Question

You’re assigned to a patient that has just returned from the PACU after having a left thoracotomy. He has a chest tube to a disposable portable drainage unit with suction a urinary catheter in a intravenous line oxygen by cannula A left lateral chest dressing and is on pause oximetry.

1. what specific assessments would you make as soon as you have received report and settled the patient in bed?

2. Your assessment reveals that the patient is in pain and has decreased breath sounds cannot turn without assistance and is very groggy from the anesthesia based on this information and type of operation that was performed what would be the best nursing diagnosis for this patient?

3. Write an expected outcome for each nursing diagnosis

Complications Sign or symptom

Atelectasis

Pneumonia

Paralytic ileus

Thrombophlebitis

Urinary retention

Urinary tract infection

Wound infection

Pulmonary embolus

Hemorrhage and shock

Wound dehiscence

Fluid imbalance

1) patient education for home care of the post surgical patient as discharge should include which five points?

2. it is essential to send home ___ for the patient being discharged to home care.

Answer 1

Post thoracotomy care reduces the risks of respiratory failure and other complications. Soon after receive the patient from PACU the nursing responsibilities would be

*check incision site for bleeding

*assessment of pain with pain scale

*check the chest tube for position, patency and make sure that the system is closed.

*check for breathing pattern -PO2, PCO2 values for further decision making.

NURSING DIAGNOSIS

Ineffective breathing pattern related to lung incision, pain and anaesthesia.

1.Acute pain relate to surgical incision

Expected outcome

Reduce pain by proper positioning, assessment of site and prevention of infection by using aseptic techniques and analgesics.

2.Ineffective breathing pattern related to chest tube drainage and anaesthesia.

Expected outcome

Improve breathing pattern by preventing pneumothorax, haemothorax and infection.

Improve tissue perfusion during post anaesthesia by assessing depth and rate of breath and by pulseoxymetry.

3.Impired physical mobility related to the thoracic surgery

Expected out come

Attain self physical mobilization by breathing exercise , skeletal exercise for abduction and assistance to move to chair from bed.

COMPLICATIONS AT HOME

1.Infection like pneumonia

2.Thrombophlebitis

3.wound infection

4.Wound dehiscence

5.Hemorrhage and shock

THINGS CAN BE SENT TO HOME

Heating pad

Spirometer

Medication.

Patient with chest tube:

Ambulatory chest drainage bag

Drainage chart.

Spirometer

Medication.

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