Pulmonary and cardiac surgeries Flashcards
physiotherapists role
What are the common pulmonary surgeries?
Lobectomy
Bilobectomy
Segmentectomy
Sleeve resection
Lung volume reduction surgery
Pneumonectomy
What are the common pleural surgeries?
Pleurodesis
Pleuroectomy
Decortication
What is the common incision site for pulmonary surgeries?
Incision called a thoracotomy.
An opening in the thorax, usually in between the ribs and these are opened to expose the chest cavity.
What is a lobectomy or bilobectomy?
Lobectomy is the removal of one of the lobes (commonly for lung cancer)
Bilobectomy is the removal of two lobes
What is a segmentectomy or wedge resection?
This is where part of the lung is removed for a biopsy, for a small or benign tumour
What is a sleeve resection?
Removal of part of the bronchus. Plus or minus a lobectomy
What is a pneumonectomy?
The removal of a whole lung.
What is a lung volume reduction surgery?
The removal of part of a lung to make it function more effectively.
What is a pleurodesis?
A surgery for current pleural effusion or pneumothorax.
A chemical irritant is inserted into the pleural space to encourage the lung to stick to the chest wall
What is a pleuroectomy?
Is where inside the parietal pleura is stripped to create kind of open wounds to allow visceral pleura to stick to again to remove the space between lung and chest wall.
What is a decortication?
The removal of thickened areas of visceral pleura to allow the lung to expand and not collapse.
What are some complications after pulmonary surgery?
Atelectasis (usually on the side of the surgery)
Pain- struggling to breath and cough
Diaphragm Dysfunction- phrenic nerve can be cut or disrupted
Recurrent laryngeal nerve damage- hoarse quiet voice and struggles to cough
Bronchopleural fistula (air leak)- breach between the lung and pleura.
Shoulder pain and reduced ROM
What is the physiotherapists role pre-op for pulmonary surgeries?
Spirometry to assess suitability for surgery
Pre-rehab to optimise post op function
Expectation education
Education around breathing exercises, incentive spirometry, mobilising and DVT/PE prevention
What are the physiotherapists role post-op for pulmonary surgeries?
Incentive spirometry
Breathing exercises
Chest clearance
Early mobilisation
Shoulder exercises
Precautions post pulmonary surgery
Suction- check with consultant before doing open suction as it can disrupt the anastomosis leading to break down and causing bronchopleural fistula
Positive pressure- pt might have a large air leak. Check with surgeon. Might be a risk for a wound break down and pneumothorax.
Positioning post pneumonectomy- pt should not lie on non-operate side. Risk of anastomsis break down and bacteria growth
What are the common cardiac surgeries?
Coronary artery bypass graft (CABG)
Valve replacement
Transplant
What is a coronary artery bypass graft (CABG)?
Native vessel is used to connect the aorta to coronary artery
Pec major is divided, sternum is divided and the pt is put on bypass.
Common to have atelectasis post surgery
What is a mitral valve replacement?
The mitral valve is one of the four of the hearts valves
This valve is replaced by a mechanical valve or a valve from animal tissue
What is an aortic valve replacement?
The aortic valve moves blood away from the heart to the rest of the body.
Common complications of cardiac surgeries?
Ventilator acquired pneumonia
Atelectasis
Hypoxaemia
Pain
Peripheral nerve injury
Anxiety
Fatigue
Pleural effusion
What is the physiotherapists role for pt having cardiac surgeries?
Pre-op education: mobility and breathing exercises
Prevent sputum retention
Optimise lung volumes
Early mobilisation
Prevention of shoulder or thoracic stiffness
Assess for any MSK complications post op
Specific precautions post cardiac surgery
Positioning: avoid side lying to minimise shearing stress on sternum
Positive pressure: if Bp is low, positive pressure could compromise further. Undrained pneumothorax is contraindicated
Mobilisation: not mobs if pt on intropes to support Bp. Sitting and mobs not allowed if a intra-aortic balloon pump is situ.
What is SBAR communication?
A communication tool used to improve the quality of patient handovers
Situation, background, assessment, recommendation
Situation in SABR
What is going on with the patient?
What is the situation you’re calling about?
Who is the patient, where are they?
