A 17-year-old client with osteosarcoma of the left humerus is scheduled for limb-salvage surgery followed by chemotherapy. Which nursing intervention is most important during the preoperative period?

Preoperative care for adolescents with osteosarcoma should prioritize psychosocial assessment and support, especially for body image concerns, which are critical during this developmental stage. Other options are less appropriate preoperatively.

Preoperative Psychosocial Assessment in Adolescent Osteosarcoma

For a 17-year-old client with osteosarcoma scheduled for limb-salvage surgery, the most important preoperative nursing intervention is to assess the client's understanding of the procedure and provide emotional support for body image concerns. This directly addresses the unique developmental and psychosocial needs of an adolescent facing a cancer diagnosis and a body-altering surgical procedure.

The adolescent period is a critical time for identity formation and body image development. A diagnosis of osteosarcoma and the prospect of limb-salvage surgery, while aimed at preserving the limb, still involves a major surgical intervention that will result in visible scarring, potential functional limitations, and a prolonged recovery that includes chemotherapy. The International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines emphasize that the goal of surgical intervention in pediatric oncology is not only local tumor control and survival but also the improvement of quality of life . This quality-of-life focus begins in the preoperative period, where the nurse must gauge the client's comprehension of the planned surgery and its aftermath. A gap in understanding can lead to heightened anxiety, unrealistic expectations, and poorer postoperative coping and adherence to the treatment plan. By assessing understanding, the nurse can identify and clarify misconceptions, ensuring the adolescent and family can provide truly informed consent and participate actively in their care.

Providing emotional support for body image concerns is equally critical and is a direct application of the IPSO guideline's quality-of-life principle . The surgery will alter the appearance and function of the left humerus, which can be devastating for an adolescent's self-esteem and social integration. The nurse must create a safe space for the client to verbalize fears about scarring, changes in physical appearance, and how peers might react. This therapeutic communication is a core nursing intervention that can reduce psychological distress, which, if unaddressed, can negatively impact the overall treatment trajectory. Research on preoperative therapy in cancer patients demonstrates that emotional well-being is a dynamic component of quality of life that requires active support from the point of diagnosis through treatment .

The incorrect options fail to prioritize the immediate psychosocial and educational needs. Encouraging vigorous physical therapy preoperatively is contraindicated; the affected limb is structurally compromised by the tumor, and aggressive movement could precipitate a pathological fracture or increase pain. Providing detailed information about prosthetic devices is premature and potentially harmful, as the primary goal of limb-salvage surgery is to save the native limb, and introducing the concept of amputation and prosthetics could cause unnecessary psychological trauma unless the surgical plan definitively changes. Restricting visitors to prevent infection is not a standard preoperative intervention for a client who is not yet neutropenic from chemotherapy; this measure is more relevant during the postoperative myelosuppression phase, and imposing such isolation preoperatively could worsen the adolescent's sense of social isolation and distress.