Thoracic surgery refers to operations on the organs in the chest including the heart, lungs, and esophagus. The document discusses various types of thoracic surgeries like lobectomy, pneumonectomy, wedge resection, and lung transplant that are performed to diagnose, treat, or repair conditions of the lungs. It also covers surgeries related to the heart like pericardiectomy and esophageal surgeries like esophagectomy. Important aspects of pre-operative, intra-operative and post-operative nursing management are outlined with a focus on airway maintenance, respiratory monitoring, coughing exercises, and chest tube care.

1. THORACIC
SURGERY AND
ITS NURSING
MANAGEMENT
BSC (H) NURSING
RAKCON

2. INTRODUCTION
THORACIC SURGERIES REFER TO OPERATIONS ON
ORGANS IN THE CHEST, INCLUDING THE HEART,
LUNGS AND ESOPHAGUS.
THESE ARE OPERATIVE PROCEDURES PERFORMED
TO AID IN THE DIAGNOSIS AND TREATMENT OF
CERTAIN PULMONARY CONDITIONS.

3. DEFINITION
CARDIOTHORACIC SURGERY (ALSO KNOWN AS
THORACIC SURGERY) IS THE FIELD OF
MEDICINE INVOLVED IN SURGICAL TREATMENT
OF ORGANS INSIDE THE THORAX (THE
CHEST)— GENERALLY TREATMENT OF
CONDITIONS OF THE HEART AND LUNGS.

4. ANATOMY AND PHYSIOLOGY OF THORAX
• The thorax or the upper trunk is a region between the base of the neck and the
diaphragm. It houses the heart and lungs and is encased by the ribs.
• The thorax includes the thoracic cavity and the thoracic wall.
• The main organs and structures of the thoracic cavity include:
• a) The trachea, 2 bronchi, 2 lungs
• b) The heart, aorta, superior and inferior vena cava, numerous other vessels
• c) The oesophagus
• d) Lymph vessels and lymph nodes.

5. FUNCTIONS OF THE THORAX
a) Forms joints between the upper limb and the axial
skeleton
b) Gives attachment to the muscles of respiration
c) Enables breathing to take place
d) Protects the heart, lung and other large blood vessels.

6. PURPOSES OF THORACIC SURGERY
1. To diagnose or repair lungs
affected by cancer
2. To treat diseased or injured
organs in the thorax
3. To treat pleural diseases
including pneumothorax and
pleural effusions.

7. INDICATIONS
1. Lung carcinoma
2. Chest trauma
3. Oesophageal cancer
4. Emphysema
5. Lung and heart transplantation
6. Cardiac trauma
7. Cardiac tumor
8. Esophageal atresia
9. Esophagectomy
10.Oesophageal cancer

8. RELATED TO LUNGS
LOBECTOMY
PNEUMONECTOMY
WEDGE RESECTION
LUNG TRANSPLANT
Related to heart
Decortication
Pericardiactomy
Pericardial window
Related to oesophagus
Esophageal myotomy
Esophagectomy
TYPES OF THORACIC SURGERY

9. LOBECTOMY
• It is the removal of a lobe of the lung. When the pathology is
limited to one area of a lung, lobectomy is done. It is carried out
for bronchogenic carcinoma, giant emphysematous blebs, benign
tumors, metastatic malignant tumors, bronchiectasis, and fungus
infection

10. PNEUMONECTOMY
• It is the removal of an entire lung.
• It is done chiefly for cancer when the lesion cannot
be removed by a lesser procedures.
• It may also be performed for lung abscesses,
extensive unilateral tuberculosis.
• The removal of right lung is more dangerous than
the removal of left lung since the right lung has a
larger vascular bed and its removal imposes a
greater physiologic burden.

11. WEDGE RESECTION
Small localized section of the lung tissue is
removed.
This procedure is done for random lung biopsy
and for the excision of small peripheral nodules.
It is and ideal procedure for the treatment of
certain types of lung cancer requiring the removal
of small lesions of cancer cells.
A wedge resection is also preferred for patients
who cannot tolerate the removal of a large sized
section of the lung when there may be a
significant decrease in lung function.

12. LUNG TRANSPLANT
• A surgical procedure to replace a
diseased or failing lung with a
healthy lung, usually from a deceased
donor. When faced with COPD,
pulmonary fibrosis, pulmonary
hypertension and cystic fibrosis a
lung transplant may be required.
•

13. SEGMENTAL RESECTION
Also called segmentectomy, it is the
removal of a segment of the lung.
Compared to wedge resection a larger
piece of lung tissue is removed in this
procedure.

