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Difficulty: Very hardReduction of Risk Potential

A healthcare team is managing the recovery of a 60-year-old client who underwent a right total pneumonectomy yesterday for bronchogenic carcinoma. The client's current continuous intravenous (IV) infusion is 0.9% sodium chloride running at 125 mL/hr. During the morning assessment, the nurse records the following clinical parameters:

- Vital Signs: Blood pressure 146/88 mm Hg, heart rate 116 bpm, respiratory rate 28 breaths/min
- Hemodynamics: Central Venous Pressure (CVP) reading is 15 mm Hg
- Arterial Blood Gas (ABG): pH 7.32, PaCO2 56 mm Hg, PaO2 65 mm Hg, HCO3 27 mEq/L
- Auscultation: Fine crackles present in the dependent lobes of the left lung

Based on these findings, which action should the nurse implement immediately to mitigate the risk of a life-threatening complication?

  1. A
    Turn the client onto the left lateral decubitus position to optimize ventilation in the unoperated lung.
  2. Decrease the intravenous fluid infusion rate and immediately notify the healthcare provider of the findings.Answer
  3. C
    Administer prescribed intravenous sodium bicarbonate to actively correct the uncompensated metabolic acidosis.
  4. D
    Prepare the client for an emergent right-sided chest tube insertion to relieve excessive intrathoracic pressure.

Answer

The correct action is to decrease the intravenous fluid infusion rate and immediately notify the healthcare provider.
Following a pneumonectomy, the entire right ventricular cardiac output is forcefully directed into the single remaining pulmonary vascular bed. This physiological shift places the client at an extreme risk for flash pulmonary edema. A Central Venous Pressure (CVP) of 15 mm Hg (normal 2-8 mm Hg) combined with hypertension, tachycardia, and new-onset left lung crackles clearly indicates severe fluid overload. The current IV infusion rate of 125 mL/hr is dangerously high for this specific surgical population. The priority action to reduce the risk of imminent physiological collapse is to strictly limit fluid intake and notify the provider for further orders, such as administering a diuretic.

Step-by-Step Solution

1
Analyze the client's vital signs and hemodynamic data.
CVP is significantly elevated at 15 mm Hg (normal is 2-8 mm Hg), accompanied by hypertension and tachycardia.
To determine fluid volume status, which currently indicates severe hypervolemia.
2
Auscultate lung sounds and interpret the arterial blood gas (ABG) results.
Fine crackles in the left (remaining) lung and respiratory acidosis (pH 7.32, PaCO2 56 mm Hg) are present.
To identify the physiological consequence of the hypervolemia, which is pulmonary edema compromising the only functional lung.
3
Correlate assessment findings with the specific surgical risks of a total pneumonectomy.
The client is suffering from fluid overload because the IV rate of 125 mL/hr is excessively high for a single pulmonary vascular bed.
Post-pneumonectomy clients are extremely vulnerable to right-sided heart failure and flash pulmonary edema; recognizing this risk dictates immediate fluid restriction over any other intervention.

Key Concept

Post-pneumonectomy fluid management and complication recognition
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Topics

Reduction of Risk Potential

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