Surgical Management

Question 1

Most common for lung resection?

Answer 1

Posterolateral & Lateral

Question 2

Where is the incision for lung resection?

Answer 2

incision follows 4th IC space

Question 3

What is subxiphoid common for?

Answer 3

peri and/or epicardium

Question 4

Incision for diaphragmatic procedure:

Answer 4

Lateral or thoracoabdominal

Question 5

Position for posteriolateral thoracotomy:

Answer 5

almost prone

arm overhead

Question 6

What muscles are divided for poterolateral thoracotomy?

Answer 6

Lower trap, serr ant, lats divided – trying to preserve long thoracic
If cut & spread – intercostal nerve damage

Question 7

Position for anterolateral thoracotomy?

Answer 7

Arm extended, behind the back

Question 8

Muscles involved for anteriolateral thoracotomy?

Answer 8

Pec major incised;
serr ant separated,
breast tissue reflected for female
Bilat approach used for lung transplant

Question 9

Position for lateral thoracotomy:

Answer 9

Shldr abduction, rotation – caution for integrity of brachial plexus

Question 10

Muscles involved in lateral thoracotomy:

Answer 10

Lats is retracted;
serr ant or intercostals are incised
Spares the lats but gives gives good access
Care to preserve long thoracic nerve

Question 11

Position for axillary thoracotomy:

Answer 11

Shldr abduction, rotation – caution for integrity of brachial plexus
Pec major & serr ant are incised

Question 12

Most common approach for cardiothoracic operations:

Answer 12

median sternotomy

Question 13

Advantage of VATS;

Answer 13

reduced hospital length of stay, less blood loss, less pain, improvement in pulmonary function, early patient mobilization, less inflammatory reaction

Question 14

PT with Midsternotomy/Median Sternotomy:

Answer 14

UE ROM – full restoration post op

Question 15

PT post thoracotomy:

Answer 15

Full ROM post op – shldr, trunk (thoracic extension)
Posture
Splinting with pain, splinted cough technique, incentive spirometry, functional mobility, chest expansion, airway clearance

Question 16

Complications with thoracotomy:

Answer 16

Respiratory complications
cardiac complications
shoulder pain
pain
bleeding

Question 17

Respiratory surgical complications:

Answer 17

Major cause of perioperative morbidity & mortality

Atelectasis, pneumonia, respiratory failure

Question 18

Cardiac complications for surgery:

Answer 18

2nd most common cause perioperative morbidity & mortality
Arrhythmias, ischemia

Question 19

Post surgical shoulder pain:

Answer 19

80% pts experience ipsilat shldr pain
Referred pain from diaphragm (phrenic nerve)
Don’t disregard this symptom – consider other options

Question 20

Wedge Resection

Answer 20

removal of a portion of a lung without anatomical divisions

Question 21

Lung volume reduction surgery (LVRS) (or pneumectomy

Answer 21

removes large emphysematous (non-functioning) areas of the lung

Question 22

Benefits of LVRS:

Answer 22

Helps with thoracic mobility

Increase gas exchange

Question 23

Percutaneous revascularization procedures

Answer 23

Angioplasty
Atherectomy
Stenting
Common to use balloon-equipped catheter via peripheral arterial access site

Question 24

When is coronary artery bypass graft required?

Answer 24

with coronary arterial atherosclerosis results in full blockage

Question 25

When in CABG preferred management?

Answer 25

when 3 vessels are obstructed

Question 26

Which arteries/veins are used in a CABG?

Answer 26

saphenous veins, L internal mammary artery Artery used for characteristics to prevent atherosclerosis Better graft patency

Question 27

Clinical complications of CABG:

Answer 27

``` Pulmonary infections Atelectasis Soreness – chest wall, shoulder LE discomfort LE infection ```

Question 28

Post-op focus of CABG:

Answer 28

``` Functional mobility Deep breathing exercises for lung reexpansion Pt education on modifiable risk factors Pt education on sternal precautions AROM without exertions Monitor vital signs with tx ```

Question 29

Which valves have most problems in older adults?

Answer 29

aortic and mitral

Question 30

Risk factors for valve disease

Answer 30

rheumatic fever, endocarditis, hypercholesterolemia, hypertension, hx of IV drug use

Question 31

Aortic insufficiency:

Answer 31

failure of aortic valve to close tightly causes back flow of blood into the left ventricle

Question 32

When is a carotid endarterectomy indicated?

Answer 32

Indicated for pt’s with symptoms & >50% stenosis of carotid artery Indicated for pt that is asymptomatic & >60% stenosis

Question 33

When is a cartoid endarterectomy investigated?

Answer 33

Investigated/Dx due to symptoms of TIA, stroke

Question 34

Risk factors for AAA:

Answer 34

``` Hypertension Hypercholesterolemia Tobacco use (even prior) Collagen vascular disease Family history of aortic disease ```

Question 35

Surgery indicated for AAA when:

Answer 35

Aneurysm > 5 cm Rapid enlargement Sudden change in pain

Question 36

What are peripheral vascular interventions determined by:

Answer 36

``` Characteristics of lesion (location, stenosis vs. occlusion, length) Pattern of arterial occlusion Pt demographics Clinical situation Intraprocedural factors ```

Question 37

Common sites for peripheral vascular interventions:

Answer 37

femoral-popliteal region, aortofemoral region, infrapopliteal, axillobifemoral

Question 38

PT considerations for peripheral vascular interventions:

Answer 38

Wt bearing on affected extremity – caution Exercise & mobility are important Elevate affected extremity when sitting Precautions

Question 39

What is the strongest predictor of successful outcome of peripheral vascular intervention?

Answer 39

claudication symptoms

Question 40

Gene Therapy for the Stimulation of Angiogenesis

Answer 40

Recombinant human vascular endothelial growth factor (VEGF)—agent for stimulating growth of new blood vessels Adult heart has reduced ability to produce growth factors and stimulate angiogenesis

Question 41

Disadvantages of Gene Therapy for the Stimulation of Angiogenesis

Answer 41

stimulation of cell proliferation may cause detrimental effects if cell proliferation occurs at wrong site

Question 42

Pacemaker Implantation- PT Considerations

Answer 42

Shoulder ROM precautions – need to have adhesion formation over lead wires Arm sling may be given for enforcement Consider other co-morbidities

Question 43

Signs of pulmonary complications:

Answer 43

``` Inc temperature Inc WBC Change in breath sounds (esp from preop) Abnormal CXR Dec expansion of thorax SOB Change in cough & sputum production ```

Question 44

Surgical precautions after CABG:

Answer 44

``` no push or pulling no lifting more than 10 pounds pillow coughing no driving Log rolling to sit up ```