Clinical nursing question

Question

A nurse summons you too assess a 300-pound, one-day post-operative cholecystectomy patient. He has no fever, has no productive cough, and has a negative chest x ray. He is, however, reluctant to change body position in bed. Auscultation reveals normal breath sound, but shows diffuse "crackles" in the posterior segments of the lower lobes. Specific first interventions would include:

A. Oxygen therapy 

B. Aerosol treatment every 4 hours until crackles are gone

C. Positive pressure hyperinflation therapy

D. "Shake-up" regimen

I think the answer is C, but my friends put D

Answer 1

The question, in particular, asked for the first intervention. I think D is the correct answer. His Chest X-ray is normal. I would not jump into positive pressure therapy. I hope this helps!

Answer 2

Hi Tiffany! I believe that D is the correct answer. Since this patient has been largely immobile since their procedure, it's not uncommon that they have had fluid settle into the bases of their lungs causing the crackles (especially since we are probably giving them fluids while in the hospital). Before doing something more invasive like positive pressure therapy (and potentially over inflating/ damaging the lungs), some movement is probably the best first line option to try to clear out some fluid and get rid of those crackles. Hope that helped!