pulling on rails, elevating the head, or turning the upper and lower body at different times create dangerous torsion (twisting) on the spine.
3
Select the safest execution method for the required technique.
Using extra staff to logroll and placing a pillow between the legs prevents adduction of the upper leg, keeping the spine straight during the turn.
Proper body mechanics and sufficient staff are fundamental elements of basic care and comfort that prevent injury to both the client and the nurse.

Key Concept

Basic care positioning for a postoperative spinal surgery client requires logrolling to prevent spinal flexion and torsion.
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Topics

Basic Care and Comfort

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