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Indications for Thoracic Surgery
- Removal of empyema, abscess, chronic effusions, tumors/masses
- Tracheal/esophageal resection
- Lung Reduction (emphysema)
- Hiatal hernia repair
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Manifestations of Lung Cancer
Persistent, productive cough (blood tinged); chest pain; dyspnea/wheeze; anorexia; fatigue; wt loss; N/V; palpable lymph nodes
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Diagnosis of Lung Cancer
CXR, CT scan/MRI, positron emission tomography (PET), Sputum for cytology, fiberoptic bronchoscopy, VATS, mediastinoscopy
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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
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Thoracotomy
Incision into the thoracic cavity
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Median sternotomy
Open heart surgery
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Lateral Thoracotomy
- Posterolateral Incision - larger
- Anterolateral incision - smaller
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Pre-Op Care
- Diagnostic Studies - baseline lung/CV status
- Smoking cessation
- Teach - pulmonary hygiene, pain control (PCA, intermittent, splint incision), chest tubes
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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
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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
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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
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Where do CTs go?
5th anterior or midaxillary line
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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)
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Air Leak
Occurs when + pressure escapes from the pleural space, bubbling in water seal, may need more suction pressure
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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
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Pt Education Heimlich Valve
Never clamp
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