A nurse is preparing to discharge a client who is a status post-operative laryngectomy. The nurse should recognize which of the following discharge teaching is the highest priority?

A. Respond to ventilator alarms: While it is crucial to respond to ventilator alarms promptly to ensure the client’s safety and adequate ventilation, this action is not the highest priority in relation to the use of neuromuscular blockers. The use of neuromuscular blockade requires a broader focus on the patient's overall care and safety.
B. Report the absence of spontaneous respirations: Reporting the absence of spontaneous respirations is important, as neuromuscular blockers can cause paralysis of the respiratory muscles. However, the focus should be on maintaining the client's safety and comfort while they are on mechanical ventilation, rather than just reporting findings.
C. Provide passive range-of-motion exercises: This is the priority action when caring for a client receiving neuromuscular blockers. Since the client cannot move voluntarily due to the effects of the neuromuscular blockade, passive range-of-motion exercises are essential to prevent complications such as contractures and muscle atrophy. This intervention helps maintain joint mobility and circulation, which is critical in patients who are mechanically ventilated for an extended period.
D. Encourage the client to attempt to breathe on their own: Encouraging the client to breathe on their own is not appropriate when they are receiving neuromuscular blockade, as their respiratory muscles are paralyzed. Instead, the focus should be on ensuring that the mechanical ventilation settings are adequate to provide proper oxygenation and ventilation while the client cannot initiate breaths independently. This action could lead to respiratory distress if attempted while under neuromuscular blockade.

A. An adverse event. An adverse event is an unintended injury or complication resulting from medical care rather than the patient’s underlying condition. In this case, the surgical site infection (SSI) developed as a complication of surgery, requiring additional treatment. While adverse events may prolong recovery, they do not always indicate negligence or preventability.
B. A never event. Never events are serious, preventable medical errors that should not occur under proper care, such as surgery on the wrong site, retained surgical instruments, or administering the wrong medication. While SSIs are concerning, they are not classified as never events because they can occur even when proper precautions are taken.
C. A near miss. A near miss refers to an event that could have caused harm but was prevented before reaching the patient. Since the infection did occur and required intervention, it does not qualify as a near miss. A near miss example would be identifying and correcting a medication error before administration.
D. A sentinel event. Sentinel events involve unexpected occurrences that result in serious injury, permanent harm, or death, such as patient suicide, wrong-site surgery, or a fatal medication error. Although the infection required prolonged treatment, it did not lead to severe harm or death, making it an adverse event rather than a sentinel event.