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Question

Difficulty: HardBasic Care and Comfort

A client who underwent a subtotal thyroidectomy earlier today reports experiencing severe upper back tension. The client asks the nurse to lay the bed completely flat to facilitate sleep. Which action is most appropriate for the nurse to take?

  1. Explain the need for a semi-Fowler's position and arrange pillows to securely support the head, neck, and shoulders.Answer
  2. B
    Position the client flat on their back and place a rolled towel beneath the cervical spine to stretch the muscles.
  3. C
    Assist the client onto their side with the mattress completely flat to encourage rest and prevent aspiration.
  4. D
    Flatten the bed temporarily to perform a soothing back massage before returning the mattress to an upright angle.

Answer

The correct action is to keep the client in a semi-Fowler's position while arranging pillows to support the head, neck, and shoulders in a neutral alignment.
Following a thyroidectomy, maintaining a semi-Fowler's position is a critical safety intervention to decrease venous pressure, minimize surgical site edema, and protect the airway. Providing firm support with pillows keeps the head and neck in a neutral alignment. This relieves the client's upper back muscle tension while simultaneously preventing hyperextension and dangerous strain on the fresh suture line.

Step-by-Step Solution

1
Analyze the physiological implications of the surgical procedure.
A subtotal thyroidectomy involves a neck incision, carrying a high risk of localized edema and hemorrhage that can rapidly compress the trachea.
Understanding the specific post-operative risks establishes the foundation for safe positioning.
2
Evaluate the safety of the client's comfort request.
The client requested a completely flat bed. Lying flat increases venous pressure in the head and neck, which exacerbates surgical site edema.
The nurse must determine if a comfort measure contraindicates medical safety requirements.
3
Identify the proper anatomical alignment needed.
The neck must be kept in a neutral position to prevent tension on the suture line; hyperextension or extreme flexion must be avoided.
Proper alignment prevents wound dehiscence and further tissue trauma.
4
Select the nursing intervention that safely addresses both safety and comfort.
Maintaining a semi-Fowler's position (30-45 degrees) prevents airway edema, while strategically placed pillows relieve the upper back tension without compromising neck neutrality.
This balances the ABCs (Airway, Breathing, Circulation) with the core nursing duty of providing basic care and comfort.

Key Concept

Post-operative positioning for airway protection and comfort
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Topics

Basic Care and Comfort

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