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Difficulty: MediumBasic Care and Comfort

A practical nurse is assigned to care for a client who underwent a lumbar laminectomy 24 hours ago. The client has become increasingly restless, is exhibiting new-onset mild confusion, and requires a bed bath with a complete linen change. Which of the following actions should the practical nurse take? Select all that apply.

  1. Use the logrolling technique with the assistance of at least one other staff member to turn the client.Answer
  2. B
    Document the client's confusion as an expected, normal finding related to the aging process.
  3. C
    Elevate the head of the bed to 45 degrees and place a rolled towel under the client's knees.
  4. Place a pillow between the client's legs to maintain proper spinal alignment during the turn.Answer
  5. Provide the prescribed as-needed analgesic medication approximately 30 minutes before beginning the hygiene care.Answer
  6. F
    Apply soft wrist restraints immediately to prevent the confused client from touching the surgical dressing.

Answer

The practical nurse should use the logrolling technique with assistance, place a pillow between the client's legs for alignment, and administer prescribed pain medication 30 minutes prior to the bed bath.
Following a lumbar laminectomy, the client's spine must be kept in neutral alignment to prevent injury to the surgical site. This requires the logrolling technique with multiple staff members and the use of a pillow between the legs to prevent twisting of the spine. Furthermore, administering prescribed analgesia before a demanding physical activity like a linen change promotes optimal comfort and reduces pain during movement.

Step-by-Step Solution

1
Analyze the client's surgical procedure and strict postoperative positioning requirements.
The client had a lumbar laminectomy, meaning the lumbar spine must be kept perfectly straight (neutral alignment) to prevent surgical site damage.
Understanding physical limitations dictates safe mobility and positioning techniques, ruling out bending the spine or head elevation.
2
Evaluate the need for comfort and proactive pain management.
The client requires a linen change which involves movement. Administering an analgesic 30 minutes prior ensures the medication peaks during the physical turning.
Proactive pain management is a key component of basic care and significantly improves client tolerance of necessary hygiene tasks.
3
Assess the correct response to the client's new-onset confusion and restlessness.
Sudden confusion requires investigation for underlying physiological causes (like hypoxia) and the implementation of least-restrictive safety measures, rather than immediate restraint application or dismissing it as normal aging.
Promoting safety while maintaining client rights prevents complications and the unnecessary, unsafe use of restraints.

Key Concept

Basic care, safe positioning, and comfort measures for a postoperative spinal surgery client.
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Topics

Basic Care and Comfort

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