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Difficulty: MediumBasic Care and Comfort

The practical nurse (PN) is providing care for a client who recently returned to the surgical unit following a subtotal thyroidectomy. Which positioning technique should the PN implement to maintain client comfort and safety?

  1. Elevate the head of the bed to a semi-Fowler's position and support the client's head and neck.Answer
  2. B
    Maintain the client in a flat, supine position with a small rolled towel beneath the shoulders.
  3. C
    Instruct the client to actively flex and extend the neck every two hours to prevent muscle stiffness.
  4. D
    Assign the unlicensed assistive personnel (UAP) to manage the client's neck alignment when turning.

Answer

Elevate the head of the bed to a semi-Fowler's position and support the client's head and neck.
Following a thyroidectomy, placing the client in a semi-Fowler's position (30 to 45 degrees) with the head and neck carefully supported by pillows is the optimal intervention. This position utilizes gravity to reduce swelling and edema in the neck area. Furthermore, keeping the head in a neutral, supported position decreases tension on the surgical suture line, minimizes discomfort, and crucially helps maintain a patent airway, which is the absolute primary postoperative priority for this specific surgery.

Step-by-Step Solution

1
Analyze the client's surgical procedure (subtotal thyroidectomy).
Identify that the surgical incision is on the anterior neck.
Understanding the surgical site is essential for determining the safest and most comfortable postoperative position.
2
Determine the primary postoperative risks for this procedure.
Recognize that edema, bleeding, and hematoma formation in the neck can lead to life-threatening airway obstruction.
Anticipating complications guides the prioritization of nursing interventions.
3
Select the positioning technique that mitigates these risks.
Choose a semi-Fowler's position with the head and neck carefully supported by pillows.
Gravity helps reduce edema in the head and neck, while firm support prevents hyperextension or hyperflexion, protecting the airway and the integrity of the suture line.

Key Concept

Basic Care and Comfort: Postoperative Positioning for Airway Protection
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Topics

Basic Care and Comfort

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