CP

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Author:
jessiekate22
ID:
169998
Filename:
CP
Updated:
2012-09-11 02:56:03
Tags:
Surgeries
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Description:
VIVA
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  1. what is cardiothoracic surgery (CT)?
    • - surgery in the thorax- above diaphragm
    • - heart, lungs, pleura, mediastinum
    • - things particular to this sugery- chest drains, CPB, cardioplegia, collapsed lungs during surgery
    • - CT surgery can be open or closed
  2. What is a median sternotomy incision?
    - down the middle of the sternum
  3. where is the incision of a thoracotomy?
    • along the rib when anterior
    • when lateral:
    • when posterolateral:

  4. what is a thoracoscopy incision? 
  5. What are indications for thoracic surgery?
    • Lung
    • - Cancer
    • - chronic infection
    • - excision of other tissue eg abscess
    • Pleura
    • - chronic infection- empyema (puss in pleural space)
    • chest wall
    • medaistinum
    • oesophagus
  6. what is empyema?
    - pus in pleural space
  7. Where do most complications occur with surgery?
    - post op complications will occur more in thoracic surgery
  8. What is a thoracoscopic surgery used for?
    • - VATS
    • - pleural surgery eg Bx or pleuradesis (layers stick together such as a pneumothorax)
  9. when is a thoracotomy surgery used?
    • - mm sparing (through IC mm)
    • - ribs retracted
    • - may # ribs or resect a section for better access
  10. thoracic surgery
    - will need to see these pt
    • - no CPB (central pulmonary bypass)
    • - return to step downward unless risk factors
  11. what are the types of pleural surgeries?
    - may not see pt unless in pain
    - remember the shoulder
    • - pleurodesis- sticking together of the two pleura (viceral to parietal). There is a thoracoscopic or open, fusion of pleura, material introduced to set up inflam reaction such as talc
    • - decortication- stripping of the pleura. Done when chronic pleural infection, thickened pleura stripped off lung, allows lungs to reexpand
    • - repair of defects eg pneumothorax (stapling of blebs)
  12. what pt of thoracic surgery have high complications?
    • very high risk of complications for:
    • - smoking
    • - thoracic incision
    • - pain
    • - lung collapse
    • Preop is essential
  13. What is a lobectomy?
    - removal of one or more lobes of a lung
  14. when is a lobectomy used?
    • - pt has cancer
    • - chronic infection
  15. bronchietasis
    - chronic infection
  16. What is the surgical procedure of lobectomy?
    • - thorocotomy
    • - r/o lobes
    • - drains
    • - remaining lung expands and fills space
  17. what is a drain draining at the apical point of a lung?
    - air
  18. what is a drain draining at the basal point of the lung>
    - fluid
  19. What is a TEA?
    thoracic epidural
  20. WHat is the post opcare of a lobectomy?
    • - 2 drains
    • - pain controlled by TEA or PCA
    • - physio asap
  21. What are the physiotherapy key points of a lobectomy?
    • - LIE AFFECTED LUNG UPPERMOST- using gravity to open the lung
    • - better ventilation
    • - helps re-expand
    • -better for pain control
    • - can assist with drainage of pulmonary secretions
  22. What must you NOT do with a lobectomy patient?
    • unless told to do by a surgeon
    • - suction
    • - use CPAP or PEP
    • - remember the shoulder
  23. What is a pneumonectomy?
    - removal of a whole lung
  24. When should a pneumonectomy be conducted?
    - when a pt has cancer
  25. What is the surgical procedure for a pneumonectomy?
    • - these patients can go off very quickly due to poor lung  clearance due to pain
    • - thoracotomy 
    • - r/o lung- chop off bronchus
    • - bronchial stump oversewn
    • - +/- ICC, may be clamped
    • - cavity fills up with fluid (blood)- should be lower than the level of the stump, eventually fibrosis occurs
    • - postpneuomonectomy space
  26. What is the post op care of a pneumonectomy?
    • - pain control through thoracic epidural or PCA
    • - physio commences asap
  27. What are the key physiotherapy points?
    • - very high for postop complications
    • - smoking, lung disease
    • - pain
    • - thoracic mechanism
    • - do not lie affected side up (MISSING LUNG DOWN, WE DONT WANT FLUID OVER STUMP or it will drain into other lung) as draining blood into good lung, wetting bronchial 
    • - DO NOT suction or use CPAP or PEP
    • - remember the shoulder
  28. What is a LVRS?
    • - lung volume reduction surgery
    • - to reduce volume
    • -bulectomy
    • - restore better respiratory mechanics through less volume
    • - wedge resection, sleeve resection, segmental resection
  29. What are other names for chest drains?
    • - chest tubes
    • - chest drains
    • - intercostal catheter (ICC)
    • - underwater seal drain (UWSD)
    • - pleurocath
    • - they are put in the pleural space
  30. Why would a chest drain be used?
    • - open thorax- thoracotomy/ sternotomy
    • - loss of negative intrapleural pressure
    • - remove build up of air or fluid without allowing air to return to pleural space
    • - prevents extraair into pleural space
  31. Chest drain set up
    • - chest drains need to have a one way valve to allow fluid and air to escape but not to be sucked back into the pleural space- underwater seal! 
    • - fluid drains via gravity- drains MUST ALWAYS BE HELD BELOW THE THORAX
    • - suction may be aplied to hasten drainage
    • - water cannot be sucked into the pts pleural space due to length of tube (-ve pressure neded) and gravity dependent position of the drain
    • SEE NOTES
  32. What thing do we usually observe with chest drains?
    • - drain site
    • - amount drainage - how much fluid in 1st contain 
    • - bubbling - air 2nd container- not good for healthy person
    • - swing- good, means drain is workng, transmission of pleural pressure changes to the fluid in the tube 
    • Fluid moves towards pt on inspiration and away on experation 
  33. Removing chest drains
    • - once drainage has reduced 
    • - once bubbling has stopped
    • - if CXR shows no Ptx or effusion
    • - technique for remval - cut, hold breath, pull out
  34. Chest drains physiotherapy key points
    • - mobilisation- you can but suction usually attached to wall. You can disconnect, unless told otherwise
    • - transferring
    • - positioning
    • - treatment eg percussion- around
    • - pain
    • Safety
    • - movement
    • - disconnection at patient
    • - disconnection at drain
    • - clamping- only after pneuomectony 
    • Dont kick, keep upright, dont pull, keep below pt chest 

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