INVASIVE PROCEDURES Diseases of the lungs that requires surgical procedure: ! "ung a#scess $! "ung cancer %!

! C&sts or #enign tu'ors (! E'ph&se'a )! Chest *rau'a O#+ecti,es of pre-operati,e care for the patient undergoing surger&: ! *o ascertain the patients functional reser,e! $! *o ensure that the patient is in opti'al condition for surger&!

Diagnosis . Preparation: Co''on incisional approach *horacoto'& / incision ,ia the side of the chest Sternoto'& / incision through and do0n the #reast#one! VA*S 1Video-Assisted *horacoscopic Surger&2 / insertion of thoracoscope and surgical instru'ents into the thora3 through an& of three to four s'all incision in the chest 0all

*horacic Surgeries and Procedures "O4EC*O56 / surgical re'o,al of one lo#e of the lungs! - indicated for patient 0ith #ronchogenic carcino'a7 giant e'ph&se'atous #le#s or #ullae7 #enign tu'ors7 'etastatic 'alignant tu'ors7 #ronchiectasis and fungus infections! PNEU5ONEC*O56 / is the re'o,al of an entire lung! - indicated for patient 0ith lung cancer7 lung a#scess7 #ronchiectasis7 e3tensi,e unilateral tu#erculosis! E8P"ORA*OR6 *9ORACO*O56 / internal ,ie0 of the lung -'a&#e used to confir' carcino'a or chest trau'a!

 SE:5EN*EC*O56 1Seg'ental Resection2 / refers to re'o,al of a section of a lo#e of the lungs! ;ED:E RESEC*ION / s'all locali<ed section of lung tissue re'o,ed-usuall& pie shaped! -perfor'ed for rando' lung #iops& and s'all peripheral nodules!

Pre-operative Management :oal is to 'a3i'i<e respirator& function to i'pro,e the outco'e postoperati,el& and reduce ris= of co'plication! *o re'o,e all in,ol,e tissue 0hile preser,ing as 'uch functional lung as possi#le!

Pre-operative Management o 9istor& ta=ing- respirator& and cardiac

- Chest auscultation - Assess for retained secretion -Pul'onar& function studies - A4: - 4ronchoscopic e3a'ination - Chest 3-ra& - 4lood tests - 5RI -EC:

Pre-operative Nursing Management I'pro,ing Air0a& Clearance - 0hich includes hu'idification7 postural drainage and chest percussion after ad'inistration of #ronchodilators! 9ealth teachings regarding the t&pe of anesthesia7 use of chest tu#es and drainage s&ste'7 ad'inistration of o3&gen or possi#le use of ,entilator7 use of incenti,e spiro'etr& and proper positioning!

 Pre-operati,e Nursing 5anage'ent 9ealth teachings / techniques of coughing7 splinting the insicion site7 pain 'anage'ent and relie,ing an3iet&! :i,e proph&lactic anticoagulant as prescri#ed to reduce perioperati,e incidence of DV* and pul'onar& e'#olis'! Ensure that patient full& understands surger& and is e'otionall& prepared> consent for the procedure! Post-operative Management 5onitoring of ,ital signs O3&gen ad'inistration ,ia 'echanical ,entilator7 nasal cannula or face 'as= Inta=e and output 'onitoring hourl& 1 IV?2 Proper positioning: - ?or lo#ecto'& / positioning includes l&ing on the #ac= or turned to either side - ?or pneu'onecto'& / l&ing on #ac= and turned to0ard the operati,e side - ?or seg'ental resection / l&ing on #ac= and turned onto nonoperati,e side If patient is conscious you may elevate the head Post-operati,e 5anage'ent Proper chest drainage 'anage'ent Assess and docu'ent pain le,el Assist to turn7 cough7 deep #reath and use incenti,e spiro'etr&! Assess for signs of co'plications including c&anosis7 d&spnea and acute chest pain 0hich 'a& indicate atelectasis! Ela,ated te'perature and ;4C / infection Pallor and increased pulse / internal he'orrage Dressings are assessed for fresh #leeding!

 5onitor A4: and o3&gen saturation frequentl&7 pulse o3i'eter!

