Exam 22: Thoracic Surgery

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)include patients with:

Thoracotomy can be performed with the patient in one of three common positions:lateral,semilateral,and supine.While the supine position is used for the median sternotomy approach,which of the lateral positions is used for an anterolateral approach?

Michael Stayman,a 53-year-old smoker with hemoptysis and dyspnea,had an outpatient bronchoscopy.His oxygen saturation remains below 90% on 2 L of oxygen.He is very concerned about the results of the biopsies and possible diagnosis.The pulmonologist has written an order for home oxygen to manage his dyspnea.The nurse is preparing Michael and his wife for discharge and reviewing specific instructions related to his bronchoscopy and home oxygen therapy.What does the nurse consider the most important aspect of education for Michael and his family?

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

An example of a true statement about TNM and staging diagnostic classification for lung cancer is:

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?

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?

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

Aaron Greenberg,a 59-year-old retired roofer with mesothelioma,is scheduled for a left pleurodesis for malignant pleural effusion and unresolved spontaneous pneumothorax.The perioperative nurse responsible for the thoracic surgery service has consulted with the surgeon to determine which agent will be used.She has an unsterile product that has been typically used in the past,but sterile processing informs her that they do not have the capacity to sterilize this agent.She also notes that the OR does not have a policy or guidelines for the administration of chemotherapeutic antineoplastic agents or safety training and a spill kit.Based on these conditions,what agent will the surgeon and nurse select for Mr.Greenberg's procedure?

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

Assessment of the skin and the patient's general condition is important in preventing perioperative complications.The nurse should assess the patient's smoking history (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 statement that best reflects an appropriate strategy that the nurse could use in assessing the patient's smoking history.

Pneumonectomy is removal of an entire lung,usually to treat malignant neoplasms.What structures are excised or resected in order to remove the entire lung and complete the surgery?

The perioperative nurse will need to collaborate with the anesthesia provider,since continuous hemodynamic monitoring,oximetry,and ventricular function assessment by transesophageal echocardiography (TEE)are all performed intraoperatively.Cardiopulmonary bypass (CPB)may also be required.Select all the procedures for which these preparations are indicated.

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,what action by the lungs occurs to facilitate air intake?

Carla Fortunato,a 38-year-old healthy nonsmoking woman with a suspicious lesion on the lateral margin of her right middle lobe,is having a thorascopic lung biopsy and has been selected and prepared for the ambulatory surgery center's fast track recovery and discharge program.The plan is that she will be discharged on postoperative day 2 with a chest tube and portable drainage system.The perioperative nurse has arrived to meet Carla,conduct the preoperative nursing assessment,and begin Carla's discharge education.After asking Carla if she has questions or any concerns,the nurse provides Carla with the important risk reduction strategies based on her procedure,condition,and postoperative expectations.What will be the primary focus of the nurse's teaching?

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.

Roger Waring'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.Roger's TNM and staging classification are:

The thoracic outlet is 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.The great vessels of the head,neck,and arm pass through this space.What syndrome is caused by the compression of these structures?

Sandra Lewis,an experienced perioperative nurse,was called to the surgical intensive care unit to assist the thoracic surgery fellow with a chest tube reinsertion on a postoperative thoracotomy patient who sustained a pneumothorax on removal of his chest tube.Recognizing this as a teaching opportunity with several new graduate nurses and a medical student,Sandra reviewed several risk reduction strategies related to chest tube insertion.She positioned the opened sterile insertion tray near the surgeon's dominant hand.Which of the chest tube insertion risk reduction strategies should be Sandra's next priority?

What is the ideal position for bronchoscopy?