Nursing 211

N211: Health Differences Across the Lifespan I of 148 Segmentectomy is a certain amount of lung segment is removed. A chest tube drainage system may or may not be required. Pre-Operative Nursing Interventions Include reducing client anxiety with teaching about the procedure and post-operative care. Determine client’s support systems and ability to care for self after surgery. Administer preoperative medications, such as antibiotics, opioid analgesics, and anti-anxiety medications. Obtain baseline vital signs, oxygen saturation and cognitive status for comparison postoperatively. Post-Operative Nursing Interventions Include maintaining patent airway, position client for optimal ventilation and perfusion, maintain sterility of operative dressing, and maintain safety. Administer antibiotics, bronchodilators, corticosteroids, inhalation agents as ordered. Maintain adequate pain management to facilitate chest expansion and optimal ventilation. Assess hemodynamic stability of ABGs, central venous pressure (CVP), pulmonary pressure artery (PA), pulmonary capillary wedge pressure (PCWP), cardiac output, integrity of chest tube drainage system, color of drainage and amount of drainage. Place client in semi-fowler’s position to improve cardiac output and to facilitate lung expansion. Assist client to turn, cough and deep breathe every two hours to help drain the lungs of accumulated secretions and permit full lung expansion, preventing atelectasis. Splint chest incision to facilitate breathing exercises and coughing. Plan coughing and deep breathing exercises after pain has been relieved to facilitate maximum lung inflation. Auscultate lungs before and after breathing treatments to assess the effectiveness of interventions. Humidify air to liquefy secretions for easier expectoration. Monitor respiratory rate and pattern; administer low flow oxygen to prevent hypoxemia. Monitor chest drainage system to ensure adequate respiration and to detect hemorrhage. Remain with patient during procedures to provide encouragement and support. Administer pain medication along with non-pharmacological pain relief measures such as distraction and relaxation because pain increases anxiety and decreases compliance with necessary treatments. Assess level of pain using the pain scale of 1-10. Lobectomy clients should be positioned lying on the back or turned to either side. Segmental resection clients are positioned lying on back and tilted to the non-operative side; positioning on operative side may place tension on sutures and promote bleeding. Chest tubes are usually inserted. Pneumonectomy clients are positioned on back and tilted toward the operative side but not in a full lateral position. Chest tubes are usually not used. Positioning client with operative side tilted slightly down promotes desired consolidation of fluid on the operative side, and aids in ventilation and perfusion. Chest tubes are used to remove or drain blood or air from the intrapleural space, to expand the lung after surgery, and to restore sub atmospheric pressure to the thoracic cavity. Many brands exist, and all are based on the traditional three-bottle water-seal system. In three-bottle water-seal suction, ©2012 Achieve Page 81

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