Possible Side Effects of Thoracic Surgery Respirator& Insufficienc&: if the rest of the lung cannot co'pensate for the loss of the lo#e Pul'onar& E'#olis': a #lood clot can lodge in the ,essels of the lung7 causing an area to lose #lood suppl& Deep Vein *hro'#osis: l&ing in #ed for long periods after surger& can cause #lood to pool in the ,eins of the legs and clot7 causing a DV*

Cardiac arrh&th'ias: the heart #eats irregularl& and stops pu'ping #lood as efficientl& 4leeding Infection 4ronchopleural fistula: a connection for's #et0een the lung and the surrounding area leading to air lea=age Home instructions Planned treat'ents Acti,ities E3ercises Continuation of deep #reathing and coughing e3ercises!

RENA" SUR:ER6 INDICA*IONS: - for patients 0ith se,ere =idne& da'age such as : ! Cancer of the =idne& / renal cell carcino'a $! Pol&c&stic =idne& disease %! Serious =idne& infections

(! @idne& tranplantation

*6PES O? NEP9REC*O56

! Radical Nephrecto'& / the preferred treat'ent if the tu'or can #e re'o,ed! - this includes re'o,al of the =idne& 1tu'or27adrenal gland7 sorrounding fatt& tissue and l&'ph nodes $! Si'ple Nephrecto'& / perfor'ed for li,ing donor transplant purposes requires re'o,al of the =idne& and a section of the attached ureter %! "aparoscopic Nephrecto'& / can #e perfor'ed for re'o,al of the =idne& 0ith a s'all tu'or! - the surgeon ,ie0s the =idne& and sorrounding tissue 0ith a use of a fle3i#le ,ideoscope! Pre-operative Management Assess the renal function Patient is prepared for surger&7 and consent is 0itnessed! Pre-op anti#iotics and #o0el cleasing regi'en are prescri#ed! Application of antie'#olic stoc=ing7leg e3ercises are taught 4lood sa'ples for 8-'atching for possi#le transfusion7 coagulation studies Insertion of retention catheter Pul'onar& and cardiac status are assessed Intra-op Positioning "ateral lu'#ar flan= or transthoracic 0ith affected side up! Incision Site ?lan= 1posterior a3illar& line7 #eneath the t0el,th ri# to suprapu#ic area2! Post-operative Management Assess clientAs fluid and electrol&te status and respirator& status!

 5onitor hg# and hct results and urine specific gra,it&! 5onitor a'ount and character of urine drainage e,er& hour! O#ser,e for signs of urinar& infection Assess patenc& of urinar& or 0ound drainage tu#e> reinforce or change dressing as needed! Pro,ide pain relief Post-operative Management 9ealth teachings include: - coughing and deep #reathing e3ercises7 use of incenti,e spiro'etr& to pre,ent atelectasis and pul'onar& co'plications! - assistance in turning #ecause patient 'a& e3perience pain and 'uscle soreness! ?or @* / i''unosuppressant drugs are ordered! 9o'e Instructions:

- teach pt! to inspect and care for the incision! - acti,it& and lifting restriction7 dri,ing and pain 'anage'ent! - notif& ph&sician a#out pro#le's li=e fe,er7 #reathing difficult&7 0ound drainage7 #lood in the urine7 pain or s0elling of the legs! - encourage to eat health& diet and drin= adequate liquids! - e'otional support- loss of one =idne&7 possi#ilit& of dial&sis and recurrence of Ca! Complications Infection 9e'orrhage and shoc= Post operati,e pneu'onia *hro'#oe'#olis' Paral&tic Ileus

 O#struction of Urinar& Drainage Re+ection of transplant

PROS*A*E SUR:ER6 Indication: ! 4P9 14enign Prosatatic 9&pertroph&2 $! Prostate Cancer Surgical approach depends on si<e of the gland7 se,erit& of o#struction7 age7 underl&ing health7 and prostatic disease Surgical Procedures ! *ransurethral Resection of the Prostate 1*URP2 / the 'ost co''on approach to re'o,e 4P9! A retroscope is passed through the urethra to e3ercise and cauteri<ed the e3cessi,e prostatic tissue! $! Suprapu#ic Prostatecto'& / an incision into supra#u#ic area and through #ladder 0all7 and the prostate gland is re'o,e fro' a#o,e! %! Retropu#ic Prostatecto'& / incision can #e 'ade in the lo0er a#do'en to 1at the le,el of s&'phisis pu#is2 approach the prostate! Useful 0hen the prostate is large! (! Perineal Prostatecto'& / it in,ol,es incision through the scrotu' and rectu'!*he prostate gland is re'o,ed through an incision in the perineu'!Inconti-nence7se3ual d&sfunction and rectal in+ur& 'ight occur! )! Radical Prostatecto'& / 'a&#e done to resect cancer of the prostate! *he prostate gland7 se'inal ,essicle and the cuff of #ladder nec= are re'o,ed #& a retropu#ic or transpu#ic route! B! "aparoscopic Radical Prostatecto'& / it is perfor'ed through ( to B s'all incisions in the 'id-a#do'en! *his approach reduces the ris= of post-op erectile and urinar& d&sfunction! C! *ransurethral incision of the Prostate- 1*UIP2- 6A: laser is use to 'a=e s'all incision in the s'ooth 'uscle! Pre-operati,e Nursing 5anage'ent Reducing An3iet& - e3plain the nature of procedure and the e3pected post-operati,e care

