A nurse is providing care for a client who is 2 days postoperative following abdominal surgery and is about to progress from a clear liquid diet to full liquids. Which of the following items should the nurse tell the client he may now request to have on his meal tray?

Choice A reason: Leave the pad in place for at least 40 minutes

Leaving the aquathermia pad in place for at least 40 minutes is not recommended. The typical duration for applying an aquathermia pad is 20 to 40 minutes1. Prolonged exposure beyond this time can lead to complications such as burns or vasoconstriction, where blood vessels constrict instead of dilate, potentially increasing blood pressure and causing discomfort.

Choice B reason: Set the pad’s temperature to 42.2°C (108°F)

Setting the pad’s temperature to 42.2°C (108°F) is too high. The recommended temperature range for an aquathermia pad is generally between 40.5°C to 43°C (105°F to 109.4°F)3. Temperatures above this range can increase the risk of burns and skin damage. It is crucial to follow the manufacturer’s guidelines and institutional protocols to ensure safe and effective use of the pad.

Choice C reason: Use safety pins to keep the pad in place

Using safety pins to keep the pad in place is not safe. Safety pins can puncture the pad, causing leaks and potentially leading to electrical hazards. Instead, the pad should be secured with tape or a cloth cover to ensure it stays in place without causing damage.

Choice D reason: Stop the treatment if the client’s skin becomes red

Stopping the treatment if the client’s skin becomes red is the correct action. Redness of the skin can indicate the beginning of a burn or other skin damage. It is essential to monitor the client’s skin condition frequently during the application of heat therapy and to discontinue the treatment immediately if any signs of adverse reactions, such as redness or discomfort, are observed.

The correct answers are:

Condition:

• a. Pneumothorax
  (After a thoracotomy and chest tube insertion, pneumothorax is a potential complication as air can accumulate in the pleural space, compromising lung expansion.)

Actions:

• b. Administer oxygen as prescribed.
  (To ensure adequate oxygenation while resolving the pneumothorax)
• b. Ensure the chest tube is functioning properly.
  (Ensuring the chest tube is removing air from the pleural space to restore lung expansion)

Parameters to Monitor:

• c. Respiratory rate and effort.
  (To assess the client's respiratory status and detect any changes indicating distress or worsening pneumothorax)
• c. Oxygen saturation levels.
  (To continuously assess oxygenation and detect any hypoxia)

Rationale:

A pneumothorax is more likely post-thoracotomy, especially with a chest tube insertion, as air is a primary concern in the pleural space. Monitoring respiratory parameters like oxygen saturation and respiratory effort helps evaluate the client's respiratory function and chest tube efficacy.