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Difficulty: Very hardBasic Care and Comfort

A client who underwent a complete left-sided pneumonectomy three days ago requires routine hygiene and repositioning to prevent skin breakdown. The client is currently resting in a supine position but reports stiffness and back discomfort. Which positioning action by the practical nurse is the safest and most appropriate for this client?

  1. Assist the client into a left lateral position with a pillow providing back support.Answer
  2. B
    Turn the client onto the right lateral position to avoid placing pressure directly on the surgical incision.
  3. C
    Place the client in a prone position for 15 minutes to facilitate the drainage of posterior airway secretions.
  4. D
    Lower the head of the bed to a flat supine position and elevate the client's legs to promote venous return.

Answer

The safest positioning action is to assist the client into a left lateral position with appropriate pillow support.
The correct action is to position the client on their left side. Following a complete pneumonectomy, the client must be positioned on their back or on the operative side (the side where the lung was removed). Because this client had a left-sided pneumonectomy, placing them on the left side ensures that the remaining right lung is positioned uppermost. This allows the healthy lung to expand fully with gravity's assistance and prevents the mediastinum and heart from shifting and compressing the only functional lung.

Step-by-Step Solution

1
Identify the specific surgical procedure and the affected anatomical side.
The client had a left-sided pneumonectomy, meaning the left lung was entirely removed, leaving only the right lung functional.
Surgical alterations dictate precise postoperative positioning limitations to ensure client safety.
2
Determine the primary physiological goal of positioning for this specific surgery.
The goal is to maximize the expansion and ventilation of the remaining right lung while preventing a fluid or tissue shift into the empty pleural space (mediastinal shift).
Proper oxygenation relies entirely on the single unoperative lung, which must not be restricted.
3
Select the position that fulfills this physiological safety requirement.
Positioning the client on the operative side (the left side) allows the good lung (right side) to remain uppermost and expand fully without compression from abdominal or mediastinal structures.
Lying on the unoperative (good) side would cause the heart and mediastinum to compress the only functional lung, leading to respiratory failure.

Key Concept

Postoperative Positioning for Pulmonary Surgeries
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Topics

Basic Care and Comfort

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