Pulmonary Surgery Flashcards
(27 cards)
What are the indications of pulmonary surgery?
Malignancy
Inflammatory
Trauma
Degenerative
Congenital
What are the types of pulmonary resection?
Pneumonectomy
Lobectomy
Segmental resection
Wedge resection
What is a pneumonectomy?
When the entire Lung is removed
What is a lobectomy?
Any of the five lobes may be removed
What is a segmentation resection?
When a broncopulmonary segment is removed
What is a wedge resection?
Used for diagnosis in a lung biopsy and treatment of a localized carcinoma
What pre operative investigations can be done?
Bronchoscopy
Medianoscopy
CT scan
Ultrasound
Lung function
What are the indications of thoracic surgery?
Median sternotomy -In the middle of the sternum to access the heart
Thoracotomy
What pre operative management can be done to the patient?
Explaining to them how to maintain aquequate ventilation of lungs and breathing exercises.Also understanding how to clear secretions.Reassurance that huffing,deep breathing and coughing wnt harm stitches
What other things can be done?
Clearing secretions before surgery and removing excess secretions through PD.Effective huffing and puffing and coughing to loosen and clear secretions
-Posture
-breathing exercises
-upper and lower extremities exercises
-moving in bed
What breathing exercises are taught?
Diaphragmatic
Unilateral lower thoracic expansion of both sides of incision(except for pneumonectomy)
Apical expansion for operative side(except for pneumonectomy)
What should a physio check post operative?
Incision,temp,pulse rate,RR,BP,O2 Therapy,Drains,Drug chart
What problems may arise post operatively?
Decreased breath sounds,Chest expansion,Mobility of trunk and shoulder
Ineffective cough
Poor posture
What is the post-operative treatment plan?-1st and 2nd day
4 times a day
Sitting up in bed with back supported by pillows to inhibit diaphragmatic and chest movement.
-Ensure adequate analgesia to reduce pain without producing resp depression
-Breathing exercises and apical expansion
Huffing and coughing
PD
Foot and leg exercises
Shoulder movements(to achieve good range of movement and also give resistance with pnf techniques
What happens if patient retains secretions or unable to cough effectively?
Combine treatment with IPPB to assist with lung expansion and mobile secretions and the pressure must be kept low to prevent increase in air leak
-Nasophyrangeal suction will be required as well
What should be done from day four onwards?
Number of sessions with the physio should be reduced and walking upstairs wen pt is fit enough and controlled diaphragmatic breathing be taught
What should happen before discharge?
Thoracic expansion except following a pneumonectomy
Exercise tolerance should be restored
And breathing exercises should continue 3-4weeks after and Thoracic expansion exercises to prevent chest deformity and restore max. Respect function
What could the complications after pulmonary surgery?
Hemorrhage because of increased BP,tachycardia and arrhythmia
Wound infection
Atelectasis because of sputum retention
Bronchopleural fistula
Pneumothorax
Pleural effusion
Surgical emphysema
Laryngeal damage
Chest wall deformity,CVA,Myocardial infarction DVT
What is a bronchopleural fistula?
A communication between the bronchus and pleural cavity it occurs because there’s an infection and Disruption of a bronchiol stump a week after a pneumonectomy
What are the signs of a fistula?
Sharp rise is pulse rate
Swinging temp
Irritating cough and increase in sputum
What could be treatment of a fistula?
Aspiration of infected fluid
Insertion of underwater chest drain
Lobectomy(PD)
Pneumonectomy (keep lung clear and pt should be turned to the side)
Decortication
What are the precautions and contraindications of a Thoracotomy?
Supported cough(one hand under incision and elbow giving pressure inwards towards chest
No percussions,shaking,vibes and vibrations over drains and incisions
No rotation or SL of thorax until drain is removed
No IPPB with surgical emphysema
What are the precautions and contraindications of a Pneumonectomy?
No forced coughing
No SL until day 3
No PD
