A physical therapist is evaluating a patient who had a right lower lobe resection due to lung cancer 1 day ago. During auscultation, the patient shows decreased low-pitched crackles bilaterally; vitals are HR 99 bpm, BP 115/75 mm Hg, and SpO2 92% on 2 L of oxygen. Which action should the therapist take NEXT?

A physical therapist is evaluating a patient who had a right lower lobe resection due to lung cancer 1 day ago. During auscultation, the patient shows decreased low-pitched crackles bilaterally; vitals are HR 99 bpm, BP 115/75 mm Hg, and SpO2 92% on 2 L of oxygen. Which action should the therapist take NEXT?

• A. Begin Walking Activities, with the patient receiving 4 liters of oxygen.
• B. Contact the physician.
• C. Perform Active Range of Motion Exercises with the patient at bedside.
• D. Initiate Bronchopulmonary Hygiene

Answer: (D)

After thoracic surgery, the greatest priority is preventing or treating atelectasis by improving airway clearance. The patient’s recent right lower lobectomy, together with decreased breath sounds and low-pitched crackles and a SpO2 of 92% on supplemental oxygen, suggests under-ventilated lung regions from secretions. Bronchopulmonary hygiene directly targets this by mobilizing and clearing secretions and helping re-expand alveoli, which can improve ventilation and oxygenation. Ambulating with a higher oxygen flow doesn’t address the airway clearance issue and could be unsafe given the current oxygenation; ROM at the bedside won’t resolve the poor airway clearance either. Contacting the physician is reasonable if the patient’s condition worsens, but the immediate PT action that best fits the findings is initiating bronchopulmonary hygiene.

After thoracic surgery, the greatest priority is preventing or treating atelectasis by improving airway clearance. The patient’s recent right lower lobectomy, together with decreased breath sounds and low-pitched crackles and a SpO2 of 92% on supplemental oxygen, suggests under-ventilated lung regions from secretions. Bronchopulmonary hygiene directly targets this by mobilizing and clearing secretions and helping re-expand alveoli, which can improve ventilation and oxygenation. Ambulating with a higher oxygen flow doesn’t address the airway clearance issue and could be unsafe given the current oxygenation; ROM at the bedside won’t resolve the poor airway clearance either. Contacting the physician is reasonable if the patient’s condition worsens, but the immediate PT action that best fits the findings is initiating bronchopulmonary hygiene.