A nurse is providing preoperative teaching to an older adult female client who is scheduled for a laminectomy and uses supplements. Which of the following supplements should the nurse identify as increasing the client's risk for hypotension during surgery?

Rationale:

A. Use an incentive spirometer every 4 hours: Incentive spirometry is primarily used to promote lung expansion and prevent atelectasis postoperatively. While important, it is aimed at respiratory function, not directly at promoting circulation.

B. Remain on bed rest for 24 hours following the procedure: Prolonged bed rest can lead to venous stasis and increase the risk of thromboembolic events. Early ambulation or movement is encouraged to improve circulation and prevent complications like deep vein thrombosis (DVT).

C. Place a pillow under your knees while in bed: Placing a pillow under the knees can cause venous stasis by compressing the popliteal vessels and should be avoided. It may also contribute to joint stiffness and increase the risk of DVT.

D. Participate in range of motion exercises: Range of motion exercises encourage venous return and stimulate blood flow in the extremities. This helps prevent postoperative complications such as DVT and promotes overall circulatory health.

Rationale for correct choices:

• Placental abruption: Hypertension in pregnancy increases the risk of premature separation of the placenta from the uterine wall. In this case, the elevated BP combined with symptoms like right upper quadrant pain and hyperreflexia suggests a potential complication such as placental abruption.
• Hypertension: A blood pressure of 148/94 mm Hg is above the diagnostic threshold for gestational hypertension. When paired with signs like restlessness, headache, and hyperreflexia, it raises concern for preeclampsia, a known risk factor for placental abruption.

Rationale for incorrect choices:

• Placenta previa: Characterized by painless bleeding in the second or third trimester and associated with abnormal placental placement, not hypertension. The client has no bleeding or ultrasound findings consistent with previa.
• Oligohydramnios: Typically linked to fetal or placental insufficiency or rupture of membranes. No findings in this case suggest low amniotic fluid or related complications.
• Spontaneous abortion: This term applies before 20 weeks’ gestation. The client is 30 weeks pregnant with no signs of fetal demise or expulsion, so this condition does not apply.
• Chorioamnionitis: Requires signs of infection such as fever, uterine tenderness, or foul-smelling discharge. The client is afebrile and has clear lung sounds, making infection unlikely.
• Temperature: The recorded temperature is within normal range (37.4°C), so it does not suggest infection or another abnormality requiring urgent follow-up.
• Vomiting: Common in pregnancy and non-specific unless persistent or linked with abnormal labs. Here, it appears as an isolated symptom and does not directly imply risk of abruption.
• Hyperreflexia: While a sign of preeclampsia, it is secondary to hypertension. It supports the presence of a hypertensive disorder but is not the primary cause of abruption.
• Fundal measurement: A fundal height of 29 cm is normal for 30 weeks’ gestation and does not indicate fetal growth restriction or excess fluid that might signal a complication.