NORCET 3 - 2022 (Shift-1)
Medical & Surgical Nursing
Medium
A female patient had mastectomy after surgery patient complaining about shoulder pain. What would be the primary intervention by the nurse?
Appeared in: NORCET 3 - 2022 (Shift-1)
Explanation
- Post-mastectomy shoulder pain is an expected finding, and the nurse's primary responsibility is to assess and manage it promptly.
- Providing a prescribed analgesic is the most appropriate and immediate initial nursing action to alleviate the patient's discomfort.
- Effective pain control is crucial as it facilitates early mobilization and deep breathing, which helps prevent complications like shoulder stiffness (frozen shoulder) and respiratory issues.
- Administering pain medication is a core, independent nursing function that can be performed based on standing or PRN (as needed) orders.
Why Other Options Were Wrong
- Option A: Consulting the doctor is an escalation, not a primary intervention for expected postoperative pain. The nurse should first use the available prescribed analgesics.
- Option C: Waiting is contraindicated. Unmanaged postoperative pain can lead to significant complications, including chronic pain syndromes and adhesive capsulitis ('frozen shoulder'), which severely limits mobility.
- Option D: This constitutes nursing negligence. Pain is a subjective experience and is what the patient says it is. It must always be assessed and managed.
Related Visual
- Visual 1: Diagram - Illustrating gentle post-mastectomy exercises like wall hand-climbing, rope turning, and pendulum swings to restore range of motion.
- Visual 2: Infographic - Detailing lymphedema precautions for the affected arm, emphasizing 'No BP, No IVs, No Injections' and other protective measures.
Clinical Relevance
- Nursing practice connection: Safe nursing care depends on performing Prioritization of nursing interventions for postoperative pain management following mastectomy in the correct sequence, documenting the action clearly, and monitoring for the expected response.
- Prompt pain management is a critical nursing function that directly impacts patient recovery, comfort, and the prevention of long-term complications like chronic pain and reduced mobility.
- Nurses must educate patients on the importance of requesting and taking analgesics before pain becomes severe and especially before performing prescribed exercises to maximize their effectiveness.
- What if? - If the patient's pain was rated 9/10 and accompanied by sudden, tense swelling and dark bruising at the surgical site, the primary intervention would shift to immediately notifying the surgeon, as these are signs of a potential hematoma, a surgical emergency.
How to Approach the Question
- Identify the core issue in the clinical scenario: The patient has postoperative shoulder pain after a mastectomy.
- Note the keywords 'primary intervention'. This requires you to prioritize nursing actions from most to least important or from first to last.
- Consider the nursing scope of practice. Managing expected postoperative pain with prescribed orders is a fundamental, initial nursing role.
- Evaluate the options based on the nursing process. Providing analgesia is a direct implementation step to relieve the patient's symptom.
- Eliminate other options: 'Consulting the doctor' is an escalation, not a primary step for expected pain. 'Waiting' and 'no intervention' are incorrect and harmful, so they can be immediately ruled out.
Concept Tested & Keywords
- Concept Tested: Prioritization of nursing interventions for postoperative pain management following mastectomy.
- Stem keywords: mastectomy, post-surgery, shoulder pain, primary intervention
- Lead-in keywords: primary intervention
- Clinical cues: Patient is postoperative, making pain an expected finding.
Question ID
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Practise the full NORCET 3 - 2022 (Shift-1)
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