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Difficulty: Very hardBasic Care and Comfort

A practical nurse is preparing to assist a client with their lunch. The client is 48 hours postoperative following a right carotid endarterectomy and experienced a perioperative right-hemisphere ischemic stroke. This complication resulted in left-sided hemiplegia, left homonymous hemianopsia, and mild dysphagia. Which sequence of basic care and positioning actions should the nurse implement?

  1. A
    Position the client in a semi-Fowler's position, place the meal tray on the left side to encourage therapeutic visual scanning, and offer clear liquids.
  2. Place the client in a high-Fowler's position, set the meal tray on the client's right side, and instruct the client to tuck their chin to their chest when swallowing.Answer
  3. C
    Assist the client to a right side-lying position to support the unaffected side, place the tray on the right side, and instruct the client to tilt their head back to swallow.
  4. D
    Position the client in a high-Fowler's position, maintain slight neck extension to prevent tension on the carotid incision, and offer fluids through a straw.

Answer

Place the client in a high-Fowler's position, set the meal tray on the client's right side, and instruct the client to tuck their chin to their chest when swallowing.
This sequence addresses all of the client's specific physiological needs safely. The high-Fowler's position and chin-tuck maneuver are essential dysphagia precautions that protect the airway and prevent aspiration. Placing the meal tray on the right side accommodates both the left-sided paralysis and the left homonymous hemianopsia, allowing the client to see the food and feed themselves using their intact right arm.

Step-by-Step Solution

1
Analyze the client's visual and motor deficits based on the right-hemisphere stroke.
A right-hemisphere stroke causes left-sided hemiplegia (paralysis) and left homonymous hemianopsia (loss of the left visual field in both eyes).
Understanding the specific neurological deficits dictates where objects should be placed to promote the client's safety and independence.
2
Determine the optimal placement for the meal tray.
The tray must be placed on the client's right side.
Placing the tray on the right side aligns with the client's intact visual field and allows them to use their functional right arm to eat.
3
Identify the safest positioning for a client with dysphagia.
The client must be positioned fully upright in a high-Fowler's position (90 degrees).
An upright position uses gravity to help food travel down the esophagus and prevents accidental aspiration into the lungs.
4
Determine the appropriate swallowing technique to protect the airway.
The client should use the chin-tuck maneuver during swallowing.
Tucking the chin toward the chest narrows the airway opening (larynx), significantly reducing the risk of food or liquid entering the trachea.

Key Concept

Basic care and positioning for a client with stroke-induced neurological deficits and dysphagia requires absolute airway protection (high-Fowler's position, chin tuck) and environmental adaptation (approaching and placing items on the unaffected side).
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Topics

Basic Care and Comfort

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