[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Medical–surgical nursing](https://durgical.com/en/nursing/areas/med-surg/) › Care after lung surgery and thoracotomy: chest drain, pain, lung expansion and the shoulder # Care after lung surgery and thoracotomy: chest drain, pain, lung expansion and the shoulder - Safe practice After lung surgery the nurse controls pain so the patient can breathe deeply and cough, watches the drain, gets them moving and protects the shoulder. Updated Nov 13, 2026 ## Key points - Pain stops deep breathing and coughing: time pain relief before breathing exercises and walking. - Supported cough: press a pillow over the incision when coughing or sneezing. - Early mobilisation, guided by safety checks of vital signs, lines and drains, is part of enhanced recovery. - About 80 % of patients have shoulder pain on the side of a thoracotomy; gentle shoulder movement within pain limits helps prevent a frozen shoulder. - Chest drain: keep it below chest level, no kinks, no routine clamping; report continuous bubbling, cloudy or sudden heavy bloody drainage. - At home: call for fever of 38.3 °C or more, wound redness or discharge, breathlessness, coughing blood, leg pain or swelling, or a damaged chest tube. ## What it is After lung resection, by thoracoscopy or open thoracotomy, the main ward risks are lung complications (atelectasis and infection), air leak and bleeding through the chest drain, pain that stops deep breathing, and a stiff shoulder on the side of the incision. Nursing care combines good pain control timed with breathing exercises and early walking, supported coughing, chest-drain checks (see the chest tube page), early gentle shoulder movement and teaching for home: wound care, activity limits and warning signs. Recovering full energy takes several weeks. ## What it requires - Regular pain assessment and analgesia as prescribed, timed with activity. - Respiratory assessment: rate, SpO2, breath sounds, cough strength and sputum. - Chest drain checks every shift and as the protocol states. - Early mobilisation and breathing exercises, with physiotherapy if available. - Shoulder range-of-motion exercises on the operated side within pain limits. ## Components - Pain control. - Lung expansion and airway clearance. - Chest drain care. - Mobilisation and shoulder function. - Discharge teaching and warning signs. ## How it is applied (and why) - Assess pain at rest, on deep breathing and on coughing and give analgesia as prescribed: pain-free breathing prevents lung collapse. - Coach deep breaths and supported coughing with a pillow over the wound: this re-expands the lung and clears secretions. - Use the breathing device or deep-breathing exercises the team prescribes and record the result. - Sit the patient out and walk early, after checking vital signs, lines and drains: early walking supports lung recovery. - Check the chest drain: below chest level, no kinks, tidaling, bubbling and drainage colour. - Palpate around the drain site and neck for crepitus and mark its edge if present: spreading air under the skin suggests a worsening leak. - Start gentle shoulder and arm movements on the operated side within pain limits, several times a day: this prevents stiffness. - Teach home care: wound care, showering only when dressings are removed, no soaking in a bath, and lifting limits set by the surgeon. - Teach the warning signs and who to call before discharge. ## In nursing practice - Postoperative lung complications, atelectasis and infection, are the main concern after thoracic surgery. - Continuous bubbling in the water seal points to an air leak; the nurse looks for an external cause and reports it if none is found. - Swelling of the chest, neck or face is a reason to call the surgical team. - Pain on moving the arm or twisting the trunk is common and can last weeks. ## Common mistakes - Giving pain relief only after the physiotherapy or walking has failed. - Clamping the chest drain for transport. - Keeping the arm still to avoid pain, which leads to a stiff shoulder. - Discharging the patient without telling them what to do if the chest tube comes out: cover the hole with a clean dressing and call the surgeon at once. ## Test yourself Think of the answer, then tap the question to see it. ## Why is pain control so important after a thoracotomy? Because pain stops the patient from taking deep breaths and coughing well, which raises the risk of atelectasis and infection. ## How is the shoulder protected after a thoracotomy? With gentle active shoulder and arm movements on the operated side, within pain limits, started early and repeated several times a day. ## What does continuous bubbling in the water-seal chamber suggest? An air leak, from the patient or the system; the nurse checks the connections and dressing and reports it if no external cause is found. ## Which signs after lung surgery should make the patient call the surgeon? Fever of 38.3 °C or more, a red, hot or draining wound, pain not eased by medicine, breathlessness, coughing blood, leg swelling or pain, or a cracked or dislodged chest tube. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/care-after-lung-surgery-and-thoracotomy-chest-drain-pain-lung-expansion-and-the/) ## Connections ## Related 3 - [Chest tube: assisting insertion, the drainage system and care](https://durgical.com/en/nursing/chest-tube-assisting-insertion-the-drainage-system-and-care/) - [Airway clearance: incentive spirometry, deep breathing, coughing and oscillating devices](https://durgical.com/en/nursing/airway-clearance-incentive-spirometry-deep-breathing-coughing-and-oscillating-de/) - [Postoperative care on the ward: the first 24–48 hours](https://durgical.com/en/nursing/postoperative-care-on-the-ward-the-first-24-48-hours/) ## Related conditions 1 - [Lung cancer](https://durgical.com/en/conditions/lung-cancer/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Lung surgery - discharge](https://medlineplus.gov/ency/patientinstructions/000242.htm) (MedlinePlus, U.S. National Library of Medicine, 2026); [Essentials of physiotherapy after thoracic surgery: what physiotherapists need to know. A narrative review](https://pmc.ncbi.nlm.nih.gov/articles/PMC6200172/) (Korean Journal of Thoracic and Cardiovascular Surgery (open access, PMC), 2018); [Nursing Advanced Skills, 6.3: Nursing responsibilities for clients with chest tube drainage systems](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Advanced_Skills_(OpenRN)/06%3A_Manage_Chest_Tube_Drainage_Systems/6.03%3A_Nursing_Responsibilities_for_Clients_With_Chest_Tube_Drainage_Systems) (Open RN, Chippewa Valley Technical College (CC BY 4.0), LibreTexts, 2023). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/care-after-lung-surgery-and-thoracotomy-chest-drain-pain-lung-expansion-and-the/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/care-after-lung-surgery-and-thoracotomy-chest-drain-pain-lung-expansion-and-the/