Acute Care Flashcards
(18 cards)
What is the purpose of thoracic surgery?
To remove an irreversibly damaged area of the lung
What are the types of thoracic surgeries?
Pneumonectomy = removal of lung
Lobectomy = removal of lobe of lung
Segmental resectio = removal of segment of a lobe
Wedge resection = removal of a portion of a lung
Lung volume reduction surgery or bullectomy = removal of large emphysematous tissue
What are some of the muscles damaged during a thoracotomy?
Lats, seratus anterior, external intercostals, internal intercostals, trapezius, rhomboids
Where is a throcotomy performed?
Incision follows the path of the 4th intercostal space
Can you raise the reservoir for a chest tube?
NO
Can you lie on a chest tube?
Yes, as long as it isn’t kinked or pulled
In pneumonectomy, what position should be avoided?
Lying with surgical side up until further notice from the surgeon
What things are a part of education pre- and post-op?
Deep breathing, supportive coughing manoeuvres (pillow as a splint over incision for less vibrations), lines, scar management (prevent infection), relaxation, bed mobility, positioning, transfers, early mobilisation
Potential complications of pulmonary surgery?
Aspiration, increased pain, phrenic nerve impairment, atelectasis, ulcers, DVT
What risk factor is mainly associated with DVT?
Venous stasis (immobility post-op)
Signs and symptoms of DVT?
Leg pain, tenderness, ankle oedema, calf swelling, dilated veins, positive Homan’s sign
What is Homan’s sign?
The ankle is put in dorsiflexion and causes pain in calf or wherever the DVT is (sensitivity and specificity of test is poor)
What are the prevention strategies for DVT
early mobilisation, ankle pumps, anti-coagulants, graduated compression stockings
What do you do if you suspect your patient has a DVT?
- Stop Rx, which may be contraindicate,d until further notice (ie, stop exercise)
- Alert the surgeon, doctor or nurse
- Document findings
Cardiovascular surgery
A specialised throacic surgery involving the heart and great vessels
Common cardiovascular surgeries
Heart surgery
1. CABG (coronary artery bypass graft) = saphenous vein graft -> mobility and leg exercises restricted until doctors notice, internal thoracic artery graft, radial artery graft
2. Valve replacements (aortic and mitral valve)
3. Heart transplant
Surgery on Great Vessels
1. Aortic aneurysm repair
2. Abdominal aortic aneurysm (AAA) repair (Laparotomy)
Sternal precautions
- 6-8 weeks to heal
- Limit UE exercise while sternal incisions are healing
- No pushing (don’t push through arms while transferring, lying to sit, sit to stand)
- No pulling (i.e. opening heavy door)
- No lifting one arm above 90 degrees
- No hand behind the back
- No driving for 4 weeks
- No lifting > 10lbs for 6 weeks
Benefits of early mobilisation?
Improves breathing, chest mobility, secretion clearance, assists GI function/bowel motility, improves conditioning and activity tolerance, allow increased independence, improves mood, prevents (aspiration, thrombus formation, muscle atrophy, contractures, pressure soresm neuropathy)
