Chest surgery is always major. Simply opening the chest compromises lung function. Every disturbance of the vital organs or great vessels multiplies the risk of complications.
To minimize these dangers, you will need to prepare your patient for surgery by teaching him about his operation and its aftermath. Following surgery, you'll guide him in an active program to recover his breathing capacity, help him perform the necessary exercises in spite of his pain, and watch for signs of impending complications.
The article--the first of two devoted to the care of the thoracotomy patient--outliness the preop and postop nursing steps that will help restore lung function and avoid serious complications. Next month's installment will focus on proper management of the chest tubes and drainage systems that are integral to the patient's recovery.
First things first: Prepare the patient
Effective preoperative teaching can set the stage for your patient's recovery even before he goes to surgery. Remember that a well-prepared patient is often a calmer, more cooperative patient.
Begin by asking him what he knows about the surgery to be performed. Does he know why it's necessary? Does he know exactly what its goal is?
Work with the surgeon and anesthesiologist to educate your patient. Tell him about the type of incision he will have and what kind of scar it will leave. Tell him at what time of day surgery will be performed, how long it will take, and which preoperative medication he will receive. Show his family where to wait during surgery.
Let your patient know what to expect in the operating room and in the recovery room. An IV and perhaps a central venous line will be started before he goes to the OR or upon his arrival there. He will probably have a Foley catheter inserted while he is under anesthesia. The IV and Foley will most likely be removed on the evening following surgery or on the first postoperative day. The patient can expect to be wearing an oxygen mask when he wakes up and for one or two days thereafter.
No matter what type of operation the patient is having, he surely feels tremendous anxiety. Fear can add to the stress of surgery and alter the patient's response ot anesthesia and to postoperative care. Giving him an opportunity to discuss his feelings about the operation can minimize these effects.
A major worry for thoracotomy patients is how well they'll be able to breathe postoperatively, especially if lung tissue is to be removed. Assure your patient that, except in unusual circumstances, no surgery will be performed unless pulmonary function studies show that his breathing can withstand it. These studies include measurement of his static and dynamic lung volumes, elastic properties of his lungs, forced expiratory volume, and efficiency of gas transfer as reflected by carbon monoxide diffusion capacity and arterial blood gases.
Explain measure to re-expand the lungs
You can also explain that the surgeon will probably insert a chest tube to help expand the patient's lungs...
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