After a right hemicolectomy for treatment of colon cancer, a 57-year old client is reluctant to turn while on bed rest. Which action by the nurse would be appropriate?
A. Asking a coworker to help turn the client.
B. Explaining to the client why turning is important.
C. Allowing the client to turn when he’s ready to do so.
D. Telling the client that the physician’s order states he must turn every 2 hours.
Correct Answer: B. Explaining to the client why turning is important.
The appropriate action is to explain the importance of turning to avoid postoperative complications. Postoperative patients must be monitored and assessed closely for any deterioration in condition and the relevant postoperative care plan or pathway must be implemented.
Option A: Asking a coworker to help turn the client would infringe on his rights. Postoperative patients are at risk of clinical deterioration, and it is vital that this is minimized. Knowledge and understanding of the key areas of risk and local policies will help reduce potential problems (National Patient Safety Agency, 2007; National Institute for Health and Clinical Excellence, 2007).
Option C: Allowing him to turn when he’s ready would increase his risk for postoperative complications. The National Early Warning Score (NEWS) was developed by a working party to provide a national standard for assessing, monitoring, and tracking acutely and critically ill patients (not for use with children under 16 years or in pregnancy); the intention was that trusts would use it to replace their locally adapted early warning systems (Royal College of Physicians, 2012).
Option D: Telling him he must turn because of the physician’s orders would put him on the defensive and exclude him from participating in care decisions. The NCEPOD (2011) report found that patients whose condition was deteriorating were not always identified and referred for a higher level of care. Patients should be made as comfortable as possible before postoperative checks are performed.
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