1. Indications for Thoracic Surgery
    • Removal of empyema, abscess, chronic effusions, tumors/masses
    • Tracheal/esophageal resection
    • Lung Reduction (emphysema)
    • Hiatal hernia repair
  2. Manifestations of Lung Cancer
    Persistent, productive cough (blood tinged); chest pain; dyspnea/wheeze; anorexia; fatigue; wt loss; N/V; palpable lymph nodes
  3. Diagnosis of Lung Cancer
    CXR, CT scan/MRI, positron emission tomography (PET), Sputum for cytology, fiberoptic bronchoscopy, VATS, mediastinoscopy
  4. Nursing Care - Thoracentesis
    • Prep - Supplies & Consent
    • Pt Position - Lean over, open spacing
    • Role -lidocaine, sterile field
    • Post-Procedure - not much drainage, assess gas exchange/pain lvl
    • Complications = pneumothorax, over 1 hr
  5. Thoracotomy
    Incision into the thoracic cavity
  6. Median sternotomy
    Open heart surgery
  7. Lateral Thoracotomy
    • Posterolateral Incision - larger
    • Anterolateral incision - smaller
  8. Pre-Op Care
    • Diagnostic Studies - baseline lung/CV status
    • Smoking cessation
    • Teach - pulmonary hygiene, pain control (PCA, intermittent, splint incision), chest tubes
  9. Post-Op Care
    • Vital signs - q15 min/1st hr --> q30 min/2nd hr
    • Pain control, pulmonary hygiene, OOB, fluid/electrolytes, incision/dressing, chest tubes (maintain dressing)
    • Encourage movement of arm on the side of surgery
  10. Pain Control in Chest Tube Insertion
    Local anesthetic, pre-medicate if not emergent, post-medicate if emergent, be careful of interfering w/ neuro exam and respiratory effort
  11. Nursing Responsibilities in CT Insertion
    Emotional support and education, prepare for needle aspiration with 14-16 g spinal/cardiac needle, set up chest tube drainage system (28-32 Fr CT, thoracotomy tray), connect drainage system and tape connections, dress site, assess drainage, breath sounds, resp rate & quality, pain
  12. Where do CTs go?
    5th anterior or midaxillary line
  13. Routine Care of CTs
    Assess suction vs underwater seal, assess fluctuation, air leak, and drainage, assess presence of subQ emphysema or crepitus (air leak under the skin), assess dressing and change when protocol calls for it, keep container below insertion site, trouble shoot when necessary, assess for fluctuation/tideling in tubing (normal)
  14. Air Leak
    Occurs when + pressure escapes from the pleural space, bubbling in water seal, may need more suction pressure
  15. Heimlich Valve
    • Inspiration: neg intrapleural pressure closes the valve and prevents air from entering pleural space
    • Expiration: pos pressure opens valve and allows air/fluid to drain
  16. Pt Education Heimlich Valve
    Never clamp
Card Set
Schell Med Surg