What is the priority nursing action when a patient is transferred from the Postanesthesia care unit to the surgical unit after a lobectomy?

A lobectomy—removal of a lobe in a lung—is major surgery usually offered as a treatment for non-small cell lung cancer (NSCLC). You'll need to take your time recovering from this procedure and will go through a period of healing in the hospital and then at home. During this time, you'll be weaned from a ventilator, have chest tubes that were inserted after surgery removed, and resume eating and drinking.

How long it will take to fully recover from a lobectomy (whether an upper lobe, middle lobe, or lower lobe is removed) will depend, in large part, on the surgical technique used. Be sure you know what the surgery entails, and discuss potential complications and your prognosis with your healthcare provider before surgery.

Immediately following surgery, you'll be taken to the recovery room where you'll be monitored closely for several hours. A chest X-ray may be taken, and vital signs (such as heart rate and oxygen saturation) will be monitored until you are deemed safe to transfer.

You may be monitored in the intensive care unit (ICU) for the first day or so. The ICU is designed to take care of people who are very ill. It is not focused on accommodating family and friends. Flowers are not usually allowed, and many people are limited to only a visitor or two at a time.

Some healthcare providers suggest that only close friends and family see you at this time, so you may want to encourage others to visit after you've been transferred to a regular hospital ward.

The breathing tube that allowed the ventilator to breathe for you during surgery is sometimes left in place while you're in recovery after a lobectomy. Since this can cause some anxiety, you may continue to be under light sedation until the tube is removed.

While ventilator use does pose some risks, in most cases, you will begin to feel fine once lung capacity improves to the point where you can breathe on your own.

When the ventilator is removed and you become less sleepy, a respiratory therapist will ask you to cough and assist you in the use of an incentive spirometer. This is a device that you breathe into to exercise your lungs and help keep the small air sacs (alveoli) in your lungs open.

Your incisions will have been closed after the procedure. However, the surgeon will place a chest tube that leads out from the surgical site, which will allow excess fluid and air to exit the chest.

The chest tube will be kept in place until the surgeon is confident that the drainage has stopped and no air is leaking. The removal usually occurs three to four days after surgery but may take longer if the procedure was extensive.

If the tube is left in longer than normal, it doesn't mean your recovery is going poorly. Surgeons wish to be cautious, and it's easier to leave a tube in place a little longer than to have to reinsert it if needed.

When you're able, the nursing staff will help you sit up, and, eventually, they will encourage you to get up and walk with assistance. You may not feel like being active, but moving will help you regain your strength more quickly and reduce the risk of developing blood clots.

During your time in the hospital, you should learn how to prevent and recognize blood clots since these are not uncommon in lung cancer patients—both among those who have had lung operations and those who have not undergone surgery.

The formation of blood clots, also known as venous thromboembolism, significantly impacts your recovery and lowers survival rates.

The length of your hospital stay can vary depending on your age, health status, response to post-operative care, and the type of surgery you had:

Many people are anxious to get out of the hospital and return to their own bed, only to realize, when they do get home, that they shouldn't have been so quick to leave. Trust that your surgeon will best know when it's a good time to discharge you.

Not only does VATS require a shorter hospital stay, but it also results in fewer surgical complications. However, as a treatment for early-stage NSCLC, an open thoracotomy and VATS offers similar prognosis and survival rates.

Returning to your usual lifestyle takes time, which may come as a surprise if you were not having a lot of symptoms from your lung cancer prior to the procedure.

Focusing on small steps forward (e.g., having tubes progressively removed) rather than expecting yourself to be "back to normal" can be helpful. Even if you were fit and in good health prior to your surgery, you need to allow yourself time to heal.

As you recover, you may notice that the fatigue you experience is unlike fatigue you have coped with previously. Cancer fatigue can be frustrating, especially if you are someone who has a hard time slowing down and taking it easy.

Pace yourself when you return home. Early on in each day, focus on the activities that take the most mental or physical energy so you can cross them off your list before you become too tired to do so. Delegating tasks to others and learning to accept help can enable you to recover faster and ease the helplessness loved ones often feel.

Your healthcare provider will recommend when you should return to work. But even then, there may be some physical restrictions. For instance, you should avoid heavy lifting for the first several months to prevent strain on the chest muscles and incision.

Pulmonary rehabilitation involves a variety of therapies that are focused on helping you heal after lung cancer surgery and carry out your everyday activities.

It has a wide range of goals, some of which may be more important in your specific case than others, including making it easier to breathe, building up your tolerance for activity, managing your nutrition, and more. Components may include breathing exercises, instruction on adapting to limitations (such as swallowing challenges), diet planning, and more.

Your medical team may suggest this to you before and/or after your surgery, and how long it will last depends on your situation and progress.

Complications following a lobectomy procedure are not uncommon.

For example, if you use a ventilator to assist with breathing in only one lung during your post-operative care, it may cause low oxygen levels in the blood (hypoxemia) and possible tissue damage. These problems can be life-threatening if conditions aren't carefully monitored and prevented, but researchers continue to investigate the ideal way to manage one-lung ventilation.

Even once you are discharged, you need to be aware of some possible problems. Persistent pain referred to as post-thoracotomy pain syndrome (a type of neuropathic pain) can sometimes persist for weeks and months.

As surgical pain eases, you may still have issues with your breathing. Even with pulmonary rehabilitation, it can take time to adjust to the reduced lung capacity that results from lung cancer treatment. These are normal; you simply need to persist with recovery and have patience.

Other complications, such as infections and blood clots, warrant immediate medical care. It is important to know what symptoms should prompt you to call your healthcare provider.

Call your healthcare provider or seek emergency care if you experience:

• Pain around the incision that gets worse
• Sudden shortness of breath
• Sudden, severe chest pain
• Fever of 100.4 degrees F or higher
• Blood, pus, or unusual discharge from the incision
• Redness, swelling, and pain around the incision
• Coughing with greenish-yellow or blood-tinged phlegm
• Dizziness, confusion, or fainting

The recovery period after a lobectomy is different for everyone. To aid in your healing, keep practicing recommended breathing exercises and make an effort to avoid cigarettes (including second-hand smoke), respiratory infections (such as the cold and flu), and any environmental toxins, chemical fumes, or smoke.