# A 15-year-old client with osteosarcoma of the left tibia is scheduled for limb-salvage surgery followed by chemotherapy. Which nursing intervention should be the priority in the preoperative period?

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> subject: Child Health

## 문제

A 15-year-old client with osteosarcoma of the left tibia is scheduled for limb-salvage surgery followed by chemotherapy. Which nursing intervention should be the priority in the preoperative period?

## 보기

1. Assess the client's understanding of the surgery and provide emotional support for body image concerns **✔ 정답**
2. Administer prescribed pain medications and monitor their effectiveness closely
3. Encourage increased fluid intake to prevent dehydration during the surgery
4. Teach the client about postoperative mobility restrictions and physical therapy

**정답: 1**

## 해설

Assessing understanding and providing emotional support for body image is the priority preoperatively in adolescents. Other options address postoperative or physical needs.

## 심화 해설

Clinical Context

Osteosarcoma, a primary malignant bone tumor, predominantly affects adolescents and young adults, with the distal femur and proximal tibia being common sites . The current standard of care involves neoadjuvant chemotherapy, followed by limb-salvage surgery (LSS), and then adjuvant chemotherapy. LSS has become the preferred surgical approach when oncologically feasible, as it aims to preserve the limb while achieving wide-margin tumor resection [2]. However, the diagnosis itself and the prospect of surgery occur during a critical period of psychosocial and identity development, making preoperative psychological preparation as vital as physical preparation.

Why Option 1 Is the Priority

The priority preoperative nursing intervention is to assess the client's understanding of the surgery and provide emotional support for body image concerns. A 15-year-old client is in the developmental stage of identity versus role confusion (Erikson), where peer acceptance and body image are paramount. Osteosarcoma and its surgical treatment directly threaten this developmental task. While LSS is designed to preserve the limb and function, it still results in significant structural changes to the affected bone, often involving endoprosthetic reconstruction or allografts, which can lead to visible scarring, limb length discrepancies, or altered gait [2].

Research highlights that outcomes of LSS differ substantially between pediatric and adult patients, with variability in reconstructive durability and functional results [2]. For an adolescent, the anticipation of these changes can provoke severe anxiety, fear of social rejection, and distorted body image. Preoperative assessment of the client's baseline understanding and emotional state is essential because unaddressed misconceptions or overwhelming anxiety can impair the client's ability to provide informed assent, cooperate with postoperative care, and adhere to the subsequent rigorous chemotherapy regimen. The nursing process dictates that assessment precedes intervention; therefore, evaluating psychological readiness and providing targeted emotional support is the foundational step upon which all other teaching and care are built.

Why Other Options Are Not the Priority

Option 2: Administer prescribed pain medications and monitor their effectiveness closely.

Pain management is a critical component of care for bone tumors, which are often associated with localized, deep-seated pain. However, in the immediate preoperative period for a scheduled LSS, the client may not be experiencing acute, severe pain that requires priority pharmacological intervention over psychosocial assessment. Furthermore, the nursing process requires assessment before action. While monitoring pain is a continuous nursing responsibility, it does not take precedence over the initial psychosocial assessment that will inform the entire perioperative care plan. Uncontrolled pain should be addressed, but the question asks for the priority intervention, which is the comprehensive assessment of the client's understanding and emotional state.

Option 3: Encourage increased fluid intake to prevent dehydration during the surgery.

Maintaining hydration is a standard preoperative consideration, but the client will be placed on nothing-by-mouth (NPO) status for a specified period before surgery to reduce the risk of pulmonary aspiration during anesthesia. Encouraging fluids is a generic intervention that does not address the unique, high-priority needs of an adolescent facing a body-altering procedure for a life-threatening malignancy. It is a task-level intervention, not a priority-level nursing judgment. The physiological safety need of preventing aspiration through NPO adherence is managed by the standard preoperative protocol, not by encouraging fluids.

Option 4: Teach the client about postoperative mobility restrictions and physical therapy.

Teaching about postoperative mobility restrictions and physical therapy is an important preoperative intervention to set expectations and promote adherence. Advanced techniques such as 3D printing technology, computer navigation, and minimally invasive approaches are increasingly used in LSS to improve precision and functional recovery . However, teaching is an intervention that is most effective after the nurse has first assessed the client's baseline knowledge, anxiety level, and readiness to learn. Providing detailed information to a client who is overwhelmed, in denial, or has severe body image disturbance will be ineffective. Assessment of understanding and emotional state (Option 1) must logically precede and guide the provision of tailored education.

NCLEX-RN Testing Point

This question tests the ability to prioritize nursing care using the nursing process (assessment before intervention) and Maslow's hierarchy of needs, with a specific emphasis on the psychosocial integrity of an adolescent client. While physiological needs are often the top priority, in a controlled preoperative setting for a scheduled surgery, the immediate threat to the adolescent's self-concept and identity can take precedence. The test item requires the examinee to recognize that an adolescent with a malignancy requiring LSS faces a profound psychosocial crisis. The correct answer reflects the principle that a thorough psychosocial assessment is the foundation for all subsequent nursing actions, including pain management, fluid balance, and education. The evidence confirms that age-related disparities in outcomes exist and that the adolescent experience is unique, reinforcing the need for developmentally targeted, supportive assessment as the first step [2].

References (research sources)

- [2]Age Matters: A Systematic Review of Limb-Salvage Surgery Outcomes in Pediatric Versus Adult Osteosarcoma.Meta-analysis/systematic reviewAlharbi MA, Aljeaid RF, Althebaity F, Alharthi HA, Al-Ghamdi L, Idris KW, Aledrissi A, Al-Harbi O, Bujbara A, Balobid R, Alshehri D, Al-Juhani A. (2025) · DOI: 10.7759/cureus.99434

## 임상 시나리오

Preoperative Psychosocial Assessment for Adolescent LSSPrioritizing body image and understanding before limb-salvage surgery
For an adolescent with osteosarcoma, the preoperative nursing priority is assessing the client's understanding of the surgery and providing emotional support for body image concerns. This directly addresses the developmental crisis of identity vs. role confusion, where peer perception and physical appearance are paramount.

Even though limb-salvage surgery preserves the limb, it can result in visible scarring, limb length discrepancy, or altered gait. A thorough psychosocial assessment using open-ended questions helps identify specific fears and knowledge deficits, which is essential before any teaching can be effective.

CautionDo not delay psychosocial assessment in favor of routine tasks like fluid encouragement or general teaching. Address the client's emotional state first to reduce anxiety and build trust, which improves adherence to the subsequent plan of care.

## 핵심 개념

- **Osteosarcoma** — A primary malignant bone tumor most common in adolescents, often occurring in the metaphysis of long bones like the distal femur or proximal tibia.
- **Limb-Salvage Surgery (LSS)** — A surgical procedure to remove a bone tumor while preserving the limb, often involving reconstruction with an endoprosthesis or allograft.
- **Identity vs. Role Confusion** — Erikson's fifth psychosocial stage (adolescence) where individuals explore their independence and develop a sense of self; body image is a critical component.

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