A nurse 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?
A.
Reposition the client by log rolling every 4 hr.
B.
Place the client in protective isolation.
C.
Keep the head of the bed at a 30° angle.
D.
Initiate the use of a PCA pump for pain control.
The Correct Answer and Explanation is:
For an adolescent postoperative following scoliosis repair with Harrington rod instrumentation, the most appropriate intervention from the options provided is:
A. Reposition the client by log rolling every 4 hours.
Explanation:
Repositioning by Log Rolling:
After scoliosis surgery, particularly with the use of Harrington rods, it is crucial to maintain spinal alignment and avoid excessive movement that could compromise the surgical site. Log rolling is a technique used to reposition the patient while minimizing the risk of spinal movement. This method involves rolling the patient as a unit, rather than twisting or bending the spine, which helps to maintain the alignment of the spine and the integrity of the surgical repair. The frequency of repositioning should be based on the surgeon’s orders and the patient’s condition, but every 2-4 hours is common in practice to prevent pressure ulcers and promote comfort.
Why Not the Other Options:
B. Place the client in protective isolation:
This option is generally not necessary unless the patient has specific infection risks or there are concerns about exposure to infectious agents. Postoperative scoliosis repair patients do not typically require protective isolation unless there are complications such as infection.
C. Keep the head of the bed at a 30° angle:
While keeping the head of the bed elevated can aid in respiratory function and comfort, for a patient with a spinal fusion, specific positioning needs are more tailored. The head of the bed angle should be in accordance with the surgeon’s recommendations and the patient’s comfort and safety. There’s no universal requirement to keep it at a 30° angle unless specified.
D. Initiate the use of a PCA pump for pain control:
Patient-Controlled Analgesia (PCA) pumps can be used for pain management, but their use is determined based on the patient’s age, weight, pain level, and the healthcare provider’s assessment. In adolescents, PCA pumps are used with caution and typically after careful evaluation. The decision to initiate PCA would depend on the patient’s pain management needs and not necessarily as a first-line intervention.
In summary, log rolling is the most appropriate intervention as it aligns with maintaining spinal stability post-surgery. The other options either are not typically required or are contingent on more specific circumstances.