question about post op mastectomy

[rosy3]

Which is the priority post operative nursing intervention to be done for a patient who has undergone rt. side mastectomy?

1. To teach the patient to make the rt. arm walk on wall and use for combing hair.

2. To put the sign board at the pt. side for nurses not to perform procedures on the rt. arm

Hope to hear from some one soon.

I think the answer is 1 becoz first we teach everything to the patient and then while leaving the pt. we can put the sign for other nurses to not to operate the patient on rite arm.

Please give your suggestions along with rationale.

Thank you

[rosy3]

plz can smbdy reply...

I need to build on concepts

[JENURSE03_RN, MSN, DNP, RN]

I was thinking 2 because post-op I am concern about the patient safety. It doesn't take long to put the sign up as a precaution for other nurses.

Do you have the correct answer ??

[GradNurse561]

The answer is 2

[rosy3]

ya, i think the answer is two. But I feel like wen the patient arrive to floor from recovery unit we teach the pt. about PCA pump, and tell him about call bell, and why we do not tell the pt. at the same time about post op exercises. as combing hair is post op exercise. And wen we leave the pt. we put the sign.

However everybody is saying its answer 2. but i do not know the correct answer.

[annie.rn]

Number two is correct because it takes priority over number one. In the immediate post-op period teaching the patient about what was done during surgery (i.e., number of lymph nodes removed, type of wound closure (staples, sutures, glue, etc.), instruction about any drains, type of dressing and safety precautions (no BP/needle sticks in R arm, preventing traction on drains, etc. is most important. The doctor usually hasn't even cleared the patient for therapy at this point so that choice (#1) would be wrong. I would definitely hang the sign and discuss the BP/needle stick restrictions before I would discuss therapy w/ the pt. She will also most likely still be in quite a bit of pain and and would not be ready to start doing arm exercises yet.

Hope this helps.

[RNNPICU, BSN, RN]

My initial response was 2 since it is the immediate post op period and for safety. I do not know about cares of a post op mastectomy, but sinage and safety are always the biggest in any post op procedure. The other response sounds like self care and a nursing responsibility. Signage and safety are nursing interventions

[rosy3]

Thanks now i understood it, y option 2 is rite.

thanks to all of u

rposy

[caroladybelle, BSN, RN]

Option 2, though both are problematic.

Option 1 is incorrect, because those are not the appropriate exercises for a mastectomy pt immediately postop. Postop 24-48 hrs, they had me doing shoulder shrugs, then graduated to bring my arms up to shoulder level either in the front or to the side, and turning palms up and then down. Walking the wall with your hands comes later.

Option 2 is more appropriate for immediate postop. It is preferable to not do bp/venipuncture on the operative side for a time, but given the modern techniques of surgery, may not be as necessary long term as once thought. Due to the rise in use of sentinel lymph node biopsy, which often decreases the amount of lymph nodes removed, and manipulation of tissue, as well as use of tissue conserving techniques, there is thought to be less risk of problems, later postop.

* one useful note from those of us that have bilateral mastectomies. While we may have a preferred arm for procedures (usually the side that had the less amt/less invasive surgery/fewer lymph nodes removed) really you should be doing Bps manually, as that is gentler compression.

[Here.I.Stand, BSN, RN]

2, because taking a BP or drawing labs on the op side is an immediate safety issue.

[lrdcn3]

it is a priority question so remember, you can only do one thing and that is all, which on is more important.

[nursewr]

2.. Because that's immediate post OP... Teaching patient this exercises is not priority