Fundamentals of Nursing Q 12
A male patient who had surgery 2 days ago for head and neck cancer is about to make his first attempt to ambulate outside his room. The nurse notes that he is steady on his feet and that his vision was unaffected by the surgery. Which of the following nursing interventions would be appropriate?
A. Encourage the patient to walk in the hall alone.
B. Discourage the patient from walking in the hall for a few more days.
C. Accompany the patient for his walk.
D. Consult a physical therapist before allowing the patient to ambulate.
Correct Answer: C. Accompany the patient for his walk.
Accompanying him will offer moral support, enabling him to face the rest of the world. Ambulation stimulates circulation which can help stop the development of stroke-causing blood clots. Walking improves blood flow which aids in quicker wound healing. The gastrointestinal, genitourinary, pulmonary and urinary tract functions are all improved by walking.
Option A: A hospitalized surgical patient leaving his room for the first time fears rejection and others staring at him, so he should not walk alone. Refusal to ambulate correlated with those that eventually developed a complication. Those that eventually developed a postoperative complication were more likely to be in the higher refusal group. Thorn et al. suggested that patient compliance may be a marker of underlying complications. If patients are not engaged in their recovery, there may be a physiologic reason for refusal (i.e., a developing abscess).
Option B: Patients should begin ambulation as soon as possible after surgery to decrease complications and to regain strength and confidence. The multiple physiological benefits of patient ambulation have been documented including the prevention of muscular and cardiovascular deconditioning, reducing the risk of pulmonary and thromboembolic events, and stimulating gastrointestinal recovery through prokinetic effects
Option D: Waiting to consult a physical therapist is unnecessary. Daily ambulation requires collaboration between hospital resources, patient education and available personnel. Second, aggressive non-opioid pain medication regimens are critical to maintain a low mLOS. The increasing use of narcotics especially with a PCA prolonged the LOS. Third, refusal of ambulation often predicted the development of a postoperative complication.