What other nursing diagnoses might a nurse monitor post-op thoracic surgery client?
Activity intolerance [d/t reduced gas exchange and CO]
Space activities
Gradual increase in activity
Impaired physical mobility
ROM to affected arm = prevent ankylosis (frozen shoulder)
Grieving
What type of teaching should the nurse provide a patient post-op thoracic surgery?
Sx to report to MD [persistentSOB; worse than normal fever; increased pain; other s/s of infection]
Activity Guidelines [ROM for shoulder exercises; no lifting > 20 lbs until MD clearance approved; restperiods [profound fatigue for 4 mo post op]
Lung protective strategies
Referrals for smoking cessation = continue DB&C; get immunizations and avoiding people w/ upper respiratory infections and smokers
How does a nurse assist during thoracentesis?
Record amount & describe fluid
Position pt post-procedure
Monitor VS
Look for s/s of pneumothorax ~ do post procedure x-ray to ensure lung has re-expanded and no pneumothorax
What is a indwelling pleural catheter and how does it work?
Pleural Effusion treated with a indwelling pleural catheter
Pt connected to vacuum bottle when getting ready to drain = NOT connected all the time
When ready to Drain there is no special position needed when suction is on
As lung re-expands; catheter remains in lung and capped when not in use
What is the nursing role during the care of an indwelling pleural catheter?
Drainage orders
Infection prevention = single use bottles!
Home care teaching
What is some post-procedure care provided for patients after the insertion of a IVC filter?
Surgical Intervention for PE ~ for high risk patients [unable to take anticoagulants or high chance of PE reoccurrence
Monitor insertion site ~ s/s infection/bleeding
Check peripheral pulses = ensure perfusion is maintained
Monitor urine output b/c filter can migrate
Monitor VS ~ [dropping BP = something is wrong; embolectomy if not IVC]
After a pulmonary embolism, what kind of medication education will a nurse give to a patient?
anticoagulants 3 – 6 mo minimum
Bleeding precautions
Warfarin education if indicated
What are bleeding precautions?
Increased HR, decreased BP, bruising, petechiae, hematomas, black tarry stools
What type of warfarin education might a nurse provide for their client?
P: prevention of thrombus & PE, of thrombotic events for a-fib
T: bleeding precautions
Pregnancy is contraindicated
Avoid aspirin
No concurrent use of other anticoagulants and NSAIDs
If possible avoid concurrent use of phenobarbital, carbamazepine, phenytoin, oral contraceptives, and vitamin K
Avoid foods high in vitamin K (dark leafy greens)
What are some nursing actions for the administration of warfarin?
Monitor VS
Obtain PT (18-24sec) and monitor lvls and INR (2-3)
Antidote: vitamin K
What are some interventions for flail chest causing hypoxemia?
Mechanical ventilation ~ provided for internal stabilization of the chest and correct hypoxemia
Surgical stabilization
What are some interventions for Simple Rib Fractures?
usually, pt sent home if nothing else is happening; takes 3 – 6 wks to heal; typically surgical stabilization NOT needed
Use of a binder or rib belt to support the chest wall to reduce pain but not always b/c it inhibits inspiration
Pain = #1 problem
Impaired gas exchange = risk for or actual
Biggest risk if atelectasis ---> IS or other deep breathing exercises
What are nursing interventions for a patient with pneumothorax experiencing impaired gas exchange?
Oxygen by NRB mask = give 100% ---> reinflates lung and treats hypoxia done regardless of if not hypoxic
HOBelevated (if BP permits); promote oxygenation; cannot do if CO is a problem
Chest tube to drain air/blood, and restore negative pressure
What kind of emergent management is needed for a pneumothorax?
Emergent management: decompression by insertion of large bore needle in 2nd ICS ==> if suspected tension pneumo.. MD does this ~ helps urgently release/relieve pressure = will hear a “whoosh” sound
If open pneumo, apply occlusive dressing taped on 3 sides ~ lets air out but not in to avoid increase in pressure
What type of medication treatment is used for a PE?
Anticoagulants: prevents clotting
Heparin transitioning to oral anticoagulants
Enoxaprin for low-risk patient
Thrombolytics for massive PE
Heparin
Antidote = protamine sulfate
Given IV to prevent clot from getting larger or new clots; does not dissolve clot
Maintain APTT 1.5 - 2.5
High alert med; second nurse check
Bleeding Precautions
Enoxaprin for low-risk patient
Observe for bleeding: increased HR, decreased BP, bruising, petechiae, hematomas, black tarry stools
Avoid aspirin
How will you treat a patient experiencing an acute pulmonary embolism?
Impaired gas exchange
Bedrest in high fowler’s
Titrated O2 to pulse ox value
HFNC (warm/humidified) or Bipap as needed
Risk for decreased CO
Monitor VS & heart rhythm (dysrhythmias) & massive PE [use fluids w/ caution]