A nurse is reinforcing teaching with a client who has GERD. Which of the following instructions should the nurse include?

Postoperative care following cataract removal focuses on protecting the surgical eye, preventing increased intraocular pressure, and promoting proper healing of the lens capsule. Clients are taught to avoid activities that increase eye strain or pressure, such as bending, heavy lifting, or rubbing the eye. Positioning and use of protective devices are key components of discharge education. Proper adherence to these instructions helps reduce the risk of complications such as hemorrhage, infection, or increased intraocular pressure.

Rationale:
A. Avoiding lying on the operative side helps prevent direct pressure on the surgical eye, which could increase intraocular pressure and disrupt healing. This positioning also reduces the risk of trauma and promotes comfort during recovery. It is a key protective measure in the early postoperative period.

B. Bending at the waist increases intraocular pressure due to increased venous pressure in the head and eyes. This can place strain on the surgical site and increase the risk of complications such as bleeding or wound disruption. Clients are instructed to bend at the knees instead of the waist to avoid this pressure increase.

C. The protective eye shield should be worn as prescribed, especially during sleep, to prevent accidental rubbing or injury to the operative eye. Removing it at bedtime would increase the risk of trauma during unconscious movements. Continuous protection during sleep is essential in the early healing phase.

D. Experiencing a brow headache is not an expected or desired postoperative outcome. While mild discomfort may occur, persistent headache could indicate increased intraocular pressure or other complications. Any significant or worsening pain should be reported to the healthcare provider promptly.

Recognizing opioid-induced respiratory depression after administration of IV morphine in a postoperative client is important. Morphine is an opioid analgesic that can depress the central nervous system, leading to decreased respiratory drive, sedation, hypotension, and pinpoint pupils. The client’s worsening drowsiness, slow respirations, and decreased responsiveness shortly after receiving morphine strongly suggest opioid toxicity. Immediate identification is critical because untreated respiratory depression can rapidly progress to hypoxia, respiratory arrest, and cardiac arrest.

Rationale for correct findings:

• Respiratory; decreased respiratory effort, equal chest expansion, bilateral crackles: Decreased respiratory effort is the most urgent sign of opioid-induced respiratory depression. Opioids suppress the respiratory center in the brainstem, causing slow and shallow breathing that reduces oxygen exchange. Bilateral crackles may also suggest retained secretions or fluid accumulation due to poor ventilation. Respiratory compromise is the highest priority.

• Neurologic; somnolent: Somnolence indicates excessive CNS depression and reduced responsiveness, which commonly occurs with opioid overdose or excessive opioid effect. A client who is slow to arouse may rapidly progress to unresponsiveness if respiratory depression worsens. Increasing sedation after morphine administration is a major warning sign. This requires urgent reassessment and likely reversal intervention.

• HEENT; pinpoint pupils: Pinpoint pupils (miosis) are a classic sign of opioid toxicity and strongly support the suspicion of morphine overdose or excessive opioid response. When seen with respiratory depression and somnolence, this finding is especially concerning. It helps confirm that the symptoms are medication-related rather than another postoperative complication. Immediate intervention is needed.

• Vital Signs; Respiratory rate 10/min: A respiratory rate of 10/min is below normal and indicates significant respiratory depression. Opioid administration can suppress respiratory drive, leading to hypoventilation and poor oxygenation. This is one of the earliest and most dangerous indicators of opioid toxicity. Prompt action such as naloxone administration may be required.

• Vital Signs; Blood pressure 98/58 mm Hg: Morphine can cause vasodilation and hypotension, especially when combined with sedation and decreased respiratory effort. A drop in blood pressure from baseline suggests worsening hemodynamic status and possible poor tissue perfusion. In combination with bradycardia and CNS depression, this increases concern for opioid excess.

Rationale for incorrect findings:

• Cardiovascular; S1, S2, no murmur: The normal heart sounds without murmur indicate no acute structural cardiac issue. In this situation, respiratory compromise takes priority over mild bradycardia. Therefore, this finding is monitored but not the most immediate concern.

• Vital Signs: Temperature 37.4°C (99.4°F): This temperature is within normal postoperative range and does not indicate fever or infection. There is no evidence of sepsis or acute inflammatory complications. Compared with respiratory depression and decreased consciousness, temperature is not an urgent concern.