Thoracic Surgery

  1. General information
    1. Types
      1. Exploratory thoracotomy: anterior or posterolateral incision through the fourth, fifth, sixth, or seventh intercostal spaces to expose and examine the pleura and lung
      2. Lobectomy: removal of one lobe of a lung; treatment for bronchiectasis, bronchogenic carcinoma, emphysematous blebs, lung abscesses
      3. Pneumonectomy: removal of an entire lung; most commonly done as treatment for bronchogenic carcinoma
      4. Segmental resection: removal of one or more segments of lung; most often done as treatment for bronchiectasis
      5. Wedge resection: removal of lesions that occupy only part of a segment of lung tissue; for excision of small nodules or to obtain a biopsy
    2. Nature and extent of disease and condition of client determine type of pulmonary resection.
  2. Nursing interventions: preoperative
    1. Provide routine pre-op care.
    2. Perform a complete physical assessment of the lungs to obtain baseline data.
    3. Explain expected post-op measures: care of incision site, oxygen, suctioning, chest tubes (except if pneumonectomy performed)
    4. Teach client adequate splinting of incision with hands or pillow for turning, coughing, and deep breathing.
    5. Demonstrate ROM exercises for affected side.
    6. Provide chest physical therapy to help remove secretions.
  3. Nursing interventions: postoperative
    1. Provide routine post-op care.
    2. Promote adequate ventilation.
      1. Perform complete physical assessment of lungs and compare with pre-op findings.
      2. Auscultate lung fields every 1-2 hours.
      3. Encourage turning, coughing, and deep breathing every 1-2 hours after pain relief obtained.
      4. Perform tracheobronchial suctioning if needed.
      5. Assess for proper maintenance of chest drainage system (except after pneumonectomy).
      6. Monitor ABGs and report significant changes.
      7. Place client in semi-Fowler's position (if pneumonectomy performed, follow surgeon's orders about positioning, often on back or operative side, but not turned to unoperative side).
    3. Provide pain relief.
      1. Administer narcotics/analgesics prior to turning, coughing, and deep breathing.
      2. Assist with splinting while turning, coughing, deep breathing.
    4. Prevent impaired mobility of the upper extremities by doing ROM exercises; passive day of surgery, then active.
    5. Provide client teaching and discharge planning concerning
      1. Need to continue with coughing/deep breathing for 6-8 weeks post-op and to continue ROM exercises
      2. Importance of adequate rest with gradual increases in activity levels
      3. High-protein diet with inclusion of adequate fluids (at least 2 liters/day)
      4. Chest physical therapy
      5. Good oral hygiene
      6. Need to avoid persons with known upper respiratory infections
      7. Adverse signs and symptoms (recurrent fever; anorexia; weight loss; dyspnea; increased pain; difficulty swallowing; shortness of breath; changes in color, characteristics of sputum) and importance of reporting to physician
      8. Avoidance of crowds and poorly ventilated areas.