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Difficulty: HardBasic Care and Comfort

A practical nurse (PN) is providing care for a client who is 12 hours post-operative following a left-sided pneumonectomy for lung cancer. Which basic care and comfort interventions should the PN implement? Select all that apply.

  1. Elevate the head of the bed to a semi-Fowler's position.Answer
  2. B
    Turn the client onto the right, unoperated side every two hours.
  3. Provide a firm pillow for the client to splint the chest incision when coughing.Answer
  4. Encourage early, gentle range-of-motion exercises for the left arm and shoulder.Answer
  5. E
    Lower the head of the bed completely flat when repositioning the client.
  6. F
    Instruct the client to suppress coughing to prevent tension on the chest incision.

Answer

The correct interventions are elevating the head of the bed to a semi-Fowler's position, providing a firm pillow for splinting the incision, and encouraging early range-of-motion exercises for the operative arm and shoulder.
The correct interventions focus on maximizing respiratory function and managing localized pain. Elevating the head of the bed allows gravity to pull the diaphragm downward, maximizing lung expansion. Providing a pillow for splinting minimizes incision pain during necessary coughing, making the client more willing to clear secretions. Finally, encouraging gentle range-of-motion exercises for the arm and shoulder on the operative side prevents joint stiffness and contractures, which are common sources of delayed post-operative pain after chest surgery.

Step-by-Step Solution

1
Identify the surgical procedure and its physiological impact.
The client had a left pneumonectomy, meaning the entire left lung was removed. The client relies entirely on the remaining right lung for oxygenation and gas exchange.
Understanding the anatomical changes is required to determine safe positioning and care.
2
Determine appropriate positioning to optimize ventilation.
A semi-Fowler's position is indicated. Positioning on the unoperated side must be avoided.
Gravity helps pull the diaphragm downward in semi-Fowler's, maximizing the expansion of the remaining lung. Laying on the good lung would compress it and limit ventilation.
3
Select basic comfort measures that prevent post-operative complications specific to thoracic surgery.
Splinting the incision and performing range-of-motion exercises are selected.
Splinting controls pain to allow for vital airway clearance. Arm movement prevents 'frozen shoulder' contractures on the operative side.
4
Evaluate the remaining options for potential risks.
Lowering the head of the bed flat and suppressing coughs are identified as unsafe actions.
Both actions prioritize secondary concerns (shearing forces, incision tension) over primary airway and breathing needs (ABC prioritization).

Key Concept

Post-Operative Thoracic Care and Positioning
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Topics

Basic Care and Comfort

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