A nurse is caring for a client diagnosed with lung carcinoma and scheduled for a left pneumonectomy. The nurse should prioritize which nursing Intervention in the immediate postoperative period?

A. Set ground rules: This step involves establishing guidelines for the discussion to ensure that all participants feel respected and heard. By inviting each staff member to speak in turn and asking them to listen respectfully without making personal or professional remarks, the nurse manager is creating a safe and structured environment for open communication. Setting ground rules is crucial for facilitating a productive dialogue and minimizing conflict during negotiations.
B. Perform an opening move: This refers to the initial statement or action taken to start the negotiation process. While the nurse manager is initiating the meeting, the emphasis on respectful communication and turn-taking indicates that the focus is more on establishing an effective communication framework rather than simply making an opening statement.
C. Continue the negotiation: This step implies that the negotiation is already underway and is focused on maintaining momentum in the discussion. However, the scenario describes the nurse manager taking proactive steps to set the stage for the negotiation rather than continuing an existing conversation.
D. Clarify the problem: While it is important to identify and clarify the staffing issues and tardiness, the nurse manager's actions are more about creating an environment for discussion rather than explicitly defining the problem at this stage. Setting ground rules is a foundational step that supports problem clarification by fostering respectful dialogue among participants.

A. Increase the oxygen flow rate. The client is experiencing worsening hypoxia, tachypnea, and dyspnea, indicating progressive respiratory distress due to pulmonary embolism (PE). Increasing the oxygen flow rate is the priority to improve oxygenation, reduce the work of breathing, and prevent further hypoxemia. Providing supplemental oxygen helps stabilize the client while preparing for further interventions. The client’s rapidly deteriorating condition, suggests potential hemodynamic instability. Immediate provider notification ensures urgent evaluation for interventions such as anticoagulation, thrombolytics, or intensive monitoring.
B. Increase the oxygen flow rate, then elevate the head of the bed. While elevating the head of the bed can assist breathing by improving lung expansion, it does not address the underlying pathophysiology of PE. Notifying the provider is more critical, as the client may need immediate pharmacologic or procedural interventions to prevent further deterioration.
C. Administer pain medication, then notify the healthcare provider. Pain relief is important, but in acute respiratory distress, oxygenation and circulatory stability take precedence. Narcotics can depress respiratory drive and worsen hypoxia, making them a lower priority until the client’s respiratory status is stabilized.
D. Encourage deep breathing exercises, then check capillary refill. Deep breathing is beneficial for lung expansion but is not an effective treatment for acute PE. The priority is ensuring oxygenation and immediate medical intervention rather than focusing on routine assessments like capillary refill, which do not directly address the emergency.
E. Elevate the head of the bed, then apply compression stockings. Elevating the head of the bed may help ease breathing, but it is a supportive measure rather than a primary intervention. Compression stockings are used for DVT prevention, not for managing an active embolism, making them inappropriate as a priority action in this scenario.