(2) The patient will be instructed in special exercises that will strengthen
those muscles of the shoulders and chest that support respiratory movement. These
exercises are routinely taught by the physical therapist. The nursing personnel,
however, must be familiar with these exercises. It is a nursing responsibility to reinforce
the teaching, observe, and assist the patient in correct procedure.
(3) Preoperative patient education must include preparing the patient and
his family, the postoperative course of events, to include chest tubes, suctioning, and
artificial ventilation, as appropriate.
(4) Preoperative education can be used to reduce the potential for
complications. (For example, teaching the importance of active range of motion of the
arms may prevent the patient from developing a "frozen" shoulder.) Always explain
what must be done and why it is important. A patient will naturally be reluctant to
perform a movement or exercise that is painful to him.
d. In addition to general postoperative nursing care, the following considerations
for chest surgery patients must be noted.
Intake and output must be strictly monitored.
(2) Intravenous fluids are routinely given slowly and in limited amounts (as
ordered by the physician) to avoid fluid overload and pulmonary edema.
(3) Vigorous turning, coughing, and deep breathing must be done to expel
secretions. If these secretions are not removed, atelectasis may occur. Secretions that
cannot be removed by coughing must be removed by suctioning.
(4) Blood pressure, pulse, and respirations should be taken and recorded
frequently for the first 24 hours postoperatively. Nursing personnel should note general
appearance, skin color and temperature, character of respiration, and appearance of
the wound site. Close observation must be made for signs of shock, hemorrhage,
pulmonary edema, or respiratory embarrassment.
(5) Early ambulation of chest surgery patients is desired, with exercises as
prescribed, to promote lung reinflation, good body posture, and maintenance of
shoulder movement and muscle tone. Increase in ambulation will depend upon
physician's orders, nursing assessment, and the patient's desire for independence.
(6) Proper positioning while bed resting is extremely important. The
pneumonectomy patient should not be placed directly on his inoperative side. To do so
will place additional strain on the already overtaxed remaining lung. Patients
undergoing resection should not be placed on the operative side, as this interferes with
the desired maximum expansion of the operative lung.