Lobectomy

Lobectomy is a thoracic procedure, which removes a lobe of the lungs. It is performed when a disease pathology is limited to one area of the lung, bronchogenic carcinoma, giant emphysematous blebs or bullae, benign tumors, metastatic malignant tumors, bronchiectasis, and fungal  infections.

The surgeon makes a thoracotomy incision: its exact location depends on the lobe to be removed. When the pleuralspace is entered, the involved lung collapses and the lobar vessels and the bronchus are ligated and divided. After the lobe is removed, the remaining lobes of the lung are re-expanded. Usually, two chest catheters are inserted for drainage. The upper tube is for air removal, the lower one is for fluid drainage. Sometimes though, only one catheter is needed. Then, the chest tube is connected to a chest drainage apparatus for several days.

Pre-operative Management:

  • Improving air clearance:
  • Humidification, postural drainage and chest percussion after administration of prescribed bronchodilators.
  • Antibiotics are prescribed for infection.
  • Educating the patient:
  • Inform the patient what to expect, from administration of anesthesia to thoracotomy and the likely use of chest tubes and a drainage system postoperatively.
  • Tell the patient about the administration of oxygen postoperatively and the possible use of a ventilator.
  • Explain the importance of frequent turning to promote drainage of lung secretions.
  • Instruct the proper use of an incentive spirometry and how to perform diaphragmatic and pursed-lip breathing tecnhiques.
  • Teach the patient to splint the incision site with hands, a pillow or a folded towel to avoid discomfort.
  • Relieving anxiety:
  • Listen to the patient to evaluate his or her feelings about the illness and the proposed surgery.
  • Help the patient overcome fears and to cope with the stress of surgery by correcting any misconceptions, supporting the patient’s decision to undergo surgery and dealing honestly with questions about pain, discomfort and treatments available.

Post operative Management:

  • Vital signs are checked frequently.
  • Oxygen is administered via cannula, mask or ventilator as long as necessary.
  • Fluids are given at a low hourly rate to prevent fluid overload and pulmonary edema.
  • Careful positioning of the patient is important, bed may elevated 30 to 45 degrees.
  • Turning from back to operated side, but not completely to the un-operated side to prevent mediastinal shifting.
  • Pain medications are administered. Encourage splinting of the incision site.
  • Breathing exercises and spirometry are resumed to facilitate lung ventilation.
  • Dressings are assess for fresh bleeding.
  • Assess for signs of complications such as cyanosis, dyspnea and acute chest pain.

Photo credits:  www.nlm.nih.gov

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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