An hour after a thoracotomy, a patient complains of incisional ...

[Caiter2013]

An hour after a thoracotomy, a patient complains of incisional pain at a level 7 (based on 0 to 10 scale) and has decreased left-sided breath sounds. The pleural drainage system has 100 mL of bloody drainage and a large air leak.
 
  Which action is best for the nurse to take next?
  a. Milk the chest tube gently to remove any clots.
  b. Clamp the chest tube momentarily to check for the origin of the air leak.
  c. Assist the patient to deep breathe, cough, and use the incentive spirometer.
  d. Set up the patient controlled analgesia (PCA) and administer the loading dose of morphine.

Question 2

A lobectomy is scheduled for a patient with stage I nonsmall cell lung cancer. The patient tells the nurse, I would rather have chemotherapy than surgery. Which response by the nurse is most appropriate?
 
  a. Are you afraid that the surgery will be very painful?
  b. Did you have bad experiences with previous surgeries?
  c. Surgery is the treatment of choice for stage I lung cancer.
  d. Tell me what you know about the various treatments available.

[Ptupou85]

Answer to Question 1

ANS: D
The patient is unlikely to take deep breaths or cough until the pain level is lower. A chest tube output of 100 mL is not unusual in the first hour after thoracotomy and would not require milking of the chest tube. An air leak is expected in the initial postoperative period after thoracotomy.

Answer to Question 2

ANS: D
More assessment of the patient's concerns about surgery is indicated. An open-ended response will elicit the most information from the patient. The answer beginning, Surgery is the treatment of choice is accurate, but it discourages the patient from sharing concerns about surgery. The remaining two answers indicate that the nurse has jumped to conclusions about the patient's reasons for not wanting surgery. Chemotherapy is the primary treatment for small cell lung cancer. In nonsmall cell lung cancer, chemotherapy may be used in the treatment of nonresectable tumors or as adjuvant therapy to surgery.

[Caiter2013]

Thank you

[Ptupou85]

No problemo