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Difficulty: HardReduction of Risk Potential

A nurse is evaluating a client who underwent a right-sided pneumonectomy 24 hours ago for bronchogenic carcinoma. The client suddenly exhibits extreme restlessness, a heart rate of 122 bpm, and a respiratory rate of 30 breaths/min. The pulse oximeter reads 87% on supplemental oxygen. Arterial blood gas (ABG) analysis indicates a pH of 7.287.28, PaCO2PaCO_2 of 6262 mm Hg, and PaO2PaO_2 of 5454 mm Hg. Upon entering the room, the nurse observes the client lying in a left lateral decubitus position. Which immediate action should the nurse implement to minimize the risk of impending cardiopulmonary collapse?

  1. Assist the client into a right lateral or supine position.Answer
  2. B
    Apply a non-rebreather mask to increase the fraction of inspired oxygen.
  3. C
    Prepare to administer intravenous sodium bicarbonate to correct the acidosis.
  4. D
    Auscultate the right anterior and posterior lung fields for diminished breath sounds.

Answer

The priority action is to immediately reposition the client to the right lateral or supine position to relieve mechanical compression of the remaining functioning lung.
Following a pneumonectomy, the client must be positioned on their operative side (in this scenario, the right side) or supine. Positioning the client on the unoperated side (the left side) is strictly contraindicated. Gravity causes the mediastinal structures and any fluid accumulating in the empty surgical space to shift downward, compressing the solitary functional lung. This compression severely impairs ventilation, directly causing the acute respiratory acidosis and hypoxemia seen in the ABG results. Repositioning the client immediately relieves this mechanical compression.

Step-by-Step Solution

1
Interpret the arterial blood gas (ABG) and vital sign data.
The ABGs show acute, uncompensated respiratory acidosis (low pH, high PaCO2PaCO_2) with severe hypoxemia, indicating failure of ventilation.
Identifying the physiological state dictates whether the issue is metabolic, oxygenation-based, or ventilation-based.
2
Correlate the client's surgical history with their current physical positioning.
The client had a right pneumonectomy but is lying on their left side (the unoperated side with the only remaining functional lung).
Understanding postoperative anatomical changes is crucial. Lying on the good lung allows gravity and post-surgical fluid to compress it, causing the ventilation failure.
3
Determine the intervention that directly resolves the root cause of the decompensation.
Repositioning the client to the operative side (right) or supine allows the left lung to expand fully.
Airway and mechanical breathing interventions must take precedence over supplemental oxygen or medications when an anatomical obstruction is present.

Key Concept

Post-pneumonectomy positioning and respiratory failure prevention
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Topics

Reduction of Risk Potential

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