Mr.

J, a 49-year-old construction worker, is scheduled for a bronchoscopy for biopsy of a

right lung lesion. He initially sought medical care for hemoptysis and increasing fatigue. When
the nurse asked him to sign the operative consent, he stated he was not certain if he should go
ahead with the procedure because he feared a diagnosis of cancer.

● Has never been hospitalized

● Has had no medical problems except mild obesity
● Has a cigarette smoking history of 40 pack-years
● Is married with two children, ages 6 and 8, both children have cystic fibrosis
● Is fearful that his wife will not be able to manage without him
● Diagnostic studies: Chest x-ray revealed a mass in the upper lobe of the right lung ●
Hematocrit: 31%

What should Mr. J know if his consent for surgery is to be truly informed?

● Based on Mr. J's response after the nurse made him sign the operative consent, we
perceive that he is having anxiety regarding the effect after the operation. In order to
minimize his anxiety, the nurse should clearly explain to Mr. J in a way that he can easily
understand all the essential details of the operation, the nature and purpose of the
proposed treatment for him to know his condition. He should also be competent enough
to make a voluntary decision about whether to undergo the surgery. Other than that, he
should be also aware of the benefits of the procedure that he will have. He stated above
that he refused to sign the consent because he is frightened of being diagnosed with
cancer. In this case, the nurse should explain to him that if he refuses to be examined,
his condition might get worse and complications may arise. He should also be informed
that when he wakes up the pain will be controlled. After that, he should be instructed on
the activities that can be done after the procedure to promote complete recovery. When
he already understands all of the questions in his mind, he will truly be able to sign the
informed consent. He will be informed about the procedure's purpose, advantages, risks,
and alternatives of the given procedure or intervention. He will be diagnosed accurately
and treated appropriately.
What preoperative teaching must be done to prepare him for surgery?

● Since Mr. J is not certain if he should go ahead with the procedure because he feared a
diagnosis of cancer, as a nurse, we must respect how he feels. To alleviate what he
perceives, it is important that we explain to him in layman terms the procedure he will be
undergoing, information related to preoperative routines along with the rationale of these
procedures and preparation such as food and fluid restrictions, approximate length of
surgery, pain management, and postoperative recovery.
● The nurse should also repeat the details at times because anxiety can cause the patient
to have difficulty retaining information. By providing patient education, Mr. J would have
 the understanding of what is about to happen. Hence, this promotes a sense of control
that helps to allay the patient’s anxiety.
● Mr J. must be warned that the local anesthesia will leave him with an unpleasant taste
and a numb sensation. He also needs to be mindful of the cough reflex he will have. He
must understand that he cannot drive or use machines for 24 hours following the
surgery. Before the surgery, he must rest for four to six hours without eating or drinking.

What risk factors for surgical and anesthetic complications might you anticipate for Mr.
J? What are the potential interventions that might minimize the risks?

● The potential risk factors for surgical and anesthetic complications are (1) Obesity, this
may contribute to problems with clearance of respiratory secretions and complete
expansion of the lungs. (2) Smoking history, this increases the risk for postoperative
respiratory complications; the longer the patient can stop smoking before surgery, there
will be a lesser risk. (3) Lung conditions, the patient should have preoperative
instruction about deep-breathing and coughing techniques. The potential intervention
that might minimize the risks are as follows: examining the medical history of Mr. J and
conducting a health assessment before surgery, choosing certain medications over
others that will be safer for Mr. J, monitoring closely for specific side effects or
complications that might occur, and advising Mr. J on how to lower the risk of him having
surgical and anesthetic complications before surgery by doing things like stopping
certain medications, quitting smoking, or losing weight if his surgery is not urgent.
Bronchoscopy complications are rare, although Mr. J may be at risk for a decrease in
oxygen levels or infection. An oxygen nasal tube or face mask might be used as a
potential intervention. Manually cleaning all equipment before disinfection, controlling
patient coughing, and installing air filters are all ways to avoid infection.
Based on the assessment data provided, write one or more appropriate nursing
diagnoses.

Nursing diagnoses:
● Impaired Gas Exchange related to altered oxygen supply as evidenced by hypoxemia
● Fear related to possible diagnosis of cancer
● Interrupted family processes related to shift in family roles - Ineffective health
maintenance related to tobacco use ● Risk for Bleeding (low Hematocrit)

Collaborative problems:
Potential complications: hemorrhage, laryngospasm/bronchospasm, pneumonia, pneumothorax
References:
American Society of Anesthesiologists. (2021). Risk Factors. Retrieved October 4, 2021,
from https://www.asahq.org/madeforthismoment/preparing-for-surgery/risks/

Martin, P. (2021). 5 Anemia Nursing Care Plans. Retrieved October 4, 2021 from
https://nurseslabs.com/anemia-nursing-care-plans/4/