Help - can anyone answer this?

[miss_c]

Mrs. Murphy had a lobectomy, 24 hours after surgery, the nurse reminds Mrs. Murphy to perform her breathing exercises. The nurse notices that she complains of much pain during the exercises and auscultates crackles throughout the bases of the lung fields. What concern would the nurse have and what actions can be taken?

[CrufflerJJ, BSN, RN, EMT-P]

If she's in pain during the exercises (I'd probably be hurting if you chopped out one of my lung lobes!), the nurse may need to explore PRN pain meds for the patient (?are they ordered?). Also see if the physician is able to change the pt's pain meds to better enable her to tolerate the breathing exercises.

Crackles in lung bases doesn't sound good. This suggests fluid buildup (early onset pneumonia??) & inadequate expansion of alveoli. Could be drainage from surgical site, fluid buildup in lungs from pt's unwillingness to deep breathe/cough (due to pain).

[Daytonite, BSN, RN]

Post op care of a lobectomy patient involves monitoring respiratory status and assessing breath sounds, monitoring the surgical wound and dressings, assessing drainage and making sure chest tubes are patent and functioning, provide comfort measures, and assessing for complications

Complications of lobectomy are: hemorrhage, infection tension pneumothorax, bronchopleural fistula, empyema, a persistent air space that remaining lung tissue doesn't expand to fill.

• http://www.surgeryencyclopedia.com/La-Pa/Lobectomy-Pulmonary.html - "The specific risks of a lobectomy vary depending on the specific reason for the procedure and the general state of the patient's health; they should be discussed with the surgeon. In general, the risks for any surgery requiring a general anesthetic include reactions to medications and breathing problems. As previously mentioned, patients having part of a lung removed may have difficulty breathing and may require the use of oxygen. Excessive bleeding, wound infections, and pneumonia are possible complications of a lobectomy. The chest will hurt for some time after surgery, as the surgeon must cut through the patient's ribs to expose the lung. Patients with COPD may experience shortness of breath after surgery."

[miss_c]

Thank you very much, this helps tremendously!