A nursing is planning care for an adolescent who is postoperative following scoliosis repair with Harrington rod instrumentation. Which of the following interventions should the nurse include in the plan of care?
Place the client in protective isolation.
Initiate the use of a PCA pump for pain control.
Keep the head of the bed at a 30° angle.
Reposition the client by log rolling every-4 hr.
The Correct Answer is B
A: Placing the client in protective isolation is not necessary unless the client is immunocompromised or has another indication for isolation beyond the scoliosis repair.
B: A PCA (patient-controlled analgesia) pump allows the client to manage pain effectively by administering their own pain medication within prescribed limits, which is essential after the significant surgical intervention of scoliosis repair.
C: Keeping the head of the bed at a 30° angle is not specifically indicated for postoperative care following scoliosis repair with Harrington rod instrumentation. The position of the bed should be based on the client's comfort and specific postoperative orders.
D: Repositioning the client by log rolling every 4 hours is important to prevent complications such as pressure ulcers and to promote circulation, but it is not the priority intervention. Pain management postoperatively is crucial for client comfort, promoting mobility, and aiding in the recovery process.
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Related Questions
Correct Answer is A
Explanation
A. This option is correct. Rehabilitative care often involves educating the primary caregiver on how to assist the client in their recovery process.
B. This option suggests a focus on complete recovery, but rehabilitative care may also focus on adapting to new circumstances if complete recovery is not possible.
C. This option refers to the initiation of services, which may not specifically pertain to rehabilitative care.
D. This option incorrectly associates rehabilitative care exclusively with long-term care facilities. While rehabilitative care may occur in such facilities, it can also occur in other settings.
Correct Answer is D
Explanation
A. Transverse fractures occur straight across the bone. In this case, the bone is splintered, which is not characteristic of a transverse fracture.
B. Oblique fractures have a diagonal break across the bone. This does not match the description provided in the scenario.
C. Impacted fractures occur when one end of the bone is forced into the adjacent bone. This does not align with the description of the fracture in the scenario.
D. Correct. A comminuted fracture involves the bone breaking into multiple fragments or pieces. This aligns with the description provided in the scenario where the bone is splintered into several pieces around the shaft.
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