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Chapter 23: Problem 70

In which position should the nurse place the client following a right pneumonectomy for tumor removal? A. Left lateral decubitus B. Right lateral decubitus C. Semi-Fowler's D. High Fowler's

Short Answer

Expert verified
Answer: The best position for a patient following a right pneumonectomy is the left lateral decubitus position. This position places the remaining healthy left lung in a dependent position, which facilitates better gas exchange and reduces the workload of the right side of the heart.

Step by step solution

01

Understand each position

In each position, the patient's body is placed differently: A. Left lateral decubitus: The patient is positioned on their left side. B. Right lateral decubitus: The patient is positioned on their right side. C. Semi-Fowler's: The patient is positioned in a semi-seated position, with their head and upper body at an angle of around 30-45 degrees. D. High Fowler's: The patient is positioned in an upright seated position, with their head and upper body at an angle of around 80-90 degrees.
02

Evaluate each position

Now we will evaluate each position in the context of a patient who just had a right pneumonectomy: A. Left lateral decubitus: This would place the remaining healthy left lung in a dependent position, which could facilitate better gas exchange and reduce the workload of the right side of the heart. B. Right lateral decubitus: This would place the removed lung's side in a dependent position, which may increase the risk of complications such as fluid accumulation or atelectasis. C. Semi-Fowler's: This position can aid in lung expansion, but it may not be enough to provide optimal lung function post-pneumonectomy. D. High Fowler's: This position promotes optimal lung expansion, as it allows the maximum amount of space for the healthy lung to expand and reduces pressure on the diaphragm.
03

Choose the appropriate position

Based on the evaluation of each position, option A (Left lateral decubitus) is the best choice for a patient following a right pneumonectomy. This position helps with optimal gas exchange and reduces the workload on the right side of the heart by placing the healthy lung in a dependent position.

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Key Concepts

These are the key concepts you need to understand to accurately answer the question.

Patient Positioning
After a pneumonectomy, which is the surgical removal of a lung, proper patient positioning is crucial for recovery and overall health. Ensuring the patient's remaining lung is in the best position can enhance breathing and reduce postoperative complications.
  • Left Lateral Decubitus: For a right pneumonectomy, placing the patient in a left lateral decubitus position keeps the remaining lung in a dependent position. This facilitates better gas exchange since gravity helps deliver blood to the functioning lung.
  • Right Lateral Decubitus: Placing a patient on the right side is not ideal post-right pneumonectomy, as it may lead to complications such as fluid buildup in the surgical area.
The chosen position directly impacts respiratory function, making this an essential aspect of post-surgery care.
Postoperative Care
Postoperative care involves several steps to ensure a patient recovers smoothly after a pneumonectomy.
Firstly, monitoring is vital. Nurses need to keep a close eye on vital signs, oxygen levels, and respiratory patterns to react swiftly to any complications.
Besides this, proper nutrition and hydration are crucial. They support healing and help maintain the patient鈥檚 energy levels for recovery. Encouraging gradual movement and overseeing physical activity also play a part, helping prevent muscle atrophy and promoting circulation.
  • Frequent position changes: Whether in bed or moving around, changing positions helps prevent complications like pressure sores.
  • Pain management: Pain relief is critical to enable better breathing and physical movement.
Efficient postoperative care is vital for improving a patient's outcome and their quality of life as they recover.
Respiratory Nursing Interventions
Following a pneumonectomy, specialized respiratory nursing interventions are crucial to patient recovery. They focus on ensuring the patient's breath can expand comfortably and efficiently.
  • Incentive Spirometry: Encouraging the patient to use an incentive spirometer helps to prevent lung complications by keeping the alveoli open and improving lung function.
  • Deep Breathing Exercises: These exercises promote lung expansion and enhance oxygenation, thus reducing the risk of pneumonia or atelectasis.
Regular assessment of respiratory function helps nurses decide on interventions, ensuring that any issues are addressed swiftly. The combination of these interventions helps maintain lung function and facilitate faster recovery.
Surgical Nursing Procedures
Surgical nursing procedures surrounding a pneumonectomy are detailed and patient-focused. Nurses need to be well-versed in preoperative, intraoperative, and postoperative care protocols.
Preoperatively, educating the patient about their procedure and what to expect can help reduce anxiety and prepare them mentally and physically.
During the surgery, the surgical team ensures all instruments are sterile, and correct procedures are followed to minimize infection risks.
Postoperatively, the focus shifts to careful monitoring. Ensuring any conditions specific to pneumonectomy, like the risk of respiratory distress, are accurately managed is vital.
  • Drain Management: If chest drains are used, careful monitoring and management are critical to prevent complications like air leaks.
  • Incision Care: Keep the surgical site clean and observe for signs of infection.
These procedures build the framework for recovering from surgery safely and effectively.

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Most popular questions from this chapter

The physician is in route to perform a lumbar puncture on a client with encephalitis. The nurse assesses lethargy and sluggish pupil reactions. Which action is most appropriate? A. Notify the charge nurse of the assessment findings B. Obtain the lumbar puncture tray from supply C. Explain the lumbar puncture procedure to the family D. Elevate the head of the bed to high Fowler's

A post-chemotherapy client is experiencing hypokalemia and has an order for potassium chloride \(10 \mathrm{mEq}\). Which clinical manifestations does the nurse expect this client to exhibit? A. cramps B. muscle twitching C. diarrhea D. weak pulse

A client is admitted with pancreatitis on the previous shift. The nurse evaluates the laboratory results. Which result requires immediate intervention by the nurse? A. Potassium \(4.0 \mathrm{mEq} / \mathrm{L}\) B. Sodium \(120 \mathrm{mEq} / \mathrm{L}\) C. Serum amylase 300 units/dL D. White blood cell 12,000 cells \(/ \mathrm{mm}\)

A client with myasthenia gravis, who has been taking pyridostigmine (Mestinon), tells the nurse, "This medication's side effects are making me uncomfortable." The nurse would expect the client to complain of the medication causing which of the following effects? A. Muscle cramps B. Dry mouth C. Decreased lacrimation D. Hyperactivity episodes

A client returns to the room post-total laryngectomy and is having difficulty breathing. Secretions are noted in the tracheostomy tube. What is the nurse's first action? A. Obtain the vital signs B. Notify the charge nurse C. Suction the tube D. Start oxygen via a tracheostomy collar
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