# A nurse is caring for a client who underwent esophagectomy for esophageal cancer 24 hours ago. Which nursing intervention should be the priority? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=540715 > language: ko > subject: Adult Health ## 문제 A nurse is caring for a client who underwent esophagectomy for esophageal cancer 24 hours ago. Which nursing intervention should be the priority? The client has a nasogastric tube connected to low intermittent suction and reports mild incisional pain rated 4/10. ## 보기 1. Administer prescribed pain medication for incisional discomfort 2. Monitor respiratory status and encourage deep breathing exercises **✔ 정답** 3. Check nasogastric tube patency and drainage characteristics 4. Assess surgical site for signs of infection or dehiscence **정답: 2** ## 해설 Post-esophagectomy patients are at high risk for respiratory complications due to surgical proximity to thoracic structures and aspiration risk, making respiratory monitoring and deep breathing exercises the priority. Other interventions (pain management, NG tube check, site assessment) are important but less urgent. ## 심화 해설 Post-Esophagectomy Priority Nursing Intervention The correct answer is Monitor respiratory status and encourage deep breathing exercises. Following an esophagectomy, the immediate postoperative period carries a high risk for life-threatening pulmonary complications. The surgical approach involves manipulation or partial resection of the diaphragm and entry into the thoracic cavity, which directly compromises respiratory mechanics. Pain from the thoracotomy or laparoscopic port sites, along with the presence of a nasogastric tube, further inhibits effective coughing and deep breathing. This combination of factors leads to alveolar hypoventilation, atelectasis, and significantly increases the risk of pneumonia. A systematic review and meta-analysis confirms that pulmonary complications remain a major challenge after esophagectomy, underscoring the critical need for interventions that directly support lung expansion and airway clearance [2]. While the client’s reported pain level of 4/10 is mild, it is still a contributing factor to shallow breathing, making proactive respiratory support the highest priority over analgesia alone. The airway, breathing, and circulation (ABC) framework in nursing prioritization dictates that maintaining oxygenation and ventilation takes precedence over other concerns when a patient is at immediate physiological risk. Why the Other Options Are Not the Priority Administering prescribed pain medication is an important comfort measure, but it is not the first priority. Pain control is a means to an end; its primary value in this context is to facilitate pulmonary hygiene by enabling the client to breathe deeply and cough effectively. Simply medicating without immediately coupling it with coached respiratory exercises misses a critical window to prevent atelectasis. Checking nasogastric tube patency and drainage is a key ongoing assessment to prevent gastric distention and monitor for an anastomotic fistula, a serious complication detailed in evidence-based prevention protocols . However, a loss of patency or a change in drainage would present a developing risk, whereas respiratory compromise from hypoventilation is an immediate, ongoing threat. Assessing the surgical site for infection or dehiscence is a standard postoperative intervention, but clinical signs of infection would not manifest within the first 24 hours. This assessment is therefore a lower priority than addressing the immediate, potentially fatal risk of a pulmonary complication. The EUPEMEN collaborative’s standardized perioperative protocol reinforces that the initial focus must be on proactive respiratory support to reduce morbidity . Specific pulmonary rehabilitation strategies, such as structured breathing exercises, have demonstrated effectiveness in improving early pulmonary function recovery and reducing complications in this patient population .References (research sources) - [2]Effects of different rehabilitation strategies on physical function and complications in postoperative patients with esophageal cancer: a systematic review and meta-analysis.Meta-analysis/systematic reviewShen T, Yi Z, Chen M, Zhang X, Gu M, Luo L, Huang X. (2026) · DOI: 10.3389/fpubh.2026.1788265 ## 임상 시나리오 Post-Esophagectomy Respiratory CarePrioritizing ABCs in the First 24-48 Hours The highest priority after esophagectomy is preventing pulmonary complications due to thoracic cavity entry and diaphragmatic manipulation. Immediately implement deep breathing exercises and incentive spirometry every 1-2 hours while awake. Closely monitor respiratory status, including rate, depth, breath sounds, and oxygen saturation. Early signs of atelectasis or pneumonia, such as diminished breath sounds or a drop in SpO2 below 92%, require immediate intervention. CautionDo not let mild pain (4/10) delay respiratory interventions. Pain can cause splinting and hypoventilation; administer analgesics to facilitate effective coughing and deep breathing, but never prioritize analgesia over airway and breathing assessment. ## 핵심 개념 - **Esophagectomy** — Surgical removal of part or all of the esophagus, often involving thoracic and abdominal incisions, which compromises postoperative respiratory function. - **ABC Prioritization** — A triage framework where Airway, Breathing, and Circulation take precedence over other nursing interventions to address immediate life threats. - **Atelectasis** — Collapse of lung tissue, a common postoperative complication after thoracic surgery due to shallow breathing and impaired cough. - **Incentive Spirometry** — A device used to encourage deep breathing and sustained maximal inspiration to prevent or treat atelectasis. ## 같은 주제 문제 - [A 65-year-old male patient presents with a 3-month history of difficulty swallowing and un…](https://mymerci.kr/pages/nclex_q.php?qn_id=540712) - [A nurse is assessing a 58-year-old client with suspected esophageal cancer. 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