- discuss co'plications of surger& and ho0 patient 0ill cope a2Incontinence or dri##ling of urine #2 Retrograde e+aculation

Pro,iding Instruction - instruct in turning7 coughing and #reathing e3ercises 4o0el preparation is gi,en and proph&lactic anti#iotics are ordered Ensure that opti'al cardiac7 respirator& and circulator& status ha,e #een achie,ed to decrease the ris= of co'plication! Post operati,e Nursing 5aintaining ?luid 4alance ! 5onitor Inta=e and output 1 including irrigation2 $! 5onitor for electrol&te i'#alances Post-operati,e Nursing 5anage'ent 5onitoring Urinar& Drainage ! 5onitor urine character after prostatecto'&: a! Clear to pale pin= / nor'al during entire hospital course! #! "ight red to red / nor'al or e3pected on da& of surger& and first post operati,e da&!

Post-operative Nursing Management c! Ver& dar= red.4right red / could indicate ,enous.arterial #leeding or inadequate C4I1Continous 4ladder Irrigation.C&stocl&sis2 flo0! d! 4lood clots / are nor'al if the& are onl& occassional! Increase the C4I rate to pre,ent catheter o#struction! c! Ver& dar= red.4right red / could indicate arterial #leeding or inadequate C4I1Continous 4ladder Irrigation.C&stocl&sis2 flo0!

d! 4lood clots / are nor'al if the& are onl& occassional! Increase the C4I rate to pre,ent catheter o#struction! $! Offer fluids frequentl& to =eep the urine diluted and 'ini'i<e infection and o#struction of the catheter! %! ;hen catheter is re'o,ed7 a#out %-C da&s after surger&7 the client should ,oid 0ithin )-B hours! Nor'al in client to e3perience so'e urgenc&7frequenc& and d&suria #ut incontinence is not nor'al and 'a&#e caused #& #ladder spas'! Relie,ing pain

! Sit and dangle legs $! Earl& a'#ulation %! Analgesics Note: after the patient is a'#ulator&7 he is encourage to 0al=7 #ut not to sit for prolonged Periods71 increases intra-a#do'inal pressure2 Pre,ent Co'plications / 'ost co''on are: ! 9e'orrhage / this is noted #& copious7 #right red #lood in the urine! $! *hro'#us and E'#olis' / pre,ent #& turning and e3ercising the legs! %! 4ladder spas' / chec= for the patenc& of catheter and irrigate it as ordered #& the surgeon! ?requenc& of the spas' should decrease in $(-(D hrs! (! infection- aseptic technique is used7 anti#iotics7 'onitor for s.s of infection )! se3ual d&sfunction Discharge Instructions: ! 9ealing / health ha#its of adequate nutrition and rest help to pro'ote healing! If a perineal approach 0as used7 sit< #ath or 0ar' co'press should #e applied to the perineu'! $! Ad+usting to changes in self-concept / after prostate surger&7client 'a& ha,e per'anent or te'porar& interference 0ith se3ual functioning! Post-operati,e Nursing 5anage'ent

