iii ) Reassure the patient and the family regarding the improvement
iv ) Educate about the disease, prognosis and the therapeutic regime
v ) Extend full support to manage the disease/situation
vi ) Monitor the records and patient’s response towards the treatment
v ) Thorough record keeping
The patient after being shifted from Post Anaesthesia Recovery Room/ Intensive care unit requires vigilant monitoring and care by the nursing staff. The nursing staff may experience various mentioned situations/complications to handle post Lobectomy which require immediate intervention, quick decision, alert action and smart referrals (if required). The base of nursing diagnosis is formed by the signs and symptoms being experienced and shown by the patient on the spot and not on their medical diagnosis.
i ) Ineffective or abnormal breathing patterns which may arise due to excessive pain (local or general), incision, anxiety or general weakness
ii ) Acute pain with or without anxiety and restlessness
iii ) Ineffective coughing which may arise due to pain at site and leads to accumulation of secretions in throat which further aggravates the cough
iv ) Due to mediastinal shift, there always remains a risk for impaired gas exchange, This is alarming and requires quick intervention.
v ) Impaired mobility of the limbs of the side operated.
vi ) In relation to the chest tube drainage, there is always the risk for deficient fluid volume
The objective of nursing intervention post surgery is to enhance the outcome of the surgery by timely and effective care, guidance and management of the situation.
i ) The primary purpose of the nursing intervention is to restore the normal breathing pattern which must be visible through the patient’s normal skin colour.
ii ) To bring the patient’s breathing to normal; the nursing staff should immediately put him/her in the High Flower’s position so that the patient can breathe normally
and cough at ease. This is to ensure that the site does not stretch much while he/she coughs.
iii ) The nursing staff should also try to put the patient on his/her back as to help his/her lungs expand to their fullest.
iv ) The attempt should be to keep the patient’s airways open and to achieve this the patient can be administered with the humidified oxygen to help his/her secretions loosen followed by their suction.(K. Yoshimoto, January 2010)
v ) The nursing staff should review the effects and the side – effects of the medicines, antibiotics or drugs being consumed by the patient as to suggest the immediate alternative if required.
The mentioned points are of high importance during the post operative management of Lobectomy.
i ) Nursing staff needs to be highly supportive during post operative chest physiotherapy. They need to ensure the continuity of the breathing exercises to the patient prescribed and demonstrated by the physiotherapist.
ii ) Chest surgery can be dreadful the patient and his/ her assistances hence the nursing staff needs to reassure them while providing them with all the required assistance.
iii ) Following the lower Lobectomy, the patient must be nursed in a semi-upright position, well supported by the pillows. It would help the patient to get the full expansion of the operated lung.
iv ) The nursing staff also needs to monitor the equipment of the Oxygen therapy (if prescribed by the doctor). The amount of oxygen being given and the patient’s response to the therapy are required to be monitored constantly and recorded for future references.
v ) Utmost care is required to be taken by the nursing staff for the drains as to keep them in place.(G. Varela, 2009)
vi )The patient’s emotional and mental well being is an area which is neglected in majority of the cases and is under shadowed by the physical symptoms. The nursing staff is equally responsible to take patient’s emotional needs to keep his/her morale high.
i ) When ventilation is adequate to meet the patient’s needs
ii ) Pain is strictly under control
iii ) Case is stable and free from suspected complications
iv ) Patient and the family understands the disease process, prognosis and therapeutic lines
v ) Anxiety and fear are under control
Patient Education and Recommendations
i ) The nursing staff needs to explain to the patient the benefits of quitting smoking. She needs to develop a confidence in the patient explaining the process scientifically and also building up the patient’s morale. The nursing staff needs to tell that the Atelactasis and accumulation of secretions in the lungs would decrease if the patient quits smoking thereby giving wound bright chances to heal fast.
ii ) A strong will power needs to be build up to get convinced enough to quit smoking. Hence it is an imperative for the nursing staff to communicate well with the patient, motivate him/her. His moral level should be build up to a level which helps him/her to get rid of this dreadful addiction.
iii ) Of course the family and friends also play a crucial role hence the nursing staff also needs to communicate to the family members so that they should provide the patient a healthy (stress free) environment at home.
iv ) The patient also needs to be educated about the effective and correct method to cough to get rid of the secretions as to minimize the disturbance to the incision.
v ) Patient needs to be thoroughly educated with the physiotherapy and diaphragmatic breathing exercises.
vi ) Patient and his/her attendants should be thoroughly trained to take care of the incision, regular bandage, follow ups, general hygiene and the wound’s care.
vii ) Nursing staff also need to explain to the patient and his family to avoid direct contact with dust and to keep the nose and mouth covered with mask as to avoid cross infection.
viii ) Patient and his family needs to be explained the role of high protein rich diet which shall help building up the new cell fast. A thorough diet plan should be explained by the nursing staff before the discharge.
ix ) Patient also needs to be instructed to consume freshly prepared home made food and to avoid recooked, reheated and street food. It shall help him to keep the cross infection at bay and at the same time healthy food shall fulfill the body’s extra requirements.
x ) Also the patient needs to be explained to keep the non vegetarian food at bay.
Patient can be asked to join the rehabilitation camp which can help him build positive attitude towards life and quit smoking easily.
xi ) The patient should be educated about his sleep requirements for a speedy recovery. He can also be explained with the importance of tranquility and mental & emotional well being. It shall also help him get rid of his/her anxieties which in turn shall help him get rid of smoking.
xii ) It should be communicated to the patient that smoking is an anti-social activity. It should not only be avoided at home but also at public places and in social context.
xiii ) Nursing staff should help the patient to develop a Quit Smoking Action Plan. Together they should list down all the issues encountering as obstacle and a detailed discussion on how to remove them.
xiv ) The patient should be encouraged to keep himself/herself engaged in the healthy and positive activities such as reading good and interesting books, delving in healthy family games, social activities, keeping away from stress and the aggravating factors.
xv ) Patient should also be educated on the financial burden this dreadful addiction puts on his/her family. He should be taught with the constructive ways to engage his emotions.
xvi ) The patient should be given a complete guideline on how and when to resume with the normal activities. Also should be talked about a healthy lifestyle which can help him/her revive the life to whatever extent possible.
xvii ) The patient should also be explained with the affects if he/she still insists on continuing with the smoking. He can be explained the details of Chemotherapy and its aftereffects.
xviii ) An emergency guide should be appended at the time of discharge which should contain the complete information on how to manage the emergency situations (if arise) and complications (expected and unexpected).
xix ) Passive smoking is equally injurious to health. For the patients who are recovering from the lung surgery it becomes imperative to ask for Non- Smoke environment at home, work and social places.