The nurse is caring for a patient who has recently been diagnosed with cancer and is currently receiving their first dose of chemotherapy. Which oral hygiene practice should be avoided?

A. While pain is expected after any surgery, the focus of preoperative teaching should be on immediate post-operative expectations such as the presence of a chest tube, which is more critical for the nurse to prepare the client for. Pain management will be addressed postoperatively.
B. After a lobectomy, a chest tube is commonly placed to help drain excess air, fluid, or blood from the pleural space and prevent pneumothorax or other complications. This is a key part of the post-operative care for lung surgery.
C. Pulmonary function tests may be done before surgery to assess lung capacity and function, but they are not typically expected immediately after a lobectomy unless specified by the physician.
D. A lobectomy involves the removal of a portion of the lung, and the incision is usually made between the ribs, not through the sternum. The incision is generally intercostal, meaning it’s made between the ribs, not through the chest bone.

A. Hypoxia is common after surgery due to the effects of anesthesia and the client being in a supine position. A pulse oximetry reading of 88% indicates mild hypoxia. The first step in managing this is to encourage deep breathing or to have the patient use an incentive spirometer to improve ventilation and oxygenation. This is a non-invasive method that can help increase oxygen levels and prevent complications like atelectasis (lung collapse).

B. While opioid overdose can cause respiratory depression, there is no indication that the client is showing signs of opioid toxicity (e.g., unresponsiveness, slow/shallow breathing). The client is sleepy but easily arousable, suggesting that the sleepiness is related to the residual effects of anesthesia rather than opioid overdose. Administering naloxone is not indicated unless there are signs of severe respiratory depression or unresponsiveness, which is not the case here.

C. While postoperative hypothermia can occur, it is unlikely to cause oxygen saturation to drop to 88%. The priority action should be to improve the client's oxygenation first, as that is more immediately critical in this scenario.

D. The client's oxygen saturation of 88% is concerning, but it is manageable with initial interventions such as encouraging deep breathing. Calling a rapid response team would be appropriate if the patient's condition worsens or doesn't improve with initial interventions.