%! Do not do an& hea,& lifting or ha,e intercourse for si3 0ee=s after surger&! (! a,oid spic& foods7 alcohol7 coffee 1 causes #laderr disco'fort2 )! 9e'aturia 'a& continue #ut the client should report #right red #leeding and ina#ilit& to ,oid! B! instuctions on ho0 to 'anage drainage s&ste'7 ho0 to assess for co'lications 4REAS* SUR:ER6 Various *&pes of 5astecto'& ! Seg'ental 5astecto'& or "u'pecto'& / re'o,es the tu'or and a 'argin of #reast tissue sorrounding the tu'or! 1 #reast cpnser,ation t3t2 $! Si'ple 5astecto'& 1 total 'astecto'&2 / re'o,al of the co'plete #reast #ut no other structures! %! 5odified Radical 5astecto'& / re'o,al of the #reast and a3illar& l&'ph nodes7chest 0all 'uscles are not resected (! Radical 5astecto'& / re'o,al of the #reast7 a3illar& l&'ph nodes and underl&ing chest 0all 'uscles! )! 4reast Reconstruction / 'a&#e perfor'ed at the ti'e of 'astecto'& or 'a&#e done at a later ti'e> can #e acco'plished through su#'uscular #reast i'plant! Surgical treat'ent options Non-invasive breast cancer 4reast conser,ation alone *otal 'astecto'& alone Invasive cancer 4reast conser,ation 0ith one of the follo0ing: ! S"N4 $! A"ND *otal 'astecto'& 0ith S"N4 or

5R5 oal of Surgery

*o o#tain local control of the disease! Stages of !reast Cancer Stage I: tu'ors are less than $ c' in dia'eter and confined to the #reast Stage II: less than ) c' or tu'ors are s'aller 0ith 'o#ile a3illar& l&'ph node in,ol,e'ent Stage IIIa: greater than ) c' or tu'ors are acco'panied #& enlarged a3illar& l&'ph nodes fi3ed to one another or to ad+acent tissue! III#: ad,anced lesion 0ith satellite nodules7 fi3ation to the s=in or chest 0all7 ulceration7 ede'a or 0ith supracla,icular or intracla,icular in,ol,e'ent! IV: All tu'ors 0ith distant 'etastasis Pre-operative Nursing Interventions ! Pro,iding education and preparation a#out surgical treat'ents! $! Reducing fear and an3iet& and i'pro,ing coping a#ilit&! %! Pro'oting decision 'a=ing a#ilit&!

Post-operative Nursing Intervention !Relie,ing pain and disco'fort a! Analgesic 'edication #! Pro,ide alternati,e pain 'anage'ent c!Do not use ar' operati,e side for 4P ta=ing7 IV or in+ection $! 5anaging post-operati,e sensation! a! Reassure patient that this are nor'al part of healing and that these sensations are not indicati,e of a pro#le' %! Pro'oting positi,e #od& i'age a! Assess for readiness and pro,ide gentle encourage'ent!

#! 5aintain pri,ac& 0hile assisting her to ,ie0 the incision! c! Allo0 to e3press feelings7 ac=no0ledging her feelings! d! Reassure the her feelings are nor'al response to #reast cancer surger& e! Suggest clothing ad+ust'ents (! Pro'ote positi,e ad+ust'ent and coping a! Assisting the patient in identif&ing and 'o#ili<ing her support s&ste'! #! Pro,ide support7 education and guidance to spouse or partner! c! In,ol,e fa'il& in patient care )! I'pro,ing se3ual d&sfunction a! Encourage patient to openl& discuss ho0 she feels a#out herself and reasons in decrease li#ido #! Assu'e position that are co'forta#le c! E3pressing affection using alternati,e 'easures1 hugging7 =issing7 'anual sti'ulation2 d! referral for counselling B! 5onitoring and 'anaging co'plications a! "&'phede'a #! 9e'ato'a or sero'a c! Infection Potential complications "&'phede'a- due to inadequate l&'phatic channel to ensure return flo0 of l&'ph fluid to general circulation! side #!2 ele,ate the ar' a#o,e the heart se,eral ti'es a da&! *o pro'ote gra,it& drainage of fluid! 5gt! a!2 perfor' prescri#ed e3ercises7 start 0ith si'ple 'o,e'ent on affected

c!2 gentle 'uscle pu'ping 1 'a=ing a fist and releasing2 9e'ato'a or sero'a for'ation 9e'ato'a-collection of #lood inside the ca,it& Sero'a-collection of serous fluid 5gt: for he'ato'a a!2 0ar' sho0er #!2 0ar' co'press 5gt: sero'a a!2 unclogging the drain #!2 'anuall& aspirating the fluid 0ith needle and s&ringe Infection 5gt: a!2 'onitor for signs and s&'pto's of infection #!2 Oral or IV anti#iotics for -$ 0ee=s c!2 culture for foul s'elling discharge Pro'ote ho'e care 'anage'ent Pro,ide discharge health teachings on the follo0ing: a! Drainage 'anage'ent #! Pre,enting infection c! Post-operati,e e3ercises

