Question

A client with breast cancer is returned to the room following a right total mastectomy. The nurse should: A. Elevate the client's right arm on pillows B. Place the client's right arm in a dependent sling C. Keep the client's right arm on the bed beside her D. Place the client's right arm across her body

Short answer

Answer: Elevating the client's right arm on pillows to promote proper circulation, reduce pain and swelling, and minimize the risk of complications following a mastectomy.

Step-by-step solution

Understanding the situation

A client has just undergone a right total mastectomy for breast cancer. As a nurse, the priority is to provide proper care and positioning for the client's right arm to ensure comfort and prevent complications such as lymphedema and impaired circulation.

Eliminating incorrect options

Option B: A dependent sling would cause the arm to hang down, increasing the risk of swelling and pain due to poor blood circulation and lymphatic flow. This option is not suitable for post-mastectomy care. Option C: Keeping the client's right arm on the bed beside her does not provide proper elevation and support, which may lead to pain, swelling, and potential complications. Option D: Placing the client's right arm across her body is not a comfortable or appropriate position, as it may restrict blood flow and lymphatic drainage, increasing the risk of complications.

Identifying the correct option

Option A: Elevating the client's right arm on pillows is the best option to promote proper circulation, reduce pain and swelling, and minimize the risk of complications following a mastectomy. The nurse should elevate the arm above the level of the heart using pillows while the patient is in bed or sitting in a chair. This position encourages blood flow through the arm, reduces the risk of lymphedema, and helps maintain the client's comfort during recovery.

Key concepts

Nursing Care Post-Surgery

Post-operative care for patients who have undergone surgeries like mastectomy is crucial for their recovery and well-being. Nurses play a vital role in monitoring the patient's vital signs, managing pain, providing wound care, and ensuring that any potential complications are addressed promptly.

Immediately following surgery, the nurse's focus should include preventing infection at the surgery site and maintaining the integrity of any drains that may be in place. Effective pain relief is also critical, as it allows the patient to participate in necessary rehabilitative actions, such as arm exercises, which are important to prevent stiffness and improve circulation.

It is pertinent for nurses to educate patients on how to care for themselves once they return home. This includes instructions on how to care for the surgical site and drains, recognizing signs of infection or complications, and understanding the importance of follow-up appointments. Personalized patient education, emphasizing the need for gradual return to daily activities, can empower patients and enhance their recovery trajectory.

Continuous assessment of the patient's emotional and psychological state is also an integral part of post-surgical nursing care. The nurse should provide support and resources for dealing with the psychological impact of mastectomy, such as body image changes and grief over the loss of a breast.

Preventing Lymphedema After Mastectomy

Lymphedema prevention is an essential aspect of post-mastectomy care, as it can be a life-long concern for patients. To reduce the risk of lymphedema, which is the swelling of soft tissues due to fluid build-up, careful attention must be given to lymphatic drainage and circulation.

Nurses encourage patients to perform gentle exercises designed to stimulate lymph flow. For example, they may instruct patients on specific arm movements and to use their arm normally while avoiding heavy lifting or high-impact activities initially.

Patients should be advised to avoid constriction around the affected area by steering clear of tight clothing or blood pressure readings on the operative side. Compression garments may be prescribed in some cases to assist with fluid management.

Moreover, maintaining good skin care to prevent infection and managing overall fluid levels through a healthy diet are additional strategies to mitigate the risk of lymphedema. Nurses should also educate patients on the importance of regular monitoring and early detection of any symptoms suggestive of lymphedema, such as heaviness, tightness, or decreased flexibility in the limb.

Post-Operative Positioning

Appropriate post-operative positioning is imperative for patients following a mastectomy to facilitate healing and prevent discomfort or complications. The correct positioning of the arm, as given in option A of the exercise, is to elevate the patient's affected arm on pillows. This promotes lymphatic drainage and proper blood circulation, averting conditions such as lymphedema and venous thrombosis.

Instructing the patient to keep their arm elevated above the level of the heart, even when sitting up, is ideal for reducing swelling. This positioning should be maintained during the initial post-operative period and when swelling is most probable.

Nurses also guide patients on how to safely position themselves for sleep and rest. Avoidance of pressure on the surgical area and ensuring the arm is supported to avoid tension on sutures are important considerations.

Patients should be regularly repositioned to prevent pressure ulcers and stiffness, especially those with limited mobility or sensation. Education on proper positioning is a key aspect of self-care that patients should be able to continue at home.