Deviation in the Standard of Postoperative Care Resulting in Atelectasis (Collapsed Lung)

Evaluate breaches in the standard of care by evaluating your answers to the questions below to determine whether or not there has or has not been a Deviation in the Standard of Postoperative Care Resulting in Atelectasis (Collapsed Lung)

Answer the following questions to find out if the standard of care was followed for your case.

  • Which of the following risk factors did the patient have prior to the surgery?
    History of chronic obstructive pulmonary disease
    History of smoking
    History of bronchial asthma
    None of the above
    Why is this important?
    Risk factors for post-operative pulmonary complications include chronic obstructive pulmonary disease (COPD), increased age, tobacco use, poor nutritional status and the presence of pulmonary hypertension.
    (2010) 24 EBPRCA 2 145-155

  • Was a physical examination performed? Why is this important?
    Answer this question
    
A thorough physical examination is necessary to evaluate the patient’s stability for the procedure.

    (2010) 24 EBPRCA 2 145-155 



  • Was the patient's pain controlled with pain medication? Why is this important?
    Answer this question
    
Proper treatment of post-operative pain is important in prevention of atelectasis.

    (2010) 24 EBPRCA 2 145-155 



  • Was the patient’s respiratory status assessed? Why is this important?
    Answer this question
    
The patient’s respiratory status needs to be assessed frequently, including assessment of lung sounds (auscultation), chest excursion and presence of an adequate cough.

    (2005) 20 EBPCOG 1 23-40 



  • Were the patient’s vital signs monitored periodically? Why is this important?
    Answer this question
    
Clinical observations must be supplemented by the following monitoring devices:
    • Pulse oximeter
    • Non-invasive blood pressure monitor
    • Cardiac electrocardiogram.

    (2009) 10 EAICMD 12 576-57 



  • Was the patient instructed of the need for respiratory exercise? Why is this important?
    Answer this question
    
In order to prevent pulmonary complications, the patient must be instructed about the necessity for respiratory exercises and the proper technique needed to perform them.

    (2010) 24 EBPRCA 2 145-155 



  • Was the patient mobilized as soon as possible after surgery? Why is this important?
    Answer this question
    
Patients need to be informed that frequent changes of position are helpful in clearing secretions. Sitting the patient upright in a chair is recommended to increase both volume and vital capacity relative to the supine position.

    (1997) 185 JNLACS 6 584-592 



  • Did the patient develop post-operative atelectasis? Why is this important?
    Answer this question
    
Atelectasis is a frequent post-operative complication of open surgical procedures.

    (2008) 22 EBPRCA 1 177-191 



  • Was atelectasis identified? Why is this important?
    Answer this question
    
Atelectasis is the collapse of lung volume. Atelectasis is a pathological state and if it persists in the post-operative period it may lead to a respiratory emergency.

    (2008) 22 EBPRCA 1 177-191 



  • Were imaging studies performed to diagnose atelectasis? Why is this important?
    Answer this question
    
A chest radiograph will confirm the diagnosis.

    (2003) 10 ACARAD 11 1283-1290 



  • Which of the following treatment measures were initiated? Why is this important?
    Answer this question
    
Non-pharmacologic therapy includes:
    • Deep breathing
    • Mobilization of the patient
    • Incentive spirometry
    • Tracheal suctioning
    • Humidification
    • Chest physiotherapy with percussion and postural drainage.

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  • Was the patient provided with discharge instructions? Why is this important?
    Answer this question
    
It is of primary importance that the patient has been given specific and individualized discharge instructions.

    (2005) 20 EBPCOG 1 23-40 



  • Prior to surgery, was the patient’s chronic obstructive pulmonary disease addressed? Why is this important?
    Answer this question
    
Patients with a diagnosis of chronic obstructive pulmonary disease already have a high risk for post-operative pulmonary complications.

    (2012) 92 ESRCNA 2 321-344 



  • Was the patient advised to discontinue tobacco use prior to the surgery? Why is this important?
    Answer this question
    
Pre-operative smoking cessation at least 8 weeks before surgery has proven to be beneficial in the reduction of post-operative pulmonary complications.

    (2012) 92 ESRCNA 2 321-344 



  • Was the patient’s bronchial asthma treated prior to the surgery? Why is this important?
    Answer this question
    
Patients with poorly controlled asthma have an increased risk for post-operative pulmonary complications.

    (2010) 24 EBPRCA 2 145-155