9o'e care 'anage'ent Drainage 'anage'ent a!2 de'onstrate ho0 to e'pt& and 'easure fluid fro' the drainage de,ice #!2 de'onstrate ho0 to 'il= clots through the tu#ing of the drainage de,ice c!2 note for o#ser,ation requiring contacting the ph&sician.nurse!

d!2 identif& 0hen the drain is read& for re'o,al! Drainage 'anage'ent Ar' e3ercise Purpose: ! *o pro'ote RO5 $! *o increase circulation and 'uscle strength %! Pre,ent +oint stiffness and contractures Nursing considerations: ! Initiated on the $nd da& post-operati,el& or after surgical drain is re'o,ed $! Perfor' %3 a da& for $E 'inutes at a ti'e until full RO5 is restored1 (-B 0=s2 %! *a=e analgesic %E 'inutes #efore #eginning e3ercises if patient has disco'fort (! Instruct to ta=e 0ar' sho0er #efore e3ercising! To loose stiff muscle and provide comfort. )! 9ea,& lifting is au,oided 1 a#out (-B0=s2 E3ercise after #reast surger& ! ;all handcli'#ing $! Rope turning %! Rod or #roo'stic= lifting (! Pulle& tugging 5o#ili<ing the ar' Assess patientAs a#ilit& to perfor' self-care Encourage 0rist and el#o0 fle3ion and e3tension! Discharge 9ealth *eachings Dr& dressing for C da&s Appl& lotion or crea's after the incision are co'pletel& healed1 (-B 0ee=s2 to increase skin elasticity.

 ?ollo0-up ,isit to surgeon7 oncologist7 radiation oncologist! Reinforce infor'ation regarding other therap& used along 0ith surger& NURSIN: CARE O? PA*IEN*S ;I*9 RECONS*RUC*IVE 4REAS* SUR:ER6 USIN: *RANSVERSE REC*US A4DO5INIS 56OCU*ANEOUS ?"AP 1*RA5-?"AP2 4reast reconstruction is a process in 0hich a ne0 #reast is 'ade #& using i'plants7 transplanting autologous tissue 1'uscle7 s=in7 etc!2 fro' other parts of the #od&7 or a co'#ination of these 'ethods *he pri'ar& ad,antages of the *RA5 flap are its a#ilit& to pro,ide a per'anent7 natural #reast contour7 re'o,al of e3cess fat in the lo0er a#do'en 1tu''&-tuc=27 and tightening of the a#do'inal 0all Nursing interventions Nursing care to #e pro,ided to patients 0ith *RA5 flaps in,ol,es flap 'onitoring pain 'anage'ent drain 'onitoring pre,ention of possi#le co'plications ho'e-care training of the patient Evaluate the flap area for temperature" blood flo#" color" and capillary refill PIN$ % earl& stage &'($ (E& - accu'ulation of #lood or o#struction #& a clot in donor site ,eins PETECHI' / indicates reduced ,enous return and 'a& require addition of fresh ,eins I)*(+ C*,*(E& -P',E. *( M*TT,E& !(E'ST % indicates inadequate or reduced arterial perfusion Notif& the surgeon i''ediatel& so that the patient can #e e,aluated for further surger&

*e'perature of the flap should #e e,aluated #& touching the flap area 0ith the inde3 finger or the #ac= of the hand ;ar'th helps dilate ,eins and increases circulation! Roo' te'p! 1$(FC and % FC 2 0ith the door closed7 patient should #e co,ered 0ith 0ar'7 air-circulating #lan=ets during transport fro' the reco,er& unit to the clinic a,erage difference of $FC-%FC #et0een the #od& te'perature and the flapAs!

?lap should also #e e,aluated for o,ersensiti,it& or ede'a Capillar& refill of the flap is e,aluated #& appl&ing light pressure to the flap area 0ith the inde3 finger or a #lunt o#+ect Perfusion of flap tissues is assessed 0ith the aid of a de,ice called Doppler surgeon should #e ad,ised i''ediatel& 0hen the Doppler de,ice signals a decrease in tissue perfusion