SCTIMST Staff Nurse - 2015 (Set-A)
Medical & Surgical Nursing
Hard
A client after pneumonectomy will be positioned on?
Appeared in: SCTIMST Staff Nurse - 2015 (Set-A)
Explanation
- After a pneumonectomy, positioning the patient on the operated side or on their back (supine) is the standard of care.
- This specific positioning prevents the mediastinum (heart, trachea, and great vessels) from shifting into the empty thoracic cavity, a complication known as mediastinal shift.
- Lying on the operated side allows serosanguineous fluid to gradually fill the empty space, which helps to stabilize the mediastinum and prevent its displacement.
- The supine position is neutral and also considered safe as it does not promote a shift.
- This strategy protects the bronchial stump from torsion and avoids compressing the remaining functional lung, maximizing its ability to ventilate.
Why Other Options Were Wrong
- Option A: This option is too restrictive. While the supine position is acceptable, alternating between supine and the operated side is necessary to prevent complications of immobility like pressure ulcers and atelectasis in the remaining lung.
- Option B: This option is incorrect and dangerous because it includes turning to 'either side'. Turning to the un-operated side is strictly contraindicated after a pneumonectomy.
- Option D: This option is incorrect and extremely dangerous. Positioning on the un-operated side is contraindicated because it would cause the mediastinum to shift towards the empty operative side, compressing the only remaining lung and compromising cardiopulmonary function.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Postoperative nursing care and patient positioning following thoracic surgery as background academic context rather than a clinical decision trigger.
- Correct positioning after pneumonectomy is a critical nursing responsibility to prevent the life-threatening emergency of mediastinal shift.
- Nurses must vigilantly assess for early signs of mediastinal shift, such as respiratory distress, and late signs like tracheal deviation, and immediately notify the surgeon.
- Patient and family education about positioning restrictions is a key safety measure to prevent accidental turning onto the un-operated side.
How to Approach the Question
- First, identify the key procedure in the question: 'pneumonectomy', which is the removal of an entire lung.
- Recall the primary and most severe complication associated with this specific surgery: mediastinal shift due to the large empty space created.
- Think about the goal of post-operative positioning: to prevent this shift.
- Analyze each option based on the principles of gravity. Which position would stabilize the heart and trachea, and which would cause them to shift into the empty space?
- Eliminate the position that is most dangerous: lying on the un-operated side, as this would cause the mediastinum to fall into the empty space.
- Select the option that includes the safe positions: lying on the back (neutral) and on the operated side (uses gravity to hold the mediastinum in place).
Concept Tested & Keywords
- Concept Tested: Postoperative nursing care and patient positioning following thoracic surgery.
- Stem keywords: pneumonectomy, client, positioned
- Lead-in keywords: BEST, MOST RELEVANT CLUE
- Clinical cues: The procedure is a pneumonectomy, which means an entire lung was removed, creating a large empty space in the thorax.
- Negative lead-in flag: false
Question ID
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Practise the full SCTIMST Staff Nurse - 2015 (Set-A)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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