Surgical Management Flashcards
Most common for lung resection?
Posterolateral & Lateral
Where is the incision for lung resection?
incision follows 4th IC space
What is subxiphoid common for?
peri and/or epicardium
Incision for diaphragmatic procedure:
Lateral or thoracoabdominal
Position for posteriolateral thoracotomy:
almost prone
arm overhead
What muscles are divided for poterolateral thoracotomy?
Lower trap, serr ant, lats divided – trying to preserve long thoracic
If cut & spread – intercostal nerve damage
Position for anterolateral thoracotomy?
Arm extended, behind the back
Muscles involved for anteriolateral thoracotomy?
Pec major incised;
serr ant separated,
breast tissue reflected for female
Bilat approach used for lung transplant
Position for lateral thoracotomy:
Shldr abduction, rotation – caution for integrity of brachial plexus
Muscles involved in lateral thoracotomy:
Lats is retracted;
serr ant or intercostals are incised
Spares the lats but gives gives good access
Care to preserve long thoracic nerve
Position for axillary thoracotomy:
Shldr abduction, rotation – caution for integrity of brachial plexus
Pec major & serr ant are incised
Most common approach for cardiothoracic operations:
median sternotomy
Advantage of VATS;
reduced hospital length of stay, less blood loss, less pain, improvement in pulmonary function, early patient mobilization, less inflammatory reaction
PT with Midsternotomy/Median Sternotomy:
UE ROM – full restoration post op
PT post thoracotomy:
Full ROM post op – shldr, trunk (thoracic extension)
Posture
Splinting with pain, splinted cough technique, incentive spirometry, functional mobility, chest expansion, airway clearance
Complications with thoracotomy:
Respiratory complications cardiac complications shoulder pain pain bleeding
Respiratory surgical complications:
Major cause of perioperative morbidity & mortality
Atelectasis, pneumonia, respiratory failure
Cardiac complications for surgery:
2nd most common cause perioperative morbidity & mortality
Arrhythmias, ischemia
Post surgical shoulder pain:
80% pts experience ipsilat shldr pain
Referred pain from diaphragm (phrenic nerve)
Don’t disregard this symptom – consider other options
Wedge Resection
removal of a portion of a lung without anatomical divisions
Lung volume reduction surgery (LVRS) (or pneumectomy
removes large emphysematous (non-functioning) areas of the lung
Benefits of LVRS:
Helps with thoracic mobility
Increase gas exchange
Percutaneous revascularization procedures
Angioplasty
Atherectomy
Stenting
Common to use balloon-equipped catheter via peripheral arterial access site
When is coronary artery bypass graft required?
with coronary arterial atherosclerosis results in full blockage
When in CABG preferred management?
when 3 vessels are obstructed
Which arteries/veins are used in a CABG?
saphenous veins, L internal mammary artery
Artery used for characteristics to prevent atherosclerosis
Better graft patency
Clinical complications of CABG:
Pulmonary infections Atelectasis Soreness – chest wall, shoulder LE discomfort LE infection
Post-op focus of CABG:
Functional mobility Deep breathing exercises for lung reexpansion Pt education on modifiable risk factors Pt education on sternal precautions AROM without exertions Monitor vital signs with tx
Which valves have most problems in older adults?
aortic and mitral
Risk factors for valve disease
rheumatic fever, endocarditis, hypercholesterolemia, hypertension, hx of IV drug use
Aortic insufficiency:
failure of aortic valve to close tightly causes back flow of blood into the left ventricle
When is a carotid endarterectomy indicated?
Indicated for pt’s with symptoms & >50% stenosis of carotid artery
Indicated for pt that is asymptomatic & >60% stenosis
When is a cartoid endarterectomy investigated?
Investigated/Dx due to symptoms of TIA, stroke
Risk factors for AAA:
Hypertension Hypercholesterolemia Tobacco use (even prior) Collagen vascular disease Family history of aortic disease
Surgery indicated for AAA when:
Aneurysm > 5 cm
Rapid enlargement
Sudden change in pain
What are peripheral vascular interventions determined by:
Characteristics of lesion (location, stenosis vs. occlusion, length) Pattern of arterial occlusion Pt demographics Clinical situation Intraprocedural factors
Common sites for peripheral vascular interventions:
femoral-popliteal region, aortofemoral region, infrapopliteal, axillobifemoral
PT considerations for peripheral vascular interventions:
Wt bearing on affected extremity – caution
Exercise & mobility are important
Elevate affected extremity when sitting
Precautions
What is the strongest predictor of successful outcome of peripheral vascular intervention?
claudication symptoms
Gene Therapy for the Stimulation of Angiogenesis
Recombinant human vascular endothelial growth factor (VEGF)—agent for stimulating growth of new blood vessels
Adult heart has reduced ability to produce growth factors and stimulate angiogenesis
Disadvantages of Gene Therapy for the Stimulation of Angiogenesis
stimulation of cell proliferation may cause detrimental effects if cell proliferation occurs at wrong site
Pacemaker Implantation- PT Considerations
Shoulder ROM precautions –
need to have adhesion formation over lead wires
Arm sling may be given for enforcement
Consider other co-morbidities
Signs of pulmonary complications:
Inc temperature Inc WBC Change in breath sounds (esp from preop) Abnormal CXR Dec expansion of thorax SOB Change in cough & sputum production
Surgical precautions after CABG:
no push or pulling no lifting more than 10 pounds pillow coughing no driving Log rolling to sit up
