Questions and Answers
What is the primary function of the bronchial arteries in the thoracic cavity?
Which structure separates the right and left pleural cavities?
In which patient position is a thoracotomy typically performed?
What characterizes the visceral pleura in relation to the lungs?
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Which surgical procedure involves the use of a double-lumen endotracheal tube?
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What are the main considerations in perioperative nursing for thoracic surgeries?
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What is the role of pulmonary veins in the thoracic cavity?
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Which of the following structures is NOT part of the airway leading to the alveoli?
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What is the indication for resecting mediastinal lymph nodes?
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What is NOT a typical component of thoracic surgical instrumentation?
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What is the primary indication for performing a pneumonectomy?
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What type of surgical approach involves a large opening into the chest wall?
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What surgical technique is employed in lung volume reduction surgery regarding the management of hyperinflated lung tissue?
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In the context of thoracotomy, which incision is most commonly used?
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What is the role of bovine pericardium in lung volume reduction surgery?
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Which device is commonly used for ligating the bronchus and vessels during pneumonectomy?
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What is the primary purpose of the placement of a double-lumen endotracheal tube (ETT)?
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What complication is necessary to manage after lung volume reduction surgery?
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Which of the following lung surgeries is most directly associated with treating chronic pulmonary emphysema?
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Which instrument is typically NOT part of a thoracotomy tray?
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Which of the following surgeries involves the removal of tissue only from part of the lung?
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What is the main function of the chest drainage system after surgery?
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What is typically required alongside lung surgeries related to chest drainage?
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What distinguishes rigid bronchoscopy from flexible bronchoscopy?
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What procedure is performed using Video-Assisted Thoracoscopic Surgery (VATS)?
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During a wedge resection using VATS, what is crucial for adequate margins?
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What is the role of the mediastinoscope during a mediastinoscopy?
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Which of the following is NOT a type of lung resection performed via VATS?
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In which scenario would flexible bronchoscopy primarily be used?
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In the context of double-lumen ETT, what does the bronchial lumen specifically ventilate?
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Study Notes
Thoracic Surgery Overview
- Anatomy of the thoracic cavity includes the lungs and mediastinum, which separates right and left pleural cavities.
- Double-lumen endotracheal tubes are essential for single lung ventilation during specific thoracic surgeries.
Anatomy – Blood Supply
- Bronchial arteries from the aorta nourish the lungs.
- Pulmonary arteries transport deoxygenated blood to the pulmonary parenchyma for gas exchange.
- Pulmonary veins carry oxygenated blood back to the left atrium.
- Intercostal nerves innervate the thoracic cage.
Pleural Cavity
- The thoracic cavity contains parietal pleura (lining walls) and visceral pleura (covering lungs).
- The trachea branches into primary bronchi, leading to secondary bronchi, bronchioles, and alveoli.
Mediastinal Lymph Nodes
- Located throughout the thorax; important for diagnosing lung malignancies.
Perioperative Nursing Considerations
- Key elements include anesthesia, patient positioning, instrument count, and chest drainage systems.
- Double-lumen endotracheal tubes support single-lung ventilation during surgeries.
Patient Positioning
- Lateral position is used for procedures like thoracotomy, VATS, and single-lung transplant.
- Supine position is adopted for rigid or flexible bronchoscopy, sternotomy, and mediastinoscopy.
Instrumentation
- Open thoracic surgeries use specialized tools such as lung retractors and rib cutters.
- Minimally invasive surgeries (MIS) employ specific VATS instrumentation and bronchoscopic tools to explore and treat the thoracic cavity.
Double Lumen Endotracheal Tube
- Comprises two lumens: one collapses the operative lung while the other ventilates the non-operative lung.
- Proper placement is confirmed via flexible bronchoscopy.
Chest Drainage System
- Utilized for draining air, blood, or fluid post-surgery, restoring negative pressure to treat conditions like pneumothorax.
- Sizes typically range from 20 to 32 French, and systems may include water-seal or gravity drainage.
Surgical Interventions
- Endoscopic options include rigid and flexible bronchoscopy, mediastinoscopy, and VATS.
- Open procedures typically involve thoracotomy or esophagectomy.
Bronchoscopy
- Rigid bronchoscopy provides access to the trachea and bronchi, often combined with flexible scopes for enhanced visualization.
Mediastinoscopy
- Involves a small incision above the sternal notch, allowing examination of the mediastinum and potential biopsy of lymph nodes.
Video-Assisted Thoracoscopic Surgery (VATS)
- A minimally invasive approach for diagnostic or therapeutic lung interventions.
- Can transition to open thoracotomy if necessary.
Lung Resections with VATS
- Surgeries include wedge resection, segmentectomy, lobectomy, pneumonectomy, and lung volume reduction.
Specific Surgical Procedures
- Wedge Resection: Removal of a wedge-shaped lung section; involves adequate margins.
- Lobectomy: Involves mobilization of pulmonary vessels and bronchus, requiring chest drainage.
- Pneumonectomy: Entire lung removal indicated for invasive tumors and significant bleeding.
- Lung Volume Reduction Surgery: Focuses on removing hyperinflated lung tissue to alleviate symptoms of pulmonary emphysema.
Open Thoracic Surgeries (Thoracotomy)
- Characterized by a significant chest wall incision, with posterolateral being the most common.
- Common procedures include wedge resection, segmentectomy, lobectomy, and lung volume reduction.
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Description
This quiz covers the essential anatomy and physiology related to thoracic surgery. It includes information about the thoracic cavity, blood supply to the lungs, and key perioperative nursing considerations. Test your understanding of the critical aspects of thoracic anatomy and surgical techniques.
