unit V exam 2: lecture 8 chest surgery (8 questions)

nursing pain management

Administer pain meds Assess response to pain meds Teach to use PCA Plan care around pain med administration

what are lobectomy used for?

Lung cancer, TB, bronchiectasis, emphysema, benign lung tumors, fungal infections

what are the complications/barriers of lung transplant?

Organ rejection Effects of immunosuppressive drugs Cost

why is a single lung transplant most common?

Shortage of donors Can do bilateral if available

why would the affected lung be put into an impermeable bag?

To prevent tumor leakage Prevent cancer seeding

large pneumothorax

a lot of air collects and pushes on the lung and heart

small pneumothorax

air collects between the lung and chest wall

what is a tension pneumothorax?

air from a ruptured lung enters the pleural cavity without a means of escape as air pressure builds up, the affected lung is compressed and all of the mediastinal tissues are displaced to the opposite of the chest

large incision thoracotomy

cutting through bone, muscle, cartilage

why would the nurse place the patient on the operative side post operatively in a pneumonectomy?

facilitates expansion of remaining lung good lung up, do not lay good lung down because you do not want to compress a good lung

median sternotomy (thoracotomy incision)

heart surgeries

nursing care for VATS

oAssess respiratory function oMonitor chest tube oManage pain oObserve incision site oGeneral Post-op care oAssist to normal level of functioning Hospitalized 1-5 days

what are the complications of VATS?

oBleeding oDiaphragmatic perforation oAir emboli oPersistent pleural air leaks Tension pneumothorax

post-op care

oCareful respiratory assessment: VS with Pulse Oximetry, Lung sounds, Dressings, drains, chest tubes oPain management oHOB at least 30 degrees oSupplemental O2 oIS, Cough, DB oSplinting OOB as soon as possible

lung transplant

oCarefully selected patient with advanced COPD

lung volume reduction surgery (LVRS)

oFor severe COPD oRemove diseased tissue so healthy tissue can perform better oSmall wedges of damaged air sacs/lung tissue removed: Wedge Resection or VATS, Usually 20-30% of each lung oPalliative

exploratory thoracotomy

oIncision made into thorax to look for injured or bleeding tissue oUsed for chest traumas oPost-op chest tubes and drains

nursing dx

oIneffective Breathing Pattern oImpaired Gas Exchange oAcute Pain oActivity Intolerance oSelf Care Deficit Risk for Infection

pain management

oIntense pain for first 24h Pain control necessary to prevent post-op complications

what are the benefits of VATS?

oLess adhesion formation oMinimal blood loss oLess general anesthesia time oShorter hospitalization oFaster recovery oLess pain and post op rehab oMinimal disruption of other thoracic structures

video-assisted thoracic surgery (VATS)

oMinimally invasive approach oReal time two dimensional image of inside chest oFiber optic camera and instruments inserted into small incisions in chest wall oUsed to inspect, diagnose, and treat/manage intra-thoracic problems oCT placed at end of procedure oMay be used for lobe or lung removal oAffected lung is isolated from airway oClosed with double stapling

wedge resection

oMost conservative lung surgery oRemoval of small, localized lesion only in part of segment: Lung biopsy, Small nodule excision oPost op Chest Tubes oLow mortality oCancer reoccurrence is 15% (clean margins)

pneumonectomy

oRemoval of entire lung oDone when lobectomy or segmental resection not remove disease oFluid gradually fills space

lobectomy

oRemoval of one lobe oMost common oRemaining lung tissue fills up space oPost Op- 2 Chest Tubes

segmentectomy (segmental resection)

oRemoval of piece (segment) of lung oUsed for pts unable to handle more lengthy surgery oPost-op Chest Tubes oRemaining lung tissue fills up space

decortication

oRemoval or stripping of thick, fibrous membrane from visceral pleura oUsed for empyema (pus) unresponsive to conservative treatment oThoracotomy or VATS used oChest tube and drains post-op

pleurodesis

oRemove and prevent pleural effusions

pre-op teaching

oStop smoking oBreathing exercises oIncentive spirometry oPain control nMedication, splinting oChest tubes oOxygen oROM exercises oAddress anxiety oBe available to listen oEducation R/T procedure

bullectomy

oUsed for emphysematous COPD with large bullae oBullae are resected via thoracoscope oResults in improved lung function with less dyspnea

lateral thoracotomy-lung surgeries

posterolateral anterolateral

post-op thoracotomy

severe pain reluctance to move shoulder and arm chest tubes

thoracotomy

surgical opening into thoracic cavity done with esophageal, lung, or heart surgeries

treatment of a large pneumothorax

trapped air is removed using a chest tube

pleurodesis procedure

•Done at bedside or in OR •Local anesthesia, analgesic/sedative administered •Chest tube inserted and pleural fluid removed •Sclerosing agent instilled, CT clamped •Pt changes position to spread of agent •Causes inflammatory response which causes pleura to stick to chest wall •Prevents further fluid collection in the pleural space

nursing care for pleurodesis

•Reinforce explanation of procedure •Administer medication •Clamp CT after med instilled •Monitor VS & •Resp status per hospital protocol for 24h •Assist pt in position changes •Unclamp CT, record drainage •Complete and repeated assessment •Analgesics for comfort •Monitor CT drainage