A nurse is planning care for a client who is postoperative following the insertion of an arteriovenous graft in their left forearm. Which of the following actions should the nurse include in the plan of care?

Choice A reason: Serosanguineous drainage, which is a mixture of blood and a clear yellow liquid known as serum, is generally expected after surgery. While the amount of 150 mL may seem significant, it is not uncommon in the first hour postoperatively, especially after abdominal surgery. The nurse should continue to monitor the drainage and report if the volume increases significantly or if the drainage becomes bright red, indicating active bleeding.

Choice B reason: Greenish-yellow drainage is typically bile, which can be present in NG tube drainage after abdominal surgery. This type of drainage is not unusual and does not necessarily need to be reported unless accompanied by other concerning symptoms or changes in the patient's condition.

Choice C reason: 100 mL of red drainage is concerning and should be reported to the provider immediately. Red drainage suggests active bleeding, and in the context of the first postoperative hour, it could indicate a complication such as hemorrhage. Prompt assessment and intervention are required to address this potential emergency situation.

Choice D reason: Brown drainage may be old blood or could be related to the contents of the gastrointestinal tract. While 200 mL is a larger volume, brown drainage is not typically as concerning as bright red drainage. However, the nurse should monitor for changes in the color and consistency of the drainage, as well as the patient's vital signs and overall status.

Choice A reason: While bladder control issues can significantly affect a client's quality of life, they are typically managed by a urologist or a specialist in continence, rather than an occupational therapist. Occupational therapy focuses on improving the ability to perform activities of daily living (ADLs), which generally does not include bladder control.

Choice B reason: Difficulty swallowing, known as dysphagia, can be a symptom of myasthenia gravis due to muscle weakness. Although it is a serious concern, it is usually managed with the help of a speech therapist who specializes in swallowing difficulties, rather than an occupational therapist.

Choice C reason: Having a hard time with brushing hair is directly related to the performance of ADLs, which is the primary focus of occupational therapy. An occupational therapist can assist the client by teaching energy conservation techniques, providing adaptive equipment, and modifying the task to make it easier for the client to maintain personal grooming independently.

Choice D reason: Preferring a wheelchair over a walker is a matter of mobility and personal preference. While occupational therapy can help with mobility issues, this statement alone does not indicate a need for occupational therapy unless the client has difficulty performing ADLs due to the choice of mobility aid.