Fundamentals of Nursing Q 415
Nurse Monica is handling a female client who had undergone a mastectomy. Which is the best position in which she should place the client?
A. Head of bed elevated at least 30° with the affected arm elevated on a pillow.
B. Forward side-lying position.
C. Supine position with the affected arm remains flat.
D. Head of bed elevated at least 30° with the unaffected arm elevated on a pillow.
Correct Answer: A. Head of bed elevated at least 30°.
Position a post-mastectomy client with the head of the bed elevated at least 30 degrees, with the affected arm elevated on a pillow to promote lymphatic fluid return after the removal of axillary lymph nodes. The patient is draped with the arm free to allow for movements during the procedure. It is important not to hyperextend the arm when positioning the patient; hyperextension may cause significant postoperative neurapraxia.
Option B: Patient positioning is in a supine position in the operating room, and the breast, chest wall, axilla, and upper arm are exposed, after induction of anesthesia. Many surgeons may include the contralateral breast in the prepped operative field. There has been a growing trend toward breast conservation, and numerous studies have looked at the efficacy of breast-conserving surgery when compared to standard mastectomy techniques.
Option C: The patient is kept in a supine position with a thin sandbag under the ipsilateral scapula to facilitate axillary dissection. The ipsilateral arm is draped separately and kept free for adduction during axillary dissection.
Option D: The patient is placed supine with the ipsilateral arm stretched out level with the shoulder. The head end of the operating table is raised to 30º. The side being operated on is raised by 30º. Lymphedema is less commonly present since the advent of modified mastectomy techniques. Axillary lymph node dissection is the most significant risk factor for the development of lymphedema, with a reported incidence of greater than 20%.