Thoracic Surgery (Lobectomy, Pneumonectomy) for Progressive Care Certified Nurse (PCCN)

Thoracic Surgery (Lobectomy, Pneumonectomy)

Definition/Etiology:

• Lobectomy, pneumonectomy
• Lobe vs. lung

Pathophysiology:

• Why performed?
  • To diagnose a condition (e.g. cancer, TB, PF)
  • Remove diseased lung
    • Cancer
    • Trauma
    • Abscess
    • Emphysema

Noticing: Assessment & Recognizing Cues:

• Preparing for surgery
  • Consent for surgery
  • General anesthesia 
  • Blood work
  • Diags previously (PFT, CT scan, EKG, etc.)

Interpreting: Analyzing & Planning:

• Potential complications
• Bleeding risk
  • Monitor drainage (can be sudden, assess frequently)
• Pain (expected and can be difficult to manage)
  • WBCs Infection risk
  • Surgical site
• Other
  • Air leak
  • Arrhythmia
  • Bronchopleural fistula
  • Hemothorax
  • Pulmonary embolism

Responding: Patient Interventions & Taking Action:

• Post-procedure
• Chest-tube management (be familiar with your facility protocol)
  • Suction
  • Water-seal

Reflecting: Evaluating Patient Outcomes:

• Recovery after discharge
  • Monitor for infection
  • Pain management
  • Monitor for bleeding
• Considerations
  • Lobectomy vs. pneumonectomy
  • Overall health
  • Underlying conditions
  • Open vs. minimally invasive procedure

Linchpins (Key Points):

• Surgery: ABC 1st, Prevent complications 2nd
  • ABCs
  • Prevent complications
  • Chest tube management