A nurse is preparing a patient for surgery in the supine position. What is the rationale for this position?

Choice A reason:

Placing a grounding pad on the patient's skin near the surgical site is the correct action to prevent burns to the patient during electrocautery. The grounding pad provides a low-current-density pathway for the high-frequency cautery current to return to the electrosurgical unit, thus avoiding injury to other body areas.

Choice B reason:

Applying petroleum jelly to the patient's skin around the surgical site is not a correct action to prevent burns to the patient during electrocautery. Petroleum jelly is flammable and can ignite during electrocautery, causing fire and thermal injury to the patient.

Choice C reason:

Covering the patient's hair with a wet towel is not a correct action to prevent burns to the patient during electrocautery. A wet towel can create a conductive pathway for the cautery current to flow through, resulting in burns or shocks to the patient or the staff.

Choice D reason:

Removing any metal jewelry from the patient is a correct action to prevent burns to the patient during electrocautery, but it is not sufficient by itself. Metal jewelry can cause electrical arcing or heating, leading to skin burns or fire hazards. However, removing metal jewelry alone does not ensure a safe return pathway for the cautery current, which requires a grounding pad as well.

Choice A reason:

This is incorrect because the supine position does not allow optimal exposure of the abdominal cavity. The supine position is used for surgeries involving the anterior surface of the body, such as cardiac, thoracic, and cranial surgeries. For abdominal surgeries, other positions such as Trendelenburg or lithotomy may be used to improve access and visualization of the abdominal organs.

Choice B reason:

This is incorrect because the supine position does not prevent injury to the spinal cord and nerves. In fact, the supine position may cause nerve damage or pressure ulcers if the patient's arms, legs, and head are not properly supported and padded. The patient's arms should be abducted less than 90 degrees and the palms should face up to avoid stretching or compressing the brachial plexus and ulnar nerves. The patient's legs should be uncrossed and the heels should be padded to prevent pressure on the peroneal nerve and the skin. The patient's head should rest on a pad or pillow and the neck should be in a neutral position to avoid injury to the cervical spine and nerves.

Choice C reason:

This is correct because the supine position facilitates drainage of secretions from the mouth and throat. The supine position is commonly used during induction and emergence of anesthesia, which can impair the patient's ability to clear their airway. By lying on their back with their face up, the patient can benefit from gravity-assisted drainage of secretions from the mouth and throat, reducing the risk of aspiration or airway obstruction.

Choice D reason:

This is incorrect because the supine position does not enhance circulation and oxygenation to the brain. The supine position may actually decrease the functional residual capacity (FRC) of the lungs, which is the amount of air remaining in the lungs after a normal expiration. This can lead to reduced oxygenation and ventilation of the blood. Additionally, the supine position may cause venous congestion in the head and neck, which can impair cerebral perfusion and increase intracranial pressure. To enhance circulation and oxygenation to the brain, other positions such as reverse Trendelenburg or sitting may be used.