PRAKASH NURSING SCHOOL & COLLEGE OF NURSING, MAU,
UTTAR PRADESH
LESSON PLAN
ON
THORACTOMY
SUBMITTED TO SUBMITTED BY
Dr. Ravi Kumar B.R JYOTI MAURYA
Principal Nursing Tutor
Prakash Nursing School & Prakash Nursing School&
College of Nursing, Mau College of Nursing, Mau
SUBMITTED ON
LESSON PLAN
NAME OF STAFF : MS. JYOTI MAURYA
NAME OF SUBJECT : SURGICAL PROCEDURE
UNIT :
NAME OF THE TOPIC : THORACTOMY
DURATION : 45 min
LEVEL OF THE STUDENT : OT 2ND YEAR
NUMBER OF STUDENT : 50
METHOD OF TEACHING : Lecture cum discussion
MEDIUM OF INSTRUCTION: English, Hindi
AV AIDS : White board
DATE :
TIME :
VENUE : Classroom
GENERAL OBJECTIVE :
At the end of the class the students will be able to gain knowledge of about thoractomy
SPECIFIC OBJECTIVE :
At the end of session the student will be able to:
Define thoractomy.
Explain the etiology of thoractomy
Explain the procedure of thoractomy
Enumerate the complication of thoractomy
SR.NO SPECIFIC TIME CONTENT TEACHER LEARNER A.V EVALUATION
OBJECTIVES ACTIVITY ACTIVITY AIDS
1. To introduce 3min INTRODUCTION : Lecture Listening White
the topic board
A thoracotomy is a surgical procedure involving an
incision (cut) between the ribs to access the thoracic
cavity and organs within, such as the lungs, heart, and
esophagus, for diagnosis or treatment.
2. To define 3min DEFINITION : Lecture Listening White Define
thoractomy board thoractomy
A thoracotomy is a surgical procedure involving an incision into the chest
wall, typically between the ribs, to access the thoracic cavity and its
contents, such as the lungs, heart, and esophagus
3. To 4 min Etiolosy of thoractomy Listening White
enumerate board
etiology of Lung Cancer:
thoractomy
To assess the extent of the cancer, obtain tissue for biopsy, or
determine if surgery is an option.
Other Lung Conditions:
To explore and diagnose conditions like tumors, infections, or blood
clots.
Biopsy:
To obtain tissue samples for analysis, particularly when other
diagnostic methods like CT scans or biopsies are inconclusive.
Therapeutic Thoracotomy:
Lung Cancer: To remove a cancerous lung or part of a lung
(lobectomy or pneumonectomy).
Cardiac Conditions: To repair or replace heart valves, treat
coronary artery disease, or address other heart-related
problems.
Diaphragm Problems: To repair a diaphragmatic hernia or
other issues with the diaphragm.
Collapsed Lung (Pneumothorax): To reinflate the lung and
treat the underlying cause of the collapse.
PRE OPERATIVE CARE
Medical Evaluation:
A comprehensive assessment of the patient's medical history,
physical examination, and laboratory tests is crucial to assess the
patient's overall health and identify any underlying conditions that
may affect the surgery or recovery.
Risk Factor Assessment:
Identifying potential risks, such as smoking history, pre-existing lung
conditions, or other medical conditions, is essential to tailor the pre-
operative care plan.
Patient Education:
Providing the patient with clear and concise information about the
procedure, potential risks, and expected outcomes is vital for their
understanding and cooperation.
Smoking Cessation:
Patients who smoke should be strongly encouraged to quit at least 4
weeks before surgery to improve lung function and reduce
complications.
Medication Review:
Patients should be instructed to discuss all medications, including
over-the-counter drugs and supplements, with their healthcare
provider to determine if any need to be adjusted or discontinued
before surgery.
Preoperative Airway Management:
For high-risk patients, airway preparation, including drug therapy
and physical rehabilitation, may be recommended to improve lung
capacity and reduce airway complications.
Nutrition and Weight Management:
Assessing the patient's nutritional status and addressing any weight
loss or malnutrition is important to ensure adequate healing after
surgery.
Pain Management:
PROCEDURE
1. Anesthesia and Positioning:
The patient receives general anesthesia, and an epidural catheter
may be inserted for pain management. The patient is then positioned
on their side, often with one arm raised and supported by a padded
holder.