14. ESOPHAGECTOMY
• Esophagectomy is a surgical procedure to
remove some or all of the swallowing tube
between your mouth and esophagus and
then reconstrict it using the part of another
organ ,usually the stomach.

15. ESOPHAGEALMYOTOMY
• Esophageal myotomy is a
procedure performed by a thoracic
surgeon to help people with
achalasia swallow .
• It involves cutting away some of
the outer layers of tissue from
lower esophagus to allow food
and liquid to pass into stomach
more easily.

16. THYMECTOMY
•Removal of thymus gland is
indicated for treatment of
myasthenia gravis or for
thymic tumors.

17. THORACOTOMY
• A traditional open surgery
approach that uses an incision
to divide the ribs to resect or
remove large mediastinal
masses or tumors.

18. DECORTICATION
• The collection of pus in pleural cavity
,empyema is usually a secondary
complications of pneumonia.
• Decortication is indicated in chronic stage
of empyema , when lung is trapped and
unable to expand .
• The fibrotic ‘peel’ forms in pleural space is
removed so the lung can re expand.

19. MEDIASTINOSCOPY
• A mediastinoscopy is a process
used to examine the mediastinum.
This is the space behind the
breastbone in the middle of the
chest between 2 lungs.
• Mediastinotomy is the surgery
opening of the mediastinum .

20. PERICARDIECTOMY
• A pericardiectomy is a
procedure done on the
sac around the heart . A
surgeon cuts away this sac
or a large part of this sac .
This allows the heart to
move freely .

21. PERICARDIAL WINDOW
• It is a cardiac surgical procedure
less invasive than an open heart
surgery . It is often done after an
open heart surgery to drain and
prevent pericardial effusion.

22. CHEST DRAINAGE
• Chest drainage is the insertion of a tube into the pleural space
to evacuate air or fluid, to help regain negative pressure.
• Whenever the chest is opened, from any cause, there is loss
of negative pressure, which can result in collapse of the lung.
• The collection of air, fluid or other substances in the chest can
compromise cardiopulmonary function and even cause
collapse of the lung.
• Surgical incision of the chest wall almost always causes some
degree of pneumothorax. Air and fluid collect in the
intrapleural space, restricting lung expansion and reducing air
exchange

23. IMPORTANCE OF CHEST DRAINAGE IN
THORACIC SURGERY
• It is necessary to keep the pleural space evacuated
postoperatively and to maintain negative pressure within this
potential space.
• Therefore during or immediately after thoracic surgery, chest
catheters are positioned strategically in the pleural space and
connected to some type of drainage apparatus in order to
remove the residual air and drainage fluid from the pleural
space.
• This assists in the re-expansion of remaining lung tissue.

24. NURSE’S ROLE IN THE CARE OF CHEST TUBE
• The tube should be approximately 2.5 cm below the water level.
• Ensure that the tubing in not interfering with the movements of the patient.
• Encourage the patient to change position frequently.
• Mark the original fluid level with tape on the outside of the drainage bottle.
• Mark hourly/daily increment at the drainage level. Make sure that there is fluctuation of the fluid level in the long
glass tube. • Watch for leaks of air in the drainage system as indicated by constant bubbling in the water-seal bottle.
• Observe and report immediately signs of rapid, shallow breathing; cyanosis; pressure in the chest; or symptoms of
hemorrhage
• Encourage patient to breathe deeply and cough at frequent intervals. If there are signs of incisional pain, adequate
pain medication is indicated.
• Put the arm and shoulder of the affected side through range of motion exercises several times daily. • “Milk” the
tubing in the direction of the drainage bottle hourly.
• Stabilize the drainage bottle on the floor or in a special holder. If the patient has to be transported to another area,
place the drainage bottle below the chest level (as close to the floor as possible).

