Question

Why are post-operative patients (patients who just had surgery) at risk for atelectasis and/or pneumonia (PNA)? What nursing interventions can help prevent these complications? (typed please).

Answer 1

Post- operative pulmonary complications occur in 5%-10% of patients undergoing non thoracic surgery and in 22% high risk patients. Post-operative pulmonary complications are broadly defined as conditions affecting the respiratory tract that can adversely influence the clinical course of the patient after surgery.

Atelectasis in post op:

Atelectasis is lung condition where areas of the lungs collapse. This collapse won’t allow the alveoli in this area of the lung no longer will functions. The amount of the lung affected can vary widely between individuals.

Having a surgery is the major risk factor having atelectasis. There are two primary reasons for this: the being on ventilator during surgery and the inability to cough to clear the lungs while under anesthesia. The ability to take deep breath and cough helps to prevent atelectasis.

Post op Pneumonia:

Pneumonia after surgery is very serious problem after surgery. Causes of post pneumonia, aspirations due deep sedation patient may not cough out secretion properly it will colonize in the lower respiratory tract pneumonia will occur, lack of aspect precaution while doing surgery also will leads pneumonia if its proximal surgery area.

Nursing preventive measures for post op atelectasis and Pneumonia

Assist a patient to take a deep breathing method, there are 4 effective deep breath methods by patient without devices, with an intermittent positive pressure breathing machine (IPPB), blow bottles, and Dale-Schawartz breathing tube

While it’s not possible to determine which, if any methods truly atelectasis the following measures will try to minimize risk of atelectasis

• Frequent turning, early mobilization
• Strategies to improve ventilation: deep breathing exercise at least every 2 hours, incentive spirometer
• Strategies to remove secretions: coughing exercise, suctioning, aerosol therapy, chest physiotherapy

  

Nursing preventive measures for PNA:

• Practice a good hand hygiene that is 6 steps of hand wash and 5 movements of hands wash as per CDC guidelines
• NPO 6 hrs Prior to surgery to prevent aspirations
• Emergency – NGT do gastric lavage
• Early mobility
• Frequent positioning
• Suctioning as per requirement