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Difficulty: MediumReduction of Risk Potential

A nurse is assessing a client 2 hours after a therapeutic thoracentesis in which 1,400 mL of pleural fluid was removed. Which finding indicates a life-threatening complication that requires immediate intervention by the nurse?

  1. A
    The client's arterial blood gas results demonstrate a pH of 7.39, PaCO2 of 38 mm Hg, and PaO2 of 94 mm Hg.
  2. The client develops a new, persistent cough and begins to expectorate pink, frothy sputum.Answer
  3. C
    The client is resting in a side-lying position on the unaffected side with the head of the bed elevated 45 degrees.
  4. D
    The client reports a localized, aching pain level of 3 on a 0-to-10 scale at the posterior needle insertion site.

Answer

The finding that requires immediate intervention is the development of a new, persistent cough accompanied by pink, frothy sputum.
Following a thoracentesis where a large volume of fluid (typically defined as greater than 1,000 to 1,200 mL) is rapidly removed, the client is at an elevated risk for re-expansion pulmonary edema (REPE). This occurs due to the sudden shift in intrathoracic pressure and increased pulmonary capillary permeability as the collapsed lung tissue rapidly re-expands. A persistent, severe cough accompanied by pink, frothy sputum is a hallmark clinical sign of alveolar flooding and pulmonary edema. This indicates impending respiratory failure and requires immediate emergency interventions, such as applying high-flow supplemental oxygen and notifying the healthcare provider.

Step-by-Step Solution

1
Analyze the clinical scenario and the procedure performed.
The client underwent a therapeutic thoracentesis with 1,400 mL of fluid removed.
Removing a large volume of pleural fluid (typically greater than 1,000 to 1,200 mL) significantly increases the risk of a rapid intrathoracic pressure shift.
2
Evaluate the assessment findings against potential post-procedure complications.
Pink, frothy sputum indicates alveolar fluid accumulation, while the other findings represent expected or normal postoperative baselines.
Differentiating between expected post-operative baseline data and subtle or overt signs of physiological decompensation is essential for accurate risk reduction.
3
Identify the life-threatening emergency taking priority.
The cough and pink, frothy sputum represent re-expansion pulmonary edema (REPE).
REPE is a medical emergency that severely compromises the airway and gas exchange, requiring immediate oxygenation and provider notification.

Key Concept

Re-expansion pulmonary edema is a critical, life-threatening complication that can occur when large volumes of pleural fluid are rapidly drained.
Estimated Time:1m 15s
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Reduction of Risk Potential

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