Thoracic Anatomy and Nursing Considerations

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Questions and Answers

Which structure is not included in the mediastinum?

Trachea

Lungs (correct)

Thymus

Esophagus

What do the intercostal nerves supply in the thoracic cavity?

Diaphragm

Pleural cavity

Sternum

Muscles and skin of the thoracic wall (correct)

Which artery does not bifurcate anteriorly from the aorta in the thoracic cage?

Intercostal arteries

Subclavian artery (correct)

Mammary artery

Internal thoracic artery

Which muscle is not part of the thoracic cage formation?

Rectus abdominis Signup and view all the answers

What is the primary function of a double-lumen endotracheal tube in thoracic surgery?

To isolate one lung during the procedure Signup and view all the answers

Which of the following structures is located posteriorly in the thoracic cavity?

Thoracic vertebrae Signup and view all the answers

Which cavity is not considered a subdivision of the thoracic cavity?

Superior mediastinum Signup and view all the answers

What type of injury should surgeons be especially cautious of during thoracic surgery?

Intercostal nerve injury Signup and view all the answers

What is the most important factor determined by the surgical approach in esophagectomy?

The patient positioning and required equipment Signup and view all the answers

Which of the following conduits is NOT typically used for the reconstruction of the esophagus?

Ileum Signup and view all the answers

In the context of a transthoracic esophagectomy, which of the following is a key instrument used?

Finochetto chest retractor Signup and view all the answers

Which of the following statements about intraoperative pathologists is true during an esophagectomy?

They confirm tumor-free margins before reanastomosis. Signup and view all the answers

Which of the following accurately describes the en bloc (tri-incisional) esophagectomy?

Involves a laparotomy and two additional incisions Signup and view all the answers

What is the primary purpose of injecting an anaesthetic agent like Marcaine during surgery?

To prevent postoperative pain Signup and view all the answers

Which layer of pleura forms the outer membrane lining of the chest wall?

Parietal pleura Signup and view all the answers

What volume of pleural fluid is typically held in the pleural space?

50 ml Signup and view all the answers

What is the purpose of the negative intrapleural pressure?

To facilitate pulmonary ventilation Signup and view all the answers

How many lobes does the right lung contain?

Three lobes Signup and view all the answers

What are mediastinal lymph nodes primarily associated with?

Diagnosing lung and esophageal cancers Signup and view all the answers

Which of the following best describes the role of the right and left pulmonary veins?

They carry oxygenated blood back to the heart Signup and view all the answers

What is a potential consequence of extensive tissue dissection in thoracic surgery?

Need for blood transfusion Signup and view all the answers

Which of these is NOT typically a hemostatic agent prepared for thoracic surgery?

Oxygen masks Signup and view all the answers

During thoracic surgery, what is a crucial aspect of nursing assessment?

To evaluate the risk of unexpected outcomes Signup and view all the answers

What type of position is a patient undergoing bronchoscopy typically placed in?

Supine position Signup and view all the answers

Which device is NOT commonly used for the lateral decubitus position in thoracic surgery?

Torso restraints Signup and view all the answers

What is required if a surgical case is converted from an endoscopic to an open approach?

A major count for the closing count Signup and view all the answers

Which instrument is NOT typically used in the open approach of thoracic surgery?

Telescope Signup and view all the answers

What is the recommended practice for a perioperative nurse regarding patient positioning?

To collaborate with the surgical team to ensure safe positioning at all times Signup and view all the answers

What role do intermittent pneumatic compression devices play in surgical procedures?

They improve blood return and circulation during long surgical cases Signup and view all the answers

In which procedure is a major count required during the initial surgical phase?

Open thoracic surgery Signup and view all the answers

What is the typical intrapleural pressure status in a normal pleural cavity?

Negative pressure Signup and view all the answers

Which instrument is primarily used for visualizing the larynx during rigid bronchoscopy?

Bronchoscope Signup and view all the answers

Which of the following is essential for preventing hypothermia during surgeries with significant skin exposure?

Forced-air warming blankets Signup and view all the answers

What is the primary purpose of inserting chest catheters during thoracic surgery?

To drain air, blood, or other fluids from the intrapleural space Signup and view all the answers

Which type of tube is primarily used for surgeries that require single-lung ventilation?

Double-lumen endotracheal tube Signup and view all the answers

During the use of a double-lumen endotracheal tube, where is the bronchial lumen typically placed?

