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. Encourage the client to take breaks from oxygen use to prevent tolerance. Oxygen therapy does not cause "tolerance," and taking breaks can lead to hypoxemia in COPD clients. Continuous low-flow oxygen is essential to maintaining adequate oxygenation while avoiding hypercapnia. Stopping oxygen therapy intermittently can increase the risk of respiratory distress.
B. Assess cheeks and posterior ears for signs of skin breakdown. While it is important to monitor for pressure injuries from nasal cannula tubing, this is a general nursing consideration for all patients receiving oxygen therapy. It is not the highest priority when managing oxygen therapy in clients with COPD, where maintaining appropriate oxygen levels is critical.
C. Maintain nasal oxygen at a 1 to 2 liter/minute flow rate. Clients with COPD often have chronic CO₂ retention and rely on hypoxic drive for ventilation. Administering high-flow oxygen can suppress their respiratory drive, leading to CO₂ narcosis and respiratory failure. To prevent this, oxygen should be administered at the lowest effective flow rate, typically 1 to 2 L/min via nasal cannula, while closely monitoring oxygen saturation and blood gases.
D. Teach the client how to safely increase oxygen flow when they deem necessary. Allowing a client with COPD to adjust their oxygen flow independently can be dangerous, as excessive oxygen can lead to hypercapnia and respiratory depression. Oxygen adjustments should be made based on clinical assessments and healthcare provider orders.

A. An adverse event. An adverse event is an unintended injury or complication resulting from medical care rather than the patient’s underlying condition. In this case, the surgical site infection (SSI) developed as a complication of surgery, requiring additional treatment. While adverse events may prolong recovery, they do not always indicate negligence or preventability.
B. A never event. Never events are serious, preventable medical errors that should not occur under proper care, such as surgery on the wrong site, retained surgical instruments, or administering the wrong medication. While SSIs are concerning, they are not classified as never events because they can occur even when proper precautions are taken.
C. A near miss. A near miss refers to an event that could have caused harm but was prevented before reaching the patient. Since the infection did occur and required intervention, it does not qualify as a near miss. A near miss example would be identifying and correcting a medication error before administration.
D. A sentinel event. Sentinel events involve unexpected occurrences that result in serious injury, permanent harm, or death, such as patient suicide, wrong-site surgery, or a fatal medication error. Although the infection required prolonged treatment, it did not lead to severe harm or death, making it an adverse event rather than a sentinel event.