A 62-year-old client is in the progressive care unit 8 hours after a left pneumonectomy. The client appears lethargic and is receiving supplemental oxygen at 3 L/min via nasal cannula. During the assessment, the nurse observes the client lying in a right lateral decubitus position. The most recent arterial blood gas (ABG) values are as follows:
| Parameter | Result |
|---|---|
| pH | 7.28 |
| 58 mm Hg | |
| 25 mEq/L | |
| 64 mm Hg |
Based on these clinical findings, what is the priority nursing action to reduce the risk of a life-threatening physiological complication?
- Assist the client into a supine or left lateral position to facilitate maximal expansion of the remaining lung.Answer
- BMaintain the right lateral position to optimize ventilation-perfusion matching in the non-operative lung.
- CIncrease the oxygen flow rate to address the hypoxemia shown in the blood gas analysis.
- DPrepare for intravenous sodium bicarbonate administration to reverse the uncompensated metabolic acidosis.
Answer
Assist the client into a supine or left lateral position to facilitate maximal expansion of the remaining lung.
The client is experiencing acute uncompensated respiratory acidosis due to severe hypoventilation. Following a pneumonectomy, placing the client on the unoperated side (the right side, in this case) restricts the expansion of the sole functioning lung due to gravity and the weight of the mediastinum. To prevent a dangerous mediastinal shift and optimize gas exchange, the client must be positioned supine or on the operative side (left lateral). This allows the remaining functional lung to fully expand, which will improve ventilation and resolve the hypercapnia.
Step-by-Step Solution
Key Concept
Post-pneumonectomy Positioning and Respiratory Acidosis