Thoracoscopic Sympathectomy for Palmar Hyperhidrosis

AORN Journal, August, 2001 by Gloria M. Allen

1. Hyperhidrosis is sweating
   a. beyond the physiological need.
   b. in response to high blood pressure.
   c. as a response to tachycardia.
   d. beyond the psychological need.

2. Hyperhidrosis usually affects the
   a. face, groin, and abdomen.
   b. axillae, palms, groin, and areolae.
   c. soles of the feet and palms.
   d. soles, palms, axillae, and sometimes the face,
      groin, and legs.

3. Some of the consequences of hyperhidrosis are
   a. psychiatric problems and acne.
   b. social withdrawal and low self-esteem.
   c. social anxiety and acne.
   d. intermittent claudication and low self-esteem.

4. Sweating is a physiological response to the body
   overheating.
   a. true
   b. false

5. What controls sweating?
   a. the pineal gland
   b. the thyroid
   c. the adrenal glands
   d. the hypothalmus

6. What are the two types of sweat glands?
   a. apocrine and endocrine
   b. eccrine and hypothalmic
   c. apocrine and eccrine
   d. eccrine and accrine

7. The eccrine glands are most numerous in the
   areas of the
   a. axillae and areolae.
   b. axillae and anogenital area.
   c. palms, axillae, soles of feet, back, and chest.
   d. palms, aerolae, and axillae.

8. The advantages of the thoracoscopic approach as
   opposed to the open sympathectomy include
   a. longer surgical time and lower hospital costs.
   b. longer surgical time and smaller scar.
   c. shorter surgical time and smaller scar.
   d. higher surgical morbidity and longer recuperation.

9. Iontophoresis uses a tap water bath and electric
   current to temporarily block sweat ducts.
   a. tree
   b. false

10. Medical treatments for hyperhidrosis are
    a. locally applied astringents and sympathectomy.
    b. locally applied astringents, injections of botulinum
       toxin, and iontophoresis.
    c. botulinum toxin injections, and sympathectomy.
    d. sympathectomy and iontophoresis.

11. Sweating is controlled by the -- nervous
    system(s)?
    a. sympathetic
    b. parasympathetic
    c. sympathetic and parasympathetic

12. Thoracoscopic sympathectomy usually is performed
    as an outpatient surgery.
    a. true
    b. false

13. Extending the arms at right angles of more than
    90 degrees when positioning the patient can
    cause what complication?
    a. a dislocated shoulder
    b. carpal tunnel syndrome
    c. nerve damage
    d. muscle damage

14. Possible complications of thoracoscopic sympathectomy
    include
    a. infection, bleeding, and compensatory
       sweating.
    b. bleeding, infection, and Homer's syndrome.
    c. compensatory sweating, bleeding, infection,
       and Homer's syndrome.
    d. complete anhidosis, infection, and Raynaud's
       syndrome.

15. Symptoms of Homer's syndrome include
    a. ipsilateral small pupil, slight ptosis of the eyelid,
       and dry face.
    b. severe thirst, slight ptosis, and hyperhidrosis.
    c. dry face, extreme ptosis, and ipsilateral pinpoint
       pupil.
    d. slight ptosis of the eyelid, oily face, and ipsilateral
       large pupil.

16. As the temperature of the environment rises, the
    body is cooled by -- of the cutaneous
    blood vessels and the production of sweat.
    a. vasodilatation
    b. thermogenesis
    c. vasoconstriction
    d. biofeedback.

17. People with palmar hyperhidrosis may have trouble
    holding onto objects, playing musical instruments,
    or performing jobs that require the use of
    gloves.
    a. true
    b. false

18. Why is a thyroid profile drawn on patients who
    are scheduled for thoracoscopic sympathectomy?
    a. Thyroid function can be disrupted by hyperhidrosis.
    b. Thyroid disease can cause hyperhidrosis.
    c. All patients scheduled for surgery should have
       their thyroid function evaluated.
    d. Thyroid dysfunction can cause the surgery to
       fail.

