A nurse in the postanesthesia care unit is caring for a client who is postoperative following a thoracotomy and lobectomy. Which of the following postoperative assessments should the nurse give highest priority to?

A. Have the client refrain from talking for 24 hr. While the throat may be sore after a bronchoscopy, complete voice rest for 24 hours is not necessary. The client may speak as tolerated once their gag reflex returns.
B. Suction the client’s oropharynx frequently. Routine oropharyngeal suctioning is not recommended unless the client has excessive secretions or airway obstruction. Unnecessary suctioning can cause irritation and discomfort.
C. Irrigate the client’s throat every 4 hr. Throat irrigation is not a standard postbronchoscopy intervention. Instead, throat lozenges or gargling with warm saline may help if the client experiences mild throat discomfort.
D. Withhold food and liquids until the client’s gag reflex returns. This is the most appropriate nursing action. A bronchoscopy involves the use of local anesthesia to numb the throat, which temporarily suppresses the gag reflex. To prevent aspiration, food and fluids should be withheld until the gag reflex has fully returned.

A. Performing the procedure independently. This is the best indicator of readiness for discharge. The client’s partner must demonstrate the ability to perform tracheostomy suctioning correctly and safely without direct supervision. Proper technique includes using sterile equipment, maintaining appropriate suction pressure (80120 mmHg), limiting suction duration to 1015 seconds per pass, and allowing adequate oxygenation between passes to prevent hypoxia. Independent performance ensures the caregiver can manage airway clearance at home.
B. Verbalizing all steps in the procedure. While verbalizing the steps demonstrates understanding, it does not confirm the ability to perform suctioning correctly. Practical application is necessary to ensure competency in technique, infection control, and recognizing complications such as hypoxia or airway trauma.
C. Attending a class given about tracheostomy care. Education is essential, but attending a class alone does not confirm skill mastery. Handson practice and independent demonstration are required to ensure safe and effective tracheostomy management.
D. Asking appropriate questions about suctioning. Asking questions reflects engagement and willingness to learn, but it does not indicate that the caregiver can independently perform the procedure. Proper discharge readiness requires demonstrated competency through handson practice.