Pneumonectomy

WHAT YOU SHOULD KNOW:

Pneumonectomy (Inpatient Care) Care Guide

A pneumonectomy (new-muh-nek-tuh-mee) is surgery to open your chest wall. You may need a pneumonectomy if you have a lung abscess (infection), lung cancer, or blebs from emphysema (m-fuh-z-muh) blebs. A bleb is lung tissue that stretches like a balloon. These blebs press on the rest of the lung making it hard for you to breathe.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

There are always risks with having surgery. You may bleed more than usual, get an infection, have trouble breathing, or get blood clots. Caregivers will watch you closely for these problems. If you don't have surgery, other tests may be needed to find the cause of your illness. This may take longer than if you had surgery. It may also be harder to find the exact cause of your illness. Call your caregiver if you are worried or have questions about your health problem or care.

WHILE YOU ARE HERE:

Before Surgery:

  • Blood Tests: You may need blood taken for tests. The blood can be taken from a vein in your hand, arm, or the bend in your elbow. It is tested to see how your body is before the pneumonectomy. You may need to have blood drawn more than once.

  • Blood Transfusion:

    • You may need a blood transfusion is your blood count is low. This is called anemia. Or, you may need a blood transfusion if you lose a lot of blood during surgery. You may be able to ask a family member or friend with the same blood type to donate his or her blood. This is called a directed blood donation.

    • Many people are worried about getting AIDS or hepatitis from a blood transfusion. Usually the risk of not getting the blood if you need it is greater than getting AIDS or hepatitis. If your body doesn't have enough blood, you could have a heart attack or die.

  • Call Button: You can use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call.

  • Chest X-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing before your pneumonectomy. Caregivers may also use the x-ray to look for signs of infection like pneumonia (new-moan-yuh).

  • Gown: A hospital gown is needed so that caregivers can easily check and treat you. Put your gown on so it opens in the back. You may not be allowed to wear pajama bottoms to the operating room. This is because you may need monitors on your skin during the pneumonectomy.

  • Informed Consent: You have the right to understand your health problem in words you can understand. You should be told what tests, treatments, or procedures may be done to treat your problem. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

Pre-Op Care:

You may be given medicine right before the surgery, which makes you feel sleepy and more relaxed. You are taken on a cart to the room where your surgery will be done. Caregivers help you get comfortable on the bed. A belt may be put over your legs for safety. If you get cold, ask for more blankets.

  • General Anesthesia (an-iss-thee-zuh):

    • This is medicine given to keep you completely asleep and free from pain during surgery. It may be given as a liquid in your IV. Or, it is given as a gas through a facemask or a tube placed in your mouth and throat. This tube is called an endotracheal (end-o-tra-kee-ull) tube or "ET" tube. Usually you are asleep before caregivers put the tube into your throat. And, the ET tube is usually removed before you wake up.

    • Do not sign legal documents for 24 hours after having anesthesia. The medicine may make you drowsy and your thinking unclear. An adult will need to drive you home and stay with you for 24 hours after your surgery. Ask your caregiver for the CareNotes™ handout about anesthesia if you want more information.

  • Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.

  • Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

  • Special tubes: Some tubes may be put into an artery or vein before, during, or after surgery. These will help caregivers watch how you are doing during or after surgery.

    • Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.

    • CVP Line: A CVP line is also called a central line. It is an IV catheter (kath-uh-ter) put into a large blood vessel near your collarbone, in your neck, or in your groin. The groin is the area where your abdomen (belly) meets your upper leg. The head of your bed may be lowered to help the blood vessel fill up. This may make it easier to put in the catheter. The skin where the catheter will be placed is numbed so you won't feel much pain. The IV may be used to give medicines or to measure how your heart is doing before and after surgery.

    • Epidural: A catheter (very thin plastic tube) may be put into the epidural space in your back before or during surgery. This is the space around your spinal cord. Pain medicine can then be put through the catheter into the epidural space. Using an epidural for pain control is a way to get pain medicine without having to get a lot of shots.

  • Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

During Surgery:

Caregivers turn you on your side after you go to sleep. Caregivers then clean your chest and back with soap and water. This soap may make your skin yellow, but is cleaned off later. Sheets are put over you to keep the surgery area clean. A long incision (cut) is made between 2 ribs from front to back on one side of your chest. Caregivers may remove a little piece of your lung and send it to the lab to be studied. Or, you may need all or a part (a lobe) of one lung removed. The incision is closed with wire and stitches (thread) or staples.

After Surgery:

You are taken to a room where you can rest until you wake up. You are then taken back to your room or you may be taken to the ICU if needed. Do not get out of bed until your caregiver says it is OK. A bandage is used to cover your stitches or staples to keep the area clean and dry to prevent infection. Your family may be allowed to visit you in the ICU for short visits several times a day.

  • Activity:

    • You may need to rest in bed. You may be allowed out of bed once you are feeling better usually the day of surgery. If you are not allowed out of bed for awhile, you should exercise your legs in bed. When your caregiver says it's OK, do leg exercises in bed. You can lift one leg off the bed and draw big circles with your toes. This will help make your legs strong and help you from getting blood clots. Stop if you become tired.

    • Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you ever feel weak or dizzy, sit or lie down right away. Then call your caregiver.

  • Blood Gases: This test is also called an "ABG." Blood is taken from an artery in your wrist or groin. The groin is the area where your abdomen (belly) meets your upper leg. Your blood is tested for the amount of oxygen, acids, and carbon dioxide (di-oks-ide) in your blood. ABGs may be done if you have trouble breathing or other problems caused by your illness.

  • Prevent constipation: High-fiber foods, extra liquids, and regular exercise can help you prevent constipation. Examples of high-fiber foods are fruit and bran. Prune juice and water are good liquids to drink. Regular exercise helps your digestive system work. You may also be told to take over-the-counter fiber and stool softener medicines. Take these items as directed.

  • Breathing treatments: You may need breathing treatments to help open your airways so you can breathe easier. A machine is used to change liquid medicine into a mist. You will breathe the mist into your lungs through tubing and a mouthpiece. Inhaled mist medicines act quickly on your airways and lungs to relieve your symptoms.

  • Chest Tube(s): These are tubes that are put into your chest during the pneumonectomy. Chest tubes remove air, blood, or fluid from around your lung(s). This lets your lungs fill back up with air when you breathe. The chest tube is attached to a container with water in it or hooked to suction.

  • Day/Night Confusion: You may not know when it is daytime or nighttime if you stay in ICU. This is common for patients staying in this unit. It can be caused by having the lights on all the time. The lights may cause you to feel or act confused. You will become more aware of time when you are moved to a room on a regular floor.

  • Deep Breathing and Coughing: This breathing exercise helps to keep you from getting a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum (spit) from your lungs for you to spit out. You should deep breathe and cough every hour while you are awake even if you wake up during the night.

    • Hold a pillow tightly against your incision (cut) when you cough to help lessen the pain. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.

    • You may be asked to use an incentive (in-sen-tiv) spirometer (sper-om-ih-ter). This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your incentive spirometer 10 times in a row every hour while awake.

  • You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.

  • Foley Catheter (kath-uh-ter): This is a tube that may be put into your bladder to drain your urine. The bladder is an organ where urine is kept. The catheter may make you feel like you have to urinate. Relax and the catheter will drain the urine for you. When the catheter is taken out, you can urinate on your own.

    • Don't pull on the catheter because this will make you hurt or bleed.

    • Don't kink the catheter because the urine cannot drain.

    • Don't lift the bag of urine above the catheter. If you do this, the urine will flow back into your bladder. This can cause an infection.

  • Intake/Output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Caregivers often call this "I&O."

    • When you are allowed, drink 6 to 8 (soda-pop can size) glasses of water each day. Or, follow your caregiver's advice if you are on a fluid limit. If you are on I&O, tell your caregiver how much liquid you drink.

    • Ask your caregiver if it is OK to flush your urine down the toilet. It may need to be measured before it is thrown away.

  • Medicines:

    • Antibiotics (an-ti-bi-ah-tiks): This medicine may be given to help you fight infection caused by a germ called bacteria (bak-teer-e-uh). Antibiotics may be given by IV, as a shot, or by mouth.

    • Pain Medicine: Caregivers may give you medicine to lessen your pain. This medicine may be given as a shot, by mouth, or through your IV or epidural catheter in your back. Tell caregivers if the pain does not go away or comes back. A special pump may be used that allows you to push a button and give yourself the medicine through your IV or an epidural catheter. This is called patient-controlled analgesia (ah-null-g-z-uh) and is set up so you cannot accidentally give yourself too much medicine.

    • Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.

  • NG Tube: This is also called a nasogastric (na-zo-gas-trik) tube. This tube may be put in your nose and down into your stomach. The tube is attached to suction (vacuum) which keeps the stomach empty. This tube may help get your bowels working. Sometimes food or medicine can be given through the NG tube.

  • Pressure Stockings: Tight elastic stockings may be put on your legs to help keep blood from staying in your legs and causing clots. The stockings may also be called Ted Hose® or Jobst Stockings®.

  • Pneumatic boots: Inflatable boots are put on your legs. The boots are connected to an air pump. The pump tightens and loosens different areas of the boots. This helps improve blood flow to prevent clots.

  • Oxygen/Ventilator (ven-tih-la-ter): You may need extra oxygen when waking up and for a day or two after surgery. Caregivers may leave an endotracheal (end-o-tra-kee-ull) tube (ET tube) in your throat and lungs. Oxygen can be given through the ET tube by a breathing machine called a ventilator. Once the ET tube is taken out, you may still need oxygen. The oxygen may be given through a plastic mask over your mouth and nose. Or, it may be given through nasal prongs (short, thin tubes in your nose).

  • Wrist Restraints: These are cloth bands used to tie your wrists to the sides of your bed. Restraints are used to keep you from pulling out your special tubes, IVs, or the endotracheal tube. Caregivers will check on you often to make sure you are safe and all your needs are met while you are restrained. Restraints should only be used for a short time. They will be taken off when there is less chance that you will pull your tubes out.

© 2013 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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