A practical nurse is providing basic care for a client who is on strict bed rest following a carotid endarterectomy complicated by an ischemic stroke with left-sided hemiparesis. Which of the following actions should the nurse include in the client's daily care? Select all that apply.
- Support the client's affected left arm with pillows while they are resting in bed.Answer
- BFeed the client their prescribed meal while maintaining the head of the bed at a 30-degree angle.
- Assist the client in performing active range-of-motion exercises on their unaffected right arm and leg.Answer
- DPlace a rolled blanket tightly under the client's knees to prevent them from sliding toward the foot of the bed.
- Perform thorough oral hygiene for the client before and after they consume their meals.Answer
Answer
The correct actions are supporting the affected left arm with pillows, assisting with active range-of-motion exercises on the unaffected right extremities, and performing oral hygiene before and after meals.
Appropriate basic care for a client with hemiparesis includes supporting the affected limb to prevent shoulder subluxation, maintaining oral hygiene to clear pocketed food and prevent aspiration, and encouraging active use of unaffected extremities to preserve strength.
Step-by-Step Solution
Key Concept
Basic care and comfort for a client with hemiparesis focuses on preventing complications such as aspiration, joint subluxation, and impaired circulation through proper positioning and meticulous hygiene.