Describe the role of an AGACNP at each of the steps in postoperative care for a surgical patient.

You are part of a surgical team and your role is postoperative management of thoracic surgery. In your role, you are required to determine the course of action for the patient before you call the surgeon. A right lower-lobe resection occurred due to adenocarcinoma. The nurse has called at the 12-hour interval from surgery concerned with the amount of drainage within the chest tube. Respond to the following and support your summary and recommendations plan with a minimum of two APRN-approved scholarly resources.
Describe the role of an AGACNP at each of the steps in postoperative care for a surgical patient.
Describe the assessment steps you would take.
Explain the drainage and decompression devices and how you manage these as an AGACNP.
Discuss potential differential diagnoses you could expect from the assessment.
Discuss the hemodynamic findings one might see with your provided diagnosis.
Propose potential treatment plans that would be appropriate.

ANSWER
Role of an AGACNP in Postoperative Thoracic Surgery Care

An Acute Care Nurse Practitioner (AGACNP) plays a crucial role in the postoperative care of thoracic surgery patients. Their expertise in respiratory and critical care allows them to provide comprehensive care, ensuring optimal patient outcomes.

Steps in Postoperative Thoracic Surgery Care

Preoperative Assessment: AGACNPs conduct thorough preoperative assessments to identify potential risks and optimize patient readiness for surgery.

Intraoperative Monitoring: AGACNPs collaborate with the surgical team to monitor patient status during surgery, ensuring hemodynamic stability and oxygenation.

Postoperative Management: AGACNPs play a pivotal role in postoperative management, providing continuous assessment, interventions, and education.

Assessment Steps for a Patient with Chest Tube Drainage

Inspect the Chest Tube: Assess the chest tube for appropriate placement, patency, and secure connections.

Evaluate Drainage Characteristics: Observe the amount, color, and consistency of chest tube drainage.

Monitor Vital Signs: Monitor heart rate, blood pressure, respiratory rate, and oxygen saturation to assess respiratory and hemodynamic status.

Assess Respiratory Status: Auscultate breath sounds and assess for signs of respiratory distress, such as dyspnea, cyanosis, and increased work of breathing.

Evaluate Wound Appearance: Inspect the surgical incision for signs of infection, such as redness, swelling, and excessive drainage.

Management of Drainage and Decompression Devices

AGACNPs manage chest tubes to facilitate drainage of air, blood, and fluids from the pleural space. They:

Measure and Record Drainage: Regularly measure and record the amount, color, and consistency of chest tube drainage to monitor patient progress.

Maintain Chest Tube Patency: Ensure the chest tube remains patent by flushing with saline solution as needed.

Monitor for Complications: Monitor for signs of infection, pneumothorax, and hemothorax, and promptly address any concerns.

Educate the Patient: Provide clear instructions on chest tube care, including how to monitor for complications and seek help if needed.

Potential Differential Diagnoses

Based on the assessment findings, potential differential diagnoses include:

Retained Air: Air trapped in the pleural space after surgery can lead to persistent chest tube drainage.

Hemothorax: Accumulation of blood in the pleural space can cause excessive chest tube drainage and hemodynamic instability.

Pneumothorax: A collapsed lung due to air leakage into the pleural space can manifest as chest tube drainage and respiratory distress.

Pleural Effusion: An abnormal accumulation of fluid in the pleural space can lead to increased chest tube drainage and respiratory discomfort.

Hemodynamic Findings with Chest Tube Drainage

Excess chest tube drainage can lead to hemodynamic instability, manifesting as:

Tachycardia: Increased heart rate to compensate for decreased blood volume.

Hypotension: Low blood pressure due to reduced circulating blood volume.

Tachypnea: Rapid breathing to compensate for decreased oxygenation.

Decreased Oxygen Saturation: Hypoxemia due to impaired oxygen exchange.

Potential Treatment Plans

Depending on the assessment findings, potential treatment plans may include:

Chest Tube Management: Adjust chest tube suction or continue drainage as needed.

Supplemental Oxygen: Provide supplemental oxygen to maintain adequate oxygenation.

Fluid Replacement: Administer intravenous fluids to restore blood volume and hemodynamic stability.

Pain Management: Provide appropriate pain medication to promote comfort and facilitate deep breathing exercises.

Surgical Intervention: In cases of hemothorax or pneumothorax, surgical intervention may be necessary to remove retained blood or air.

References

American Association for Bronchology and Thoracic Medicine. (2019). Guidelines for management of adult acute respiratory distress syndrome. American Journal of Respiratory and Critical Care Medicine, 199(8), 1331-1366.

Cerfolio, R. J., & Bryant, A. S. (2019). Essentials of thoracic surgery. Elsevier Health Sciences.