A heating pad is ordered for a patient with a lumbar sprain. The nurse knows that the purpose of the heating pad is to:

Choice A reason:
Assessing the operative site is important to monitor for signs of bleeding, infection, or other complications. However, it is not the most critical, high-priority assessment immediately after surgery. While the condition of the surgical site can provide valuable information about the patient’s recovery and potential complications, it does not take precedence over ensuring the patient’s airway is clear and they are breathing adequately. The operative site can be assessed once the patient’s airway, breathing, and circulation are stable.
Choice B reason:
Airway assessment is the most critical, high-priority assessment in the PACU. Ensuring that the patient’s airway is clear and they are breathing properly is paramount because anesthesia can depress the central nervous system, leading to compromised airway patency and respiratory function. The primary goal in the immediate postoperative period is to ensure that the patient is ventilating adequately to prevent hypoxia and other respiratory complications. This involves checking for airway obstruction, monitoring respiratory rate, and ensuring that oxygen saturation levels are within normal ranges (typically 95-100% for healthy individuals). Any issues with the airway must be addressed immediately to prevent life-threatening complications.
Choice C reason:
Assessing the pulse is crucial for monitoring the patient’s cardiovascular status, including heart rate and rhythm. This can help detect arrhythmias, hypovolemia, or other cardiovascular issues that may arise postoperatively. However, while important, it is secondary to ensuring that the patient’s airway is clear and they are breathing adequately. The pulse can be assessed once the airway and breathing are confirmed to be stable. Normal pulse rates for adults typically range from 60 to 100 beats per minute.
Choice D reason:
Assessing skin integrity is important for identifying signs of pressure ulcers, infection, or other skin-related issues. However, this assessment is not the highest priority immediately after surgery. Ensuring the patient’s airway, breathing, and circulation are stable takes precedence. Skin integrity can be assessed once the patient is stable and other critical assessments have been completed. Maintaining skin integrity is essential for overall patient care, but it does not supersede the need to ensure the patient is breathing properly and has a clear airway.

Choice A reason:

Offering peppermint aromatherapy during and after chemotherapy can be an effective non-pharmacological intervention for managing chemotherapy-induced nausea and vomiting (CINV). Aromatherapy with peppermint oil has been shown to reduce nausea and improve comfort in patients undergoing chemotherapy. The scent of peppermint can have a calming effect on the gastrointestinal system, helping to alleviate nausea. This intervention is easy to implement and can be used alongside other treatments to enhance patient comfort.

Choice B reason:

Administering antiemetics before chemotherapy is a standard practice for preventing CINV. Antiemetics, such as 5-HT3 receptor antagonists (e.g., ondansetron), NK1 receptor antagonists (e.g., aprepitant), and corticosteroids (e.g., dexamethasone), are commonly used to prevent nausea and vomiting associated with chemotherapy. These medications are most effective when given prophylactically, before the onset of symptoms. Administering antiemetics before chemotherapy helps to block the pathways that trigger nausea and vomiting, providing better control over these symptoms.

Choice C reason:

Keeping Ms. Anderson NPO (nothing by mouth) for the duration of the chemotherapy is not recommended for managing CINV. Keeping patients NPO can lead to dehydration and malnutrition, which can worsen their overall condition. Instead, patients should be encouraged to eat small, frequent meals and stay hydrated to maintain their strength and well-being. Proper nutrition and hydration are essential for supporting the body’s ability to tolerate chemotherapy and recover from its side effects.

Choice D reason:

Encouraging the patient to eat and drink when not nauseated is an important strategy for managing CINV. Eating small, frequent meals and staying hydrated can help maintain energy levels and prevent dehydration. Patients should be advised to eat bland, easy-to-digest foods and avoid foods that are greasy, spicy, or have strong odors, as these can exacerbate nausea. Encouraging patients to eat and drink when they feel well can help them maintain their nutritional status and improve their overall tolerance to chemotherapy.

Choice E reason:

Offering small sips of ginger ale can help manage nausea. Ginger has natural antiemetic properties and can be effective in reducing nausea and vomiting. Ginger ale, ginger tea, or ginger candies can be soothing and help settle the stomach. This simple intervention can be easily incorporated into the patient’s routine and can provide relief from mild to moderate nausea.

Choice F reason:

Encouraging Ms. Anderson to eat a high-protein meal prior to the chemotherapy infusion is not typically recommended for managing CINV. High-protein meals can be harder to digest and may increase the risk of nausea. Instead, patients should be advised to eat light, bland meals before chemotherapy to minimize the risk of nausea and vomiting. Light meals are easier on the stomach and less likely to trigger gastrointestinal discomfort.