A child received from the recovery room after tonsillectomy and adenoidectomy. Which position should the nurse provide to the child?

Appeared in: NORCET-5 mains

Explanation

The left lateral (side-lying) position is correct because it uses gravity to promote the drainage of blood and secretions from the mouth and pharynx.
This position prevents the tongue from falling back and obstructing the airway while the child is recovering from anesthesia.
By facilitating drainage, the lateral position significantly reduces the risk of aspiration, a major postoperative complication.
It allows for effective monitoring of the child's breathing, airway, and any signs of bleeding.

Option A: The supine (on the back) position is dangerous as it allows blood and secretions to pool at the back of the throat, creating a high risk of aspiration and airway obstruction.
Option C: While the prone position also facilitates drainage, the lateral position is often preferred because it allows for easier direct observation of the child's face, airway, and breathing.
Option D: Sims' position is a specific type of lateral position with the patient's weight shifted forward. It is not the standard recovery position for post-tonsillectomy care.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Postoperative positioning to ensure airway patency and prevent complications in the correct sequence, documenting the action clearly, and monitoring for the expected response.
A nurse's primary responsibility in the immediate post-tonsillectomy period is to maintain a patent airway and prevent aspiration. Correct positioning is the first and most crucial step.
Nurses must vigilantly monitor for signs of hemorrhage. A key, subtle sign in children is frequent swallowing, as they may be swallowing blood. Other signs include restlessness, increased heart rate, and pallor.
What if? If the child shows signs of active bleeding (e.g., vomiting bright red blood, frequent swallowing), the nurse should immediately place the child on their side, notify the surgeon, and prepare for potential emergency intervention. The priority shifts from routine recovery to managing hemorrhage.

How to Approach the Question

First, identify the core of the question: It asks for the correct position after a tonsillectomy.
Next, recall the primary risks associated with this specific surgery. For tonsillectomy, the main dangers are bleeding, airway obstruction, and aspiration of blood/secretions.
Evaluate each option based on how it addresses these risks. Ask yourself: 'Does this position protect the airway and prevent aspiration?'
The supine position increases aspiration risk, so eliminate it.
Both lateral and prone positions promote drainage. Consider which is better for overall patient monitoring.
The lateral (side-lying) position allows for both drainage and easy observation of the patient's breathing and face, making it an optimal choice.

Concept Tested & Keywords

Concept Tested: Postoperative positioning to ensure airway patency and prevent complications.
Stem keywords: child, recovery room, tonsillectomy, adenoidectomy, position
Lead-in keywords: Which position
Clinical cues: The procedure (tonsillectomy) is key, as it creates a risk of bleeding and aspiration in the airway.

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E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 193-195

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 p. 37-39

Practise the full NORCET-5 mains

Attempt every question from this paper in a timed mock, then review the full solution for each one.