A home health nurse is assisting with the plan of care for an older adult client who had cataract surgery recently. Which of the following information should the nurse include in the plan of care?

Choice A rationale Deep breathing and coughing are standard postoperative interventions to prevent atelectasis and pneumonia. However, for a client who has just undergone cataract surgery, coughing is strictly contraindicated. Coughing significantly increases intraocular pressure by raising venous pressure in the head and neck. This sudden pressure spike can cause the surgical incision to open, lead to intraocular hemorrhage, or cause the newly implanted lens to become displaced. Instead, patients are taught to use deep breathing or incentive spirometry without forceful coughing. Choice B rationale Resting in a semi-Fowler's position, where the head of the bed is elevated to approximately 30 to 45 degrees, is beneficial after ocular surgery. This position utilizes gravity to help reduce swelling and decrease intraocular pressure by promoting venous drainage from the head. Maintaining this elevation helps ensure that the pressure within the eye remains within a safe range, typically 10 to 21 mmHg. It also helps prevent accidental pressure on the eye that might occur if the patient were lying completely flat. Choice C rationale Clients are instructed to avoid lying on the operative side during the initial healing phase after cataract surgery. Lying on the side of the surgery can put direct pressure on the globe and increase intraocular pressure. It also increases the risk of the patient inadvertently rubbing the eye against the pillow, which could lead to wound dehiscence or infection. Patients should be advised to sleep on their back or on the non-operative side to protect the surgical site from any external trauma. Choice D rationale Prolonged bed rest for two days is not necessary following modern cataract surgery, which is typically an outpatient procedure performed under local anesthesia. Early ambulation is encouraged to prevent systemic complications like deep vein thrombosis. Most patients are allowed to move about their homes immediately, provided they avoid strenuous activities, lifting heavy objects, or bending over at the waist. Restricting a patient to bed for 48 hours would be excessive and could lead to unnecessary physical decline in an older adult.