Exam 23: Thoracic Surgery

Video-assisted thoracic surgery (VATS)is a minimally invasive operative technique that has evolved over the past decade.It uses an endoscopic approach to visualize the thoracic cavity for diagnosis of pleural disease or treatment of pleural and lung conditions.In the adult,the surgeon creates a 2- to 3-cm incision between the ________ intercostal spaces for insertion of the 10- or 12-mm trocar.The trocar sites can also be used for insertion of a ____________.

What is the ideal position for bronchoscopy?

During electromagnetic navigation bronchoscopy (ENB),the surgeon uses electromagnetic sensors to:

Patients with lung cancer may have specific treatment based on their tumor,node,and metastasis (TNM)characteristics.An example of a true statement about the TNM system is:

The nerves of the lungs are a part of the autonomic nervous system.Which structures are constricted and relaxed by their influence?

As the perioperative nurse gathers information that is important to planning patient care,he or she should inquire about a patient's tobacco use (including the use of cigars,pipes,tobacco,or controlled substances)and any exposure to secondhand smoke within the home and/or workplace and reinforce the need to abstain following surgery.Patients might be sensitive about smoking history because of the assumed relationship between smoking and lung disease.Select the best approach the nurse could use in assessing a patient's smoking history.

Thoracotomy can be performed with the patient in one of three common positions.Which of these positions is used for an anterolateral approach?

Of all the equipment,tools,and studies available during the patient's preoperative diagnostic phase,which exam is the most indispensable diagnostic tool to outline thoracic lesions and define space-occupying nature and shape?

A 46-year-old man with early-stage lung cancer was listening to his surgeon describe the surgical plan in preparation for signing the informed consent.The surgeon described a procedure that would be done before the thoracoscopic lung surgery.The surgeon described an examination of the middle chest lymph nodes and the area below where the bronchi branch into the right and left lungs,and possibly taking biopsies of suspicious tissue.The procedure uses a hollow lighted tube with fiberoptic light-carrying fibers.Which diagnostic procedure will precede the patient's thoracoscopic lung surgery?

A patient's mediastinal node biopsies were sent for immediate frozen section and revealed metastasis of the primary tumor of the left upper lobe to the ipsilateral mediastinal nodes.The patient's TNM and staging classification is:

A 53-year-old male smoker with hemoptysis and dyspnea had an outpatient bronchoscopy.He is very concerned about the results of the biopsies and possible diagnosis.The nurse is preparing the patient and his wife for discharge and reviewing specific instructions related to his bronchoscopy.What points does the nurse include in the plan for discharge education for him and his family?

Pleurodesis is undertaken as a treatment for malignant pleural effusion and for unresolved spontaneous pneumothorax.The end point goal of a pleurodesis is to:

After reviewing the laboratory results and assessing the patient,the perioperative nurse determines that the patient's nursing diagnosis is impaired gas exchange related to surgical intervention.Select the appropriate nursing intervention that is related to assisting the patient to experience adequate gas exchange during the surgical procedure.

Direct visualization of the mucosa of the trachea,the main bronchi and their openings,and most of the segmental bronchi may also include the removal of material for microscopic study and is an integral part of the examination of patients with pulmonary symptoms such as persistent cough or wheezing,hemoptysis,obstruction,and abnormal roentgenographic changes.What diagnostic modality has been described?

In the last decade,many energy devices have entered day-to-day practice in thoracic surgery.These energy devices include:

Inspiration normally takes place when the intrathoracic pressure is slightly below atmospheric pressure and when a partial vacuum exists between the parietal and visceral pleural (intrathoracic)surfaces.As the muscles of inspiration contract to enlarge the chest cage,which action by the lungs occurs to facilitate air intake?

The indications for single-lung transplantation (SLT)include restrictive lung disease,emphysema,pulmonary hypertension,and other nonseptic end-stage pulmonary diseases,while the indications for double-lung transplantation (DLT)includes patients with:

The great vessels of the head,neck,and arm pass through a junction bound anteriorly by the manubrium,anterolaterally by the first ribs,and posteriorly by the first thoracic vertebrae and posterior angles of the first ribs of the space.Which syndrome is caused by the compression of these structures?

Patients having thoracic surgery share a common nursing diagnosis of risk for impaired skin integrity related to surgical positioning,length of surgical intervention,or use of chemical antimicrobial agents on the skin.The type of position used in thoracic surgery is determined by the operative procedure planned.In addition to placing the patient in appropriate body alignment,what other interventions can ensure that the patient's skin integrity is maintained?

During an endoscopic thoracic sympathectomy for hyperhidrosis,what action by the anesthesia provider ensures exposure and minimizes damage to the lung?