PGIMER Chandigarh NO - 2015
Medical Surgical Nursing
Medium
The surgeon has scheduled a patient for a left pneumonectomy. Which is the recommended position for this client?
Appeared in: PGIMER Chandigarh NO - 2015
Explanation
- Positioning a patient on their operative side or back after a pneumonectomy is the standard of care.
- This position allows the remaining lung to achieve maximal expansion, ensuring adequate ventilation and oxygenation.
- It utilizes gravity to contain fluid and air in the empty thoracic cavity, preventing it from contaminating the healthy lung.
- This strategy is key to preventing a mediastinal shift, where the heart and great vessels would move into the empty space, causing hemodynamic instability.
Why Other Options Were Wrong
- Option A: This option is too restrictive. While lying on the back (supine) is an acceptable position, lying on the operative side is also safe and frequently recommended. Limiting the patient to only their back is unnecessary.
- Option B: This option includes a dangerous position. The 'other side' refers to the un-operative side. Placing the patient on their un-operative side would compress the only functioning lung and risk fluid aspiration into it.
- Option C: This option is incorrect because it includes the un-operative side, which is a contraindicated position. Positioning on the un-operative side can lead to severe respiratory compromise by limiting expansion and risking fluid shifts into the only good lung.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Post-operative positioning following a pneumonectomy to guide bedside assessment, documentation, and the next nursing action.
- Nurses must strictly adhere to the surgeon's specific orders for positioning, as protocols can vary slightly. Turning is usually restricted to the back and operative side for the first 24-48 hours.
- Continuous respiratory assessment is critical. The nurse must monitor breath sounds in the remaining lung, oxygen saturation, and work of breathing. Any signs of respiratory distress require immediate intervention.
- Monitor for signs of mediastinal shift, a medical emergency. Symptoms include tracheal deviation away from the midline, sudden drop in blood pressure, increased heart rate, and severe dyspnea.
How to Approach the Question
- First, identify the key procedure in the question: a 'left pneumonectomy,' which is the complete removal of the left lung.
- Recall the primary physiological goals after this surgery: to protect the single remaining lung (the right lung) and prevent complications.
- Think about the mechanics. The main goal is to keep the remaining lung 'up' and free to expand, and to prevent fluid from the surgical site from entering it.
- Evaluate each option based on this goal. Any position that places the remaining (un-operative) lung in a dependent or compressed state is dangerous.
- Eliminate options that include turning to the 'un-operative side' or 'other side,' as this is contraindicated.
- This process of elimination leaves 'Operative side or back' as the only safe and correct choice.
Concept Tested & Keywords
- Concept Tested: Post-operative positioning following a pneumonectomy.
- Stem keywords: pneumonectomy, left, position
- Lead-in keywords: recommended position
- Clinical cues: The procedure is a pneumonectomy, which involves the removal of an entire lung, making post-operative positioning critical for the function of the single remaining lung.
Question ID
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