2. Incision:
An incision, typically 6-8 inches long, is made between the ribs, often
below the tip of the shoulder blade. The exact location of the incision
and which ribs are involved depend on the specific procedure being
performed.
3. Muscle and Tissue Division:
The surgeon divides the muscles and tissues between the ribs to
expose the pleural space, the area between the chest wall and the
lungs.
4. Rib Spreading/Removal:
The ribs may be spread apart or even partially removed to create a
larger opening for the surgeon to work within.
5. Access to Organs:
The surgeon can then access the lungs or other organs in the chest
cavity for the intended procedure, such as lung biopsy, lobectomy, or
pneumonectomy.
6. Chest Tube Placement:
After the procedure, a chest tube is placed to drain excess fluid or air
from the pleural space and assist with lung re-inflation.
7. Closure:
The incision is closed in layers, with the skin sutures or staple.
POST OPERATIVE CARE
Pain Management:
Thoracotomy can cause significant pain, necessitating
effective pain control.
Pain management strategies may include medications (e.g.,
opioids, NSAIDs), epidural analgesia, and regional nerve
blocks.
Addressing pain is crucial for encouraging deep breathing,
coughing, and ambulation.
2. Respiratory Care:
Deep breathing exercises, coughing, and using an incentive
spirometer help prevent pneumonia and atelectasis (collapsed
lung).
Early mobilization and ambulation promote lung expansion
and airway clearance.
Supplemental oxygen may be needed to maintain adequate
oxygen levels.
3. Wound Care:
The chest tube incision should be kept clean and dry.
Dressings may be needed until the incision is healed and
drainage stops.
Monitor for signs of infection (redness, swelling, pain, fever)
and report any concerns to the healthcare provider.
4. Diet and Hydration:
A balanced diet with adequate protein and fiber is important
for healing and preventing constipation.
Sip fluids throughout the day, unless otherwise instructed by
the doctor.
5. Gradual Return to Activity:
Rest when needed, but gradually increase activity levels.
Avoid strenuous activities and heavy lifting until cleared by
the doctor.
Walking is encouraged to improve circulation and lung
capacity.
6. Medications:
Follow all medication instructions carefully, including pain
relievers and other prescribed medications.
COMPLICATION
Infection:
Infection at the incision site or within the chest cavity is a
common risk, requiring antibiotics and potentially further
surgical intervention.
Bleeding:
Significant bleeding can occur during or after surgery,
potentially requiring blood transfusions or further surgery to
control the bleeding.
Air Leak:
A persistent air leak from the lung into the chest cavity can
occur, requiring a chest tube to drain the air.
Pneumothorax:
A collapsed lung (pneumothorax) can occur, especially if a
chest tube becomes clogged or malfunctions, requiring
immediate intervention.
Pain:
Postoperative pain is almost universal after thoracotomy and
can be intense, requiring pain management strategies to
prevent complications from reduced lung expansion and
respiratory function.
SUMMARY
A thoracotomy is a surgical procedure involving an incision in the
chest wall to access organs within the thoracic cavity, typically the
lungs or heart. t allows surgeons to visualize, biopsy, or remove
tissue as needed for diagnosis or treatment of various conditions.
CONCLUSION
thoracotomy, or the surgical opening of the chest, remains a valuable
procedure for accessing the thoracic cavity and treating various
conditions, advancements in minimally invasive techniques like
video-assisted thoracic surgery (VATS) offer alternatives with
potential benefits in terms of recovery and morbidity.
REFERENCES
Cao H, Zhou Q, Fan F, Xue Y, Pan J, Wang D. Right anterolateral
thoracotomy: an attractive alternative to repeat sternotomy for high-
risk patients undergoing reoperative mitral and tricuspid valve
surgery. J Cardiothorac Surg. 2017 Sep 21;12(1):85. [PMC free
article] [PubMed]
Romano MA, Haft JW, Pagani FD, Bolling SF. Beating heart surgery
via right thoracotomy for reoperative mitral valve surgery: a safe
and effective operative alternative. J Thorac Cardiovasc Surg. 2012
Aug;144(2):334-9. [PubMed]