In the non-operative bronchus to ventilate the non-operative lung Signup and view all the answers

What procedure utilizes a mediastinoscope to examine the mediastinum?

Mediastinoscopy Signup and view all the answers

Which of the following is a potential complication associated with mediastinoscopy?

Brachiocephalic artery injury Signup and view all the answers

What precaution should be taken regarding the patient before performing a rigid bronchoscopy?

Inspect the teeth and lips for integrity Signup and view all the answers

What role does a flexible bronchoscope play post-induction during a procedure with a double-lumen ETT?

To confirm correct placement of the bronchial lumen Signup and view all the answers

In what situation may water-seal suction be necessary following thoracic surgery?

If there is a persistent air leak not controlled by gravity drainage Signup and view all the answers

What is typically the primary method of sedation used during a rigid bronchoscopy?

Local anesthetic or light sedation Signup and view all the answers

Which system is used to connect chest tubes for drainage post-thoracotomy?

Water-seal or gravity drainage systems Signup and view all the answers

Study Notes

Thoracic Cavity Anatomy

The thoracic cavity, or thorax, is bordered by the thoracic wall, sternum, costal cartilages, ribs, and thoracic vertebrae.
Divided into right and left pleural cavities, mediastinum, and pericardial cavity.
Mediastinum houses key structures excluding lungs, including the thymus, esophagus, trachea, and important nerves.
Blood supply comprises internal thoracic arteries (anterior) and branches from the aorta (posterior), with drainage through mammary, azygous, and hemiazygous veins.

Lung Anatomy

Each lung is housed in its respective pleural cavity with parietal (outer) and visceral (inner) pleura.
Right lung comprises upper, middle, and lower lobes; left lung has upper and lower lobes.
Each lung receives blood supply from corresponding pulmonary arteries and returns oxygenated blood via pulmonary veins.
Mediastinal lymph nodes may be sampled during surgeries for cancer diagnosis.

Perioperative Nursing Considerations

Thoracic surgery carries risks similar to other surgical procedures; unexpected outcomes can arise despite thorough planning.
Blood product availability must be confirmed pre-, intra-, and post-operatively; anticipate need for transfusions in extensive tissue dissections.
Patient positioning varies by procedure: supine for bronchoscopy, lateral for posterolateral thoracotomy, etc.
Perioperative nurses must collaborate with surgical teams and utilize positioning devices to prevent patient injuries.

Surgical Instrumentation

Thoracic surgeries can be open or endoscopic (VATS); specific instruments are required for each.
Common open surgery instruments include Allison lung retractor and Doyens; endoscopic procedures use telescopes, cameras, and endoscopic instruments.
Counting protocols for instruments and sponges are critical to prevent retained foreign objects.

Equipment for Thoracic Surgery

Forced-air warming blankets combat hypothermia due to large skin exposure.
Fiberoptic light sources, video monitors enhance visibility during VATS.
Pneumatic compression devices assist with blood circulation during lengthy surgeries.

Chest Drainage Systems

Post-surgery, intrapleural pressure may be disrupted; chest tubes facilitate the removal of air or fluids and re-establish negative pressure.
Connect drainage systems to facilitate recovery and monitor air leaks effectively.

Double-lumen Endotracheal Tube (ETT)

Double-lumen ETT used for single-lung ventilation during procedures like lobectomy, featuring bronchial and tracheal lumens.
Proper placement is confirmed with a bronchoscope post-induction, deflating the operative lung during surgery.

Surgical Interventions

Rigid Bronchoscopy involves inserting a bronchoscope through the mouth to visualize airways; patient anxiety may arise if only local anesthesia is utilized.
Mediastinoscopy allows examination of the mediastinum; risk of bleeding necessitates thoracotomy set on standby.
Esophagectomy entails removal and reconstruction of the esophagus, requiring careful surgical approach selection.

Esophagectomy Surgical Approaches

Various approaches include Transhiatal, Transthoracic, and En Bloc esophagectomy, each with unique patient positioning and incision requirements.
Conduits for esophagus reconstruction include stomach, jejunum, and colon, with intraoperative pathology for tumor-free margins essential before reanastomosis.

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Description

This quiz explores the anatomy of the thoracic cavity, lung structure, and key perioperative nursing considerations. Delve into the borders, components, and functionality of the thorax as well as implications in surgical settings. Test your knowledge on these essential topics in healthcare.