Final answer:
After a bunionectomy, the immediate nursing care should include applying ice to the operated foot intermittently, keeping the foot elevated above heart level, and following the surgeon's orders for dressing changes and site irrigation. Maintaining the foot in a dependent position and overly frequent dressing changes without indication are not recommended.
Step-by-step explanation:
The appropriate nursing action to integrate into the immediate care of a 67-year-old woman who has undergone a bunionectomy, especially with a history of osteoarthritis, involves measures to reduce inflammation, manage pain, and prevent complications. The RICE technique, which stands for Rest, Ice, Compression, and Elevation, can be particularly beneficial in this context. Applying ice to the affected foot can help reduce swelling and pain, but it is important to do it in a way that avoids tissue damage from excessive cold exposure. Therefore, the nurse should initially apply ice to the affected foot on an intermittent schedule, such as 20 minutes on and 20-40 minutes off, rather than 1 hour on and 1 off, to prevent frostbite and other cold-related injuries. This should be combined with keeping the patient's foot elevated above the heart level to reduce swelling, which promotes blood flow back to the central circulation, thereby minimizing inflammation.
Maintaining the foot in a dependent position is not recommended because it can lead to increased swelling and pain. Additionally, changing the surgical dressing and irrigating the surgical site is typically performed as per the surgeon's protocol, and might not be as frequent as every 6 hours unless indicated by excessive drainage or other complications. It is critical that these interventions are based on the surgeon's orders and tailored to the patient's specific needs. The overall goal in the immediate postoperative period is to ensure proper wound care, manage pain, and reduce the risk of post-surgical complications.