A client fell 20 feet (6.1 meters) from the tree stand while deer hunting, sustaining a ruptured spleen. The client is receiving blood and fluid replacement while being prepared for a splenectomy. Which finding should the practical nurse (PN) report to the charge nurse?

Choice A reason: Coughing over the catheter site while cleansing the skin introduces a risk of infection. The client needs to be educated about the importance of maintaining a sterile environment to avoid contamination and infection. This behavior indicates a lack of understanding of infection control practices, which are crucial in peritoneal dialysis self-care.
Choice B reason: Wearing one sterile glove while cleansing the insertion site may seem insufficient, but it is not as immediately critical as coughing over the site. The client should be reminded of the importance of using sterile techniques, but this behavior does not pose as immediate a risk as choice A.
Choice C reason: Washing hands before opening the 4 by 4 dressing packet demonstrates good hygiene practices. This behavior indicates that the client understands the importance of hand hygiene in preventing infection, and does not require additional teaching.
Choice D reason: Pouring antiseptic solution and sterile water on sterile dressings is an appropriate practice. This behavior shows that the client is following the necessary steps to maintain a sterile environment and does not need additional teaching.

Choice A reason: Driving a car is an activity that requires physical and mental focus, which can be impaired following surgery. The client recovering from a transurethral prostatectomy might experience discomfort, pain, or the effects of anesthesia, which could affect their ability to drive safely. Additionally, there is a risk of increased pressure on the surgical site while sitting for prolonged periods, which can impact the healing process. Limiting this activity until after the first postoperative visit ensures that the healthcare provider can assess the client's recovery and provide appropriate guidance on when it is safe to resume driving.
Choice B reason: Eating high-fiber foods is generally encouraged to prevent constipation, which is a common issue post-surgery. Fiber helps maintain regular bowel movements and can reduce the strain during defecation. This is beneficial for clients recovering from a transurethral prostatectomy as straining can increase pressure on the surgical site. Therefore, there is no need to limit the intake of high-fiber foods; rather, it should be reinforced as a positive dietary habit during the recovery period.
Choice C reason: Kegel exercises are recommended to strengthen the pelvic floor muscles, which can aid in improving urinary control post-surgery. These exercises are an integral part of the recovery process for clients undergoing prostate surgery and can significantly enhance bladder function. Thus, Kegel exercises should not be limited but should be encouraged as part of the client's postoperative care plan.
Choice D reason: Walking around the house is a low-impact activity that can promote circulation and prevent complications such as deep vein thrombosis (DVT). It also helps in maintaining overall mobility and can aid in the recovery process. Limiting such light physical activity is unnecessary, as it can have several benefits for the client during the postoperative period. Encouraging gentle movement is generally advantageous for recovery.