CP Final: Surgical and Pediatric Pulmonology

Question 1

What is a thoracotomy?

Answer 1

incision into the intercostal space for access to thoracic structures for surgery like lung transplants

Question 2

What are two types of incisions?

Answer 2

1. anterolateral

2. posterolateral- most common

Question 3

What are PT implications for ventilation?

Answer 3

1. significantly impairs breathing patterns- less excursion due to pain, accessory muscles used more
2. DOE/SOB
3. RR increases due to decreased Vt

Question 4

What are gas exchange impairments?

Answer 4

1. hypoxia- decreased O2 sat and PaCO2
2. auscultation- decreased or absent breath sounds, possible crackles or wheezes
3. AC impairments

Question 5

What are musculoskeletal impairments?

Answer 5

ROM impairment in shoulder, UE pain

Question 6

What are PT treatments for a thoracotomy?

Answer 6

1. functional mobility- for atelectasis and to increase Vt and decrease secondary complications
2. deep breathing exercises- increase Vt, using incentive spirometer
3. splinted cough
4. maintain UE ROM- shoulder ABD and FLEX

Question 7

What should be done in regards to transfers?

Answer 7

always use two people to reduce pain involved

Question 8

What is a video aided thoracic surgery?

Answer 8

one small incision with several other port holes to allow for a camera and other tools into thoracic cavity

much less invasive an less complications (lung biopsy)

Question 9

What is a pneumonectomy?

Answer 9

removal of an entire lung- this decreases chest wall movement, may hear sounds in this space but there is no lung tissue there

Question 10

What are three other types of lung removals?

Answer 10

1. lobe resection
2. segmental resection
3. wedge resection

Question 11

What are these type of procedures typically used for?

Answer 11

oncologic reasons or infections

Question 12

What is a bronchoscopy?

Answer 12

video scope of the main stem bronchi down to 5-10 bifurcations of the bronchi

allows doctor to see if internal structures are inflammed, bleeding and mucus

Question 13

When are lung transplants used?

Answer 13

is done for end stage lung disease, must have:

FEV1 25-35% in obstructive, PaCO2 less than 55 mmHG in obstructive

in IPF- FVC less than 60% and DLC less than 50% due to rapid progression of disease

Question 14

What are other requirements for lung transplant?

Answer 14

smoke free for atleast 6 months and must be without other systemic diseases like cancer, other organ failure and multi drug resistant diseases

Question 15

What are 3 types of lung transplants?

Answer 15

1. double lung transplant- both lungs replaced, double anterior thoracotomy (smile scar)
2. single lung/lobar- single anterior thoracotomy
3. cadaveric vs living tissue- less common

Question 16

Why are these so many less lung transplants?

Answer 16

lung tissue is the hardest to match and usually a lung from a young person who dies unexpectedly is needed

Question 17

What are the outcome of lung transplants?

Answer 17

50% survival rate is 5-6 years- trading one disease for another

failure due to- renal failure or graft rejection

Question 18

What are signs of an acute rejection?

Answer 18

drop in lung function, increased DOE

Question 19

Why is aerobic exercise so important pre- transplant?

Answer 19

it helps the body build up reserves before having the surgery, makes it easier to recover post surgery

Question 20

What are two ways to help children with pulmonary issues?

Answer 20

1. deep breathing exercises- blowing a balloon, bubble PEP, toys
2. aerobic conditioning- get creative, trampolines, scooters, Wii’s, Educate the parents