Question

Which action would the nurse include in the plan of care of a client on the first postoperative day after total laryngectomy?

1 Position client in semi-Fowler position while in bed
2 Remind client that coughing may slow wound healing
3 Change pressure dressings and packing every 12 hours
4 Assist client with head and neck range-of-motion exercises

Answer 1

The nurse should include positioning the client in a semi-Fowler position after a total laryngectomy to facilitate breathing and maintain an open airway.

Step-by-step explanation:

In the plan of care for a client on the first postoperative day after a total laryngectomy, the nurse should include positioning the client in a semi-Fowler position while in bed. This position helps in decreasing edema and facilitating breathing as it allows the diaphragm to move more freely, which is critical after surgery. It should be noted that after general anesthesia, muscles needed for respiration may take some time to regain control, and maintaining an open airway to the lungs is imperative, especially after procedures such as a total laryngectomy where the normal airway anatomy has been altered.

Coughing in the immediate postoperative period may not be recommended due to risk of disruption to the surgical site, so it's generally not encouraged until it's deemed safe by medical providers. Furthermore, changing pressure dressings and packing should be based on the surgeon's orders and wound assessment, which are typically not every 12 hours, since excessive changing can disrupt the healing process. Also, head and neck range-of-motion exercises might be important, but they should only be done after the stability of the neck has been assessed and under the guidance of a physical therapist or as per postoperative instructions.