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Difficulty: MediumBasic Care and Comfort

A practical nurse (PN) is assisting a client with evening hygiene and preparing them for sleep. The client had a cataract extraction on the left eye earlier in the day. Which action by the PN is the most appropriate to promote comfort and prevent complications during rest?

  1. Instruct the client to sleep on their back or right side while keeping the head of the bed elevated at 30 degrees.Answer
  2. B
    Assist the client to lay on their left side with a supportive pillow to promote relaxation and uninterrupted sleep.
  3. C
    Administer the client's prescribed nighttime eye drops by verifying the room number to avoid waking the roommate.
  4. D
    Tell the client, 'Why are you anxious about sleeping? Everyone does fine after this routine procedure.'

Answer

Instruct the client to sleep on their back or right side while keeping the head of the bed elevated at 30 degrees.
The correct answer describes the optimal positioning for a client following cataract surgery. Elevating the head of the bed to 30 degrees (semi-Fowler's position) uses gravity to help decrease intraocular pressure. Sleeping on the back or the unoperated side (the right side, in this case) ensures that no direct physical pressure is applied to the newly operated left eye, promoting both comfort and safe healing.

Step-by-Step Solution

1
Identify the client's surgical procedure and the affected side.
The client had a cataract extraction on the left eye.
Knowing the surgical site is essential to determine appropriate post-procedure positioning and basic care needs.
2
Determine the physiological goals during the postoperative period for this specific surgery.
The primary goals are to prevent an increase in intraocular pressure (IOP) and protect the eye from physical trauma.
Increased IOP can damage the delicate surgical incision and lead to severe complications like hemorrhage or vision loss.
3
Select the nursing intervention that aligns with these physiological goals while providing basic care and comfort for sleep.
Elevating the head of the bed to 30 degrees (semi-Fowler's position) and keeping the client off the operative (left) side achieves these goals.
Gravity helps drain fluid away from the eye to reduce IOP, and avoiding the operative side prevents direct pressure on the healing eye.

Key Concept

Postoperative Basic Care and Positioning for Eye Surgery
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Topics

Basic Care and Comfort

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