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Zorluk: Çok zorBasic Care and Comfort

A client with severe chronic obstructive pulmonary disease (COPD) and bilateral lower extremity edema is confined to bed rest 72 hours after undergoing surgical stabilization of a pelvic fracture. To promote optimal comfort, preserve skin integrity, and accommodate all underlying physiological needs, which positioning strategy should the practical nurse execute?

  1. A
    Elevate the head of the bed to 45 degrees and sharply raise the knee gatch to prevent the client from sliding downward.
  2. B
    Keep the head of the bed completely flat and implement a strict side-to-side turning schedule every two hours.
  3. Maintain a semi-Fowler's position and place soft pillows lengthwise under the calves to suspend the heels.Cevap
  4. D
    Assist the client to lean forward onto an overbed table while allowing the legs to dangle freely at the bedside.

Cevap

The correct approach is to maintain a semi-Fowler's position and place soft pillows lengthwise under the calves to suspend the heels.
Maintaining a semi-Fowler's position allows gravity to pull the diaphragm downward, maximizing lung expansion for the client with COPD. Placing pillows lengthwise under the calves promotes venous return to reduce dependent edema while simultaneously offloading pressure from the heels and avoiding popliteal vein compression. This holistic approach safely accommodates the pelvic fracture restrictions while providing optimal basic care.

Adım Adım Çözüm

1
Analyze the respiratory requirements of the client.
The client has severe COPD, which requires the head of the bed to be elevated to facilitate lung expansion and ease the work of breathing.
Gravity pulls abdominal organs downward, allowing the diaphragm to fully contract during inspiration.
2
Evaluate the surgical restrictions related to the pelvic fracture.
Extreme hip flexion, weight-bearing, or unsupported dangling of the lower extremities must be avoided.
These actions place severe stress on the newly stabilized pelvic bones and hardware.
3
Address the circulatory and integumentary risks associated with edema and bed rest.
The lower extremities must be elevated to reduce edema, but without creating sharp bends behind the knees. The heels must also be protected from pressure.
Sharp knee gatching impedes venous return and increases deep vein thrombosis (DVT) risk. Floating the heels prevents decubitus ulcers.
4
Synthesize the findings to select the optimal position.
A semi-Fowler's position with lengthwise calf pillows safely meets respiratory, circulatory, and post-surgical requirements simultaneously.
It addresses all three competing physiological needs without violating any safety contraindications.

Anahtar Kavram

Synthesizing competing physiological needs in positioning (Airway/Breathing, Circulatory Return, and Post-Surgical Restrictions)
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Konular

Basic Care and Comfort

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