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Difficulty: MediumBasic Care and Comfort

A woman is resting in her hospital room a few hours after a right-sided modified radical mastectomy with axillary lymph node dissection. To promote optimal comfort and prevent complications, how should the practical nurse position the client's right arm?

  1. Elevated on a pillow so it rests above the level of the heartAnswer
  2. B
    Placed flat against the mattress parallel to the torso
  3. C
    Suspended in a dependent position below the level of the mattress
  4. D
    Tucked securely under the right hip to immobilize the shoulder joint

Answer

The correct action is to keep the affected arm elevated on a pillow above the level of the heart.
Following a mastectomy with lymph node dissection, lymphatic drainage in the affected arm is significantly compromised. Elevating the arm on a pillow above the level of the heart uses gravity to promote lymphatic and venous return, thereby minimizing painful edema and enhancing client comfort.

Step-by-Step Solution

1
Identify the physiological impact of the specific surgical procedure.
The client underwent a right-sided mastectomy with axillary lymph node dissection, which disrupts normal lymphatic drainage pathways in the right arm.
Understanding the anatomical changes guides strategies for comfort and complication prevention.
2
Determine the mechanical goal for positioning the affected limb.
Gravity must be utilized to assist interstitial fluid and venous blood in returning from the right arm back toward the central circulation.
Preventing fluid accumulation (lymphedema) reduces tissue tension, minimizes pain, and promotes healing.
3
Select the positioning technique that best achieves this gravitational goal.
Elevating the entire right arm on a pillow so that it rests above the level of the client's heart is the most effective intervention.
This specific elevation angle creates a downward gradient for optimal fluid drainage.

Key Concept

Post-mastectomy lymphedema prevention through therapeutic positioning
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Topics

Basic Care and Comfort

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