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Difficulty: MediumReduction of Risk Potential

A 64-year-old client is admitted to the surgical unit 3 hours after undergoing a right-sided pneumonectomy for lung cancer. The client is awake, receiving oxygen at 2 L/min via nasal cannula, and reports moderate incisional pain. Which nursing intervention is essential to reduce the client's risk of physiological decompensation?

  1. A
    Turn the client completely onto their left side to promote fluid drainage from the surgical space.
  2. Position the client in a semi-Fowler's position or slightly turned toward the right side.Answer
  3. C
    Delegate routine deep oropharyngeal suctioning to unlicensed assistive personnel (UAP) to maintain airway patency.
  4. D
    Prepare to initiate continuous positive airway pressure (CPAP) if arterial blood gas results show mild respiratory acidosis.

Answer

Position the client in a semi-Fowler's position or slightly turned toward the right side.
After a pneumonectomy, the client has only one functioning lung. Positioning the client in a semi-Fowler's position or slightly turned toward the operative (right) side achieves two critical goals: it allows the remaining healthy left lung to fully expand for optimal gas exchange, and it utilizes gravity to keep fluid from the empty right hemothorax from leaking into the healthy lung, preventing severe respiratory compromise.

Step-by-Step Solution

1
Identify the anatomical and physiological changes resulting from the procedure.
A right-sided pneumonectomy removes the entire right lung, leaving an empty pleural space (hemothorax) that will gradually fill with fluid, and leaving only the left lung for oxygenation.
Understanding the postoperative anatomy is required to anticipate physiological risks and prioritize care.
2
Determine the highest physiological risk to the client.
The greatest risk is respiratory failure caused by restricted expansion of the remaining lung or fluid shifting from the operative space into the healthy lung.
Risk reduction focuses on preventing the most immediately life-threatening complications.
3
Evaluate interventions to mitigate this risk.
Positioning the client on their back (semi-Fowler's) or toward the operative side (right side) uses gravity to keep fluid in the empty space and allows the left lung maximum room to expand.
Proper positioning is the primary non-pharmacological nursing intervention to maintain physiological integrity post-pneumonectomy.

Key Concept

Post-pneumonectomy positioning and physiological risk reduction
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Topics

Reduction of Risk Potential

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