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Difficulty: HardBasic Care and Comfort

A practical nurse is assisting with the care of a client who is 12 hours postoperative following a lumbar laminectomy with spinal fusion. The client reports severe lower back stiffness from remaining supine and requests assistance to turn onto their side. Which technique should the practical nurse implement to safely reposition this client?

  1. Place a pillow between the client's legs and work with a second staff member to turn the client's entire body simultaneously using a draw sheet.Answer
  2. B
    Instruct the client to reach across their chest to grasp the opposite side rail and gently pull their upper body over.
  3. C
    Elevate the head of the bed to 45 degrees to reduce lumbar strain before assisting the client to roll onto their side.
  4. D
    Ask the client to cross their arms over their chest while the nurse shifts their pelvis first, followed by their shoulders.

Answer

The nurse must use the logrolling technique with the assistance of another staff member, turning the client's body as a single unit with a pillow between the legs.
The correct approach for repositioning a client after a spinal fusion is logrolling. This technique requires at least two staff members using a draw sheet (friction-reducing sheet) to turn the client's head, shoulders, spine, and pelvis simultaneously as a single unit. Placing a pillow between the client's legs prevents adduction of the upper leg, which helps maintain the spine in neutral alignment during the turn.

Step-by-Step Solution

1
Identify the client's surgical procedure and the specific postoperative precautions required.
The client had a lumbar laminectomy with spinal fusion, which requires keeping the spine in strict neutral alignment.
Spinal fusion involves bone grafts and hardware that must remain completely stable during the initial healing phase to prevent injury or failure of the fusion.
2
Evaluate each repositioning technique for its impact on spinal alignment.
Only turning the body simultaneously as a single unit (logrolling) prevents spinal torsion. Other methods cause twisting of the shoulders relative to the pelvis.
Logrolling distributes movement equally across the entire spine, whereas independent movement or segmented rolling bends or twists the vertebral column.

Key Concept

Postoperative mobility and positioning following spinal surgery requires the logrolling technique to maintain neutral spinal alignment and prevent injury to the surgical site.
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Topics

Basic Care and Comfort

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