Question

A client with lung cancer is six hours post-surgical lobectomy procedure. The nurse assesses \(260 \mathrm{~mL}\) bloody chest tube drainage for the past hour. What is the most appropriate initial action? A. Elevate the head of the bed. B. Increase the IV fluid rate. C. Assess the wound dressing for drainage. D. Notify the doctor of the assessment finding.

Short answer

Answer: The most appropriate initial action is to notify the doctor of the assessment finding. This allows for proper evaluation and intervention to address the specific issue of 260 mL of bloody chest tube drainage in the past hour.

Step-by-step solution

Understand the patient's situation

The patient has lung cancer and has gone through a surgical lobectomy procedure. They have bloody chest tube drainage of 260 mL in the past hour. This information is crucial to identify the best immediate action to take for proper patient care.

Evaluate each option

A. Elevate the head of the bed: Elevating the head of the bed may cause more chest tube drainage. However, it is not the best initial action to address the concerning amount of drainage. B. Increase the IV fluid rate: Increasing the IV fluid rate may be necessary if the patient is experiencing hypotension due to blood loss. Still, it is essential to communicate with the doctor before making such decisions as it may not necessarily address the drainage concern. C. Assess the wound dressing for drainage: Assessing the wound dressing is an essential aspect of postoperative care. However, it would not address the primary concern of the high amount of bloody chest tube drainage in the past hour. D. Notify the doctor of the assessment finding: Notifying the doctor allows proper assessment and evaluation of the drainage concern. This action ensures the correct intervention is set in place based on the doctor's recommendation.

Choose the most appropriate initial action

After evaluating each option, the most appropriate initial action is D. Notify the doctor of the assessment finding. This option allows for proper evaluation and intervention to address the specific issue of 260 mL of bloody chest tube drainage in the past hour.

Key concepts

Post-Surgical Care

Following surgery, patients require careful monitoring to ensure recovery without complications. This is crucially important after procedures such as a lobectomy, where a portion of the lung is removed. Post-surgical care includes vigilant observation for any signs of bleeding, infection, respiratory difficulties, and managing pain.

As seen in the exercise, a substantial amount of chest tube drainage post-lobectomy is a significant finding that requires immediate attention. A nurse's initial step is to assess the situation in its entirety before acting. In our case, notifying the doctor is imperative as it could indicate postoperative hemorrhage. Detail-oriented supervision of vital signs, fluid balance, and comfort levels are also key components. Patients are often given specific instructions to prevent complications, such as how to cough and breathe deeply to help keep the lungs clear.

Lobectomy Procedure

A lobectomy is a surgical procedure that involves the removal of a lobe of the lung. It is a common treatment for lung cancer as well as benign diseases when less invasive procedures are not feasible. A lobectomy aims to remove diseased tissue while preserving as much lung function as possible.

Different techniques can be used to perform a lobectomy, including traditional open surgery or minimally invasive methods like video-assisted thoracoscopic surgery (VATS). The chosen approach depends on various factors such as the size and location of the tumour, the patient's overall health, and the surgeon's expertise.

Understanding the lobectomy procedure is crucial for both healthcare providers and patients. It informs postoperative expectations and care requirements, like monitoring for complications including excessive bleeding, which is hinted at by the exercise when 260 mL of bloody chest tube drainage is observed.

Chest Tube Management

Chest tube management is an essential aspect of care for patients recovering from thoracic surgeries, like a lobectomy, and for those with pleural effusions or pneumothorax. The chest tube's role is to remove air, fluid, or blood from the pleural space to prevent lung collapse and facilitate proper lung expansion.

Effective management involves regularly monitoring the volume and characteristics of the chest tube drainage. Sudden increases in drainage, as mentioned in the exercise, could signal a life-threatening complication such as hemorrhage or a leak in the pleural cavity. Nursing staff must be trained to recognize normal versus abnormal drainage, manage the tube to prevent occlusions, and ensure the drainage system is functioning correctly. Notifying the physician promptly, as suggested in the exercise, is part of effective chest tube management when abnormal findings are observed.