26. NURSING MANAGEMENT
PRE-OPERATIVE CARE
• A patient undergoing thoracic surgery requires meticulous assessment and
management because not only are these operations wide in scope, but the patient may
have obstructive pulmonary disease with compromised breathing.
• The objectives of preoperative care are:
1. To ascertain the patient’s functional reserve to determine if he can survive the
operation. 2. To ensure the optimal condition of the patient for surgery.
• A series of preoperative tests is done to determine the preoperative status of the
patient and to assess his physical assets and liabilities.
• Preoperative studies are done to provide a baseline for comparison during the
postoperative period and to reveal any unsuspected abnormalities

27. NURSING ASSESSMENT
• Chest auscultation should give an estimate of the intensity of breath sounds in
the different regions of lungs.
• The nursing assessment may also include the following:
1. sign and symptoms present
2. smoking history
3. patient’s cardiopulmonary tolerance
4. breathing pattern
5. medical conditions that exist

28. NURSING INTERVENTION
•1. Improvement of ventilation and respiratory
function
•2. Patient teaching
•3.Psychological support

29. PLANNING AND IMPLEMENTATION
• 1. Maintenance of patent airway All secretion must be aspirated by suctioning until the patient
can cough up secretion effectively. Excessive secretions will produce airway obstruction, causing
the alveoli and lung to collapse.
• Continuing nursing assessment and monitoring The BP, pulse and respiration are monitored
every 15 minutes and more frequently as indicated. The character and depth of the respiration
and patient’s color serve as important criteria in evaluating whether the lung are being
adequately expanded.
• Coughing techniques The patient must be encouraged to cough effectively since ineffective
coughing can result in exhaustion and retention of secretions, which can lead to atelectasis and
pneumonia. After helping the patient to cough the nurse should listen to both lungs, both
anteriorly and posteriorly with a stethoscope to determine whether there are any changes in
breath sounds.

30. POST OPERATIVE CARE
• The goal is to restore normal cardiopulmonary function as quickly as possible.
• Nursing diagnosis with goal and implementation
• 1. Diagnosis – ineffective airway clearance related to lung impairment ,anesthesia
and pain.
• Goal – improvement of airway clearance and achievement of patent airway.
• Nursing interventions –
• maintain an open airway
• Perform endotracheal suctioning until patient can cough effectively
• Monitor amount, viscosity ,color and odour of sputum .

31. 2. Diagnosis – impaired gas exchange related to lung
impairment and surgery
• . Goal – improvement of gas exchange and
breathing .
• Nursing interventions –
• Monitor and record bp , pulse and temp every 2-4
hours.
• Elevate head of bed 30-40 degrees when patient is
oriented and hemodynamic status is stable.
• Encourage and promote an effective cough routine
to be performed every hour during first 24 hours.
• 3.Diagnosis – acute pain related to incision ,
drainage tubes and the surgical procedures.
• Goal – relief of pain and discomfort .
• Nursing intervention –
• Evaluate location, character, quality and severity
of pain.
• Administer analgesic medication as prescribed
and as needed.
• Maintain care postoperatively in positioning the
patient .
• a)place patient in semi fowler position.
• b) assist or turn patient every 2 hrs.

32. • 4. diagnosis – anxiety related to outcomes of
surgery and pain.
• Goal – reduction of anxiety to a manageable level.
• Nursing intervention –
• explain all procedures in understandable
• Silence all unnecessary alarms on technology (
monitors, ventilators)
• Encourage and support patient while increasing
activity level.
• 5. Diagnosis – deficient knowledge of home
care procedures.
• Goal- increased ability to carry out care
procedures at home .
• Nursing interventions –
• Encourage patient to practice arm and
shoulder exercise 5 times daily at home.
• Instruct patient about home care.

33. COMPLICATIONS
• Complications following thoracic surgery may include:
• • Cardiac arrhythmias; myocardial infarction
• • Hemorrhage; post operative bleeding
• • Respiratory insufficiency
• • Pneumonia; atelectasis
• • Bronchopulmonary fistulas

34. CONCLUSION
• All the thoracic surgeries are done with an aim to help the patient return to the
highest possible functional capacity giving maximum lung expansion and
increasing the possibility of air exchange.
• Meticulous attention and proper care must be given to the patient undergoing
thoracic surgery because these operations are wide in scope and the margin of
safety is apt to be narrow.
•

35. SUMMARY
we learned about what is thoracic surgery
,its types ,indications , complications and
what nursing management can be done for
patient undergoing thoracic surgery.

37. • -Bruner/Suddharth, Textbook of Medical Surgical Nursing -Lippincott Manual of
Nursing Practice
• -Ross & Wilson, Anatomy and Physiology in Health and Illness -
www.google.com -www.mayoclinic.org
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