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Difficulty: MediumReduction of Risk Potential

A nurse is developing a plan of care for an adult client who returned to the surgical unit 4 hours ago following a left-sided pneumonectomy for a pulmonary malignancy. Which intervention is essential to include to reduce the risk of severe physiological complications?

  1. Maintain the client in a supine position or side-lying on the left side.Answer
  2. B
    Turn the client onto the right lateral decubitus position every two hours to prevent pressure injuries.
  3. C
    Auscultate the left posterior thorax initially to evaluate for the return of vesicular breath sounds.
  4. D
    Initiate an intravenous infusion of sodium bicarbonate if an arterial blood gas reveals a pH of 7.32 and a PaCO2 of 48 mm Hg.

Answer

Maintain the client in a supine position or side-lying on the left (operative) side.
Following a pneumonectomy, the client must be positioned supine or on the operative side (in this case, the left side). This positioning ensures that the remaining functional lung on the non-operative side is uncompressed and can fully expand for optimal gas exchange. Additionally, keeping the operative side down allows serous fluid to accumulate naturally in the empty hemithorax, which helps prevent a dangerous mediastinal shift by stabilizing the pressure in the chest cavity.

Step-by-Step Solution

1
Analyze the client's surgical procedure.
The client underwent a left-sided pneumonectomy, meaning the entire left lung was removed.
Understanding the anatomical changes is critical for anticipating post-operative physiological vulnerabilities.
2
Evaluate the physiological impact of positioning on the remaining lung.
Positioning on the non-operative (right) side will compress the only functional lung due to gravity, while positioning on the operative (left) side allows the functional lung to fully expand.
Maximum ventilation of the single remaining lung is essential to prevent hypoxia and respiratory failure.
3
Select the intervention that prioritizes airway and breathing risk reduction.
Maintaining the client supine or on the left side is the safest positioning strategy.
This specific positioning actively prevents respiratory decompensation and allows fluid to stabilize the empty pleural space, preventing mediastinal shift.

Key Concept

Post-pneumonectomy positioning requires the client to be placed supine or on the operative side to promote full expansion of the remaining functional lung and to prevent a mediastinal shift.
Estimated Time:1m 30s
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Reduction of Risk Potential

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