Pulmonary Surgery

Question 1

Pneumonectomy

Answer 1

Def: surgical removal of a whole lung.

Side effects: damage of phrenic n (↓ fx of diaphragm), and damage to recurrent laryngeal n (loss of fx of vocal cords), empyema, pulmonary edema, pneumonia, and heart problems.

PT intervention:
> Preop → airway clearance tq.
> Postop → teach huffing rather than coughing (more suitable after surgery), teach how to support the surgical incision during coughing, clearing secretions, O2 therapy or a ventilator may be required, use of incentive spirometer, UL mobility, breathing exercises, postural reeducation.

Question 2

Lobectomy

Answer 2

Def: surgical removal of a lung lobe.

PT intervention: encourage expansion of the remaining area of lung, breathing exercises with huffing and support of the incision site, vibrations (on the unaffected lung from day 1 and on affected lung a few days later, when pt is able to tolerate procedure), bed mobility exercises and progressive Str and End activities.

Question 3

Hemothorax and Pneumothorax

Answer 3

Def:
> Hemo: blood in the pleural cavity.
> Pneumo: air in the pleural cavity.

PT intervention:
> Use of PleuroVac: care must be taken to make sure that:
- The end of the tube stays in the water.
- The tube remains free of external bends.
- The drainage container is lower than the thorax.
!!!Air draining from the chest cavity by noting air bubbles in the water of the container!!!

Question 4

Lung transplant

Answer 4

PT intervention: constant monitoring of BP, HR, and O2 perfusion and saturation levels.
PT follows the format described for thoracotomy procedure and includes encouraging UL activity and bed mobility and assisting pt with getting out of bed.
Goal is gradual increase in exercise tolerance with an O2 sat level of over approx 90%.