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Difficulty: MediumBasic Care and Comfort

A client is transferred to the surgical unit after undergoing a right modified radical mastectomy with axillary lymph node dissection. When assisting the client into a resting position in bed, which action regarding the right arm is most appropriate?

  1. Support the arm on pillows so it rests higher than the level of the heart.Answer
  2. B
    Keep the arm flat on the mattress parallel to the client's torso.
  3. C
    Position the arm so the hand and wrist hang below the level of the mattress.
  4. D
    Bind the arm securely across the client's chest to restrict shoulder movement.

Answer

Support the arm on pillows so it rests higher than the level of the heart.
The correct action is to elevate the affected arm on pillows above the level of the heart. Because axillary lymph nodes have been removed, normal lymphatic drainage is severely compromised. Elevating the arm uses gravity to promote venous and lymphatic return, which prevents painful swelling (lymphedema) and enhances overall client comfort.

Step-by-Step Solution

1
Identify the physiological impact of the surgical procedure.
An axillary lymph node dissection disrupts the normal lymphatic drainage pathways in the affected arm, predisposing the client to lymphedema.
Understanding the anatomical changes helps prioritize the correct preventative care measure.
2
Determine the basic care and comfort goal for this specific postoperative period.
The goal is to prevent fluid pooling, minimize swelling, and maintain joint mobility without causing strain.
Excessive swelling causes severe discomfort, compromises tissue healing, and can lead to long-term complications.
3
Select the positioning technique that best achieves this goal.
Elevating the arm above the level of the right atrium (heart) enlists gravity to assist the compromised lymphatic system in returning fluid to central circulation.
Gravity is the most effective passive mechanism to reduce peripheral edema when normal lymphatic pathways are absent or healing.

Key Concept

Post-Mastectomy Care and Lymphedema Prevention
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Topics

Basic Care and Comfort

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