# A postoperative thoracotomy client with a chest tube is on day 1. Which interventions should be included in the plan of care? Select all that apply.

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> language: en  
> subject: Pharmacological and Parenteral Therapies  
> category: PPT

## Question

A postoperative thoracotomy client with a chest tube is on day 1. Which interventions should be included in the plan of care? Select all that apply.

1

Encourage incentive spirometry every hour while awake

2

Apply sequential compression devices when the client is in bed

3

Keep the drainage system above the level of the chest to prevent backflow

4

Notify the surgeon for drainage greater than 100 mL per hour for 2 consecutive hours

5

Assist with ambulation as soon as tolerated, keeping the system upright

## Explanation

Postop thoracic surgery bundle prevents VTE and atelectasis: SCDs in bed, hourly incentive spirometry, early ambulation. Drainage MUST be kept BELOW the chest level so gravity does not return fluid to the pleural space. Bright red drainage exceeding 100 mL per hour for 2 hours, or 200 mL in the first hour, warrants immediate surgeon notification for possible hemorrhage.

## In-depth explanation

Memory: chest tube system below chest, never clamp during transport (only briefly to change unit), keep upright. Tidaling = patent tube; cessation = obstruction or full re-expansion.

## Clinical scenario

Pleural drainage 80 mL serosanguineous in the last 8 hours. Pain 5/10 on PCA hydromorphone. Tidaling present. SCDs at bedside.

## Key concepts

- **tidaling** — Fluctuation of fluid in the water-seal column with respiration; indicates patent system.
- **sequential compression device** — Pneumatic leg sleeve preventing VTE in immobile patients.
- **incentive spirometry** — Device promoting deep inhalation to prevent postoperative atelectasis.

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