19. The -- sympathetic nerve fibers on or near
    the glandular cells of the sweat glands elicit the
    secretion of sweat.
    a. cholinergic
    b. anticholinergic

20. Sweat flows so rapidly in patients with hyperhidrosis
    that little of the water and more than one-half
    of the sodium and chloride are reabsorbed,
    leaving the concentration of sodium and chloride
    as high as --.
    a. 25 mEq per L to 50 mEq per L
    b. 30 mEq per L to 60 mEq per L
    c. 50 mEq per L to 60 mEq per L
    d. 60 mEq per L to 75 mEq per L

21. What cholinergic agent increases sweating?
    a. succinycholine
    b. scopolamine
    c. atropine
    d. acetylcholine

22. Medical conditions that can cause hyperhidrosis
    include
    a. fever, thryotoxicosis, diabetes mellitus, and
       cardiovascular disorders.
    b. cardiovascular disorders, gigantism, acromegaly,
       and Addison's disease.
    c. fever, thryotoxicosis, diabetes mellitus, hypoglycemia,
       gigantism, acromegaly, pheochromocytoma,
       cardiovascular disorders, and
       Hodgkin's disease.
    d. diabetes mellitus, cardiovascular disorders,
       hypothyroidism, dwarfism, pheochromocytoma,
       Addison's disease, and fever.

23. The nurse is aware that the patient undergoing
    thoracoscopic sympathectomy for palmar hyperhidrosis
    is at risk for ineffective breathing patterns
    related to
    a. positioning.
    b. potential for pneumothorax.
    c. inhibition of chest expansion.
    d. overexpansion of the chest.

24. Patients undergoing thoracoscopic sympathectomy
    for palmar hyperhidrosis often have predispositions
    to bacterial and fungal infections. As
    part of their care plan, what would the nurse do?
    a. Monitor for signs and symptoms of infection;
       administer care to wound sites, keeping them
       dry and clean; and avoid cross-contamination
       from any existing skin infection sites.
    b. Assess the patient's coping mechanisms based
       on his or her psychosocial and psychological
       status and encourage verbalization of feelings
       and experiences.
    c. Identify physical alterations that may affect
       positioning, evaluate for signs and symptoms
       of injury, and evaluate postoperative pulmonary
       function.
    d. Develop an individualized care plan, assess
       the patient's coping mechanisms, and monitor
       for signs and symptoms of infection.

25. After completing a thoracoscopic sympathectomy,
    the surgeon inserts a thoracic catheter which
    he or she submerges in a bowl of saline while the
    anesthesia care provider provides sustained lung
    expansion to force air out of the thoracic cavity.
    This catheter then is left in the patient for several
    days to ensure lung reinflation.
    a. true
    b. false

26. Which symptoms indicate a postoperative pneumothorax?
    a. bilateral chest pain, difficulty breathing, and
       cyanosis
    b. difficulty breathing, uneven breath sounds, and
       crepitus
    c. blood in the sputum, difficulty breathing, and
       rales
    d. pain on one side, difficulty breathing, and
       uneven breath sounds in the chest

27. One of the advantages of the thoracoscopic
    approach to sympathectomy is that the patient's
    activities are limited only by his or her discomfort.
    a. true
    b. false

28. Iontophoresis may be used at home and is useful
    for all areas known to be affected by hyperhidrosis.
    a. true
    b. false

29. What is one treatment for hyperhidrosis that has
    been abandoned?
    a. psychotherapy
    b. biofeedback
    c. irradiation
    d. hypnosis

30. Botulinum toxin injections are sometimes used for
    -- hyperhidrosis of the axillae, palms, and
    feet.
    a. local
    b. focal
    c. unilateral
    d. bilateral

31. A double-lumen endotracheal tube is used to
    intubate patients to allow the anesthesia care
    provider to selectively ventilate one lung while
    the other lung is deflated to allow the surgeon a
    better view of the surgical field.
    a. true
    b. false

32. Hyperhidrosis can be cold-induced, gustatory,
    olfactory, compensatory, or
    a. autoimmune modulated.
    b. psychological.
    c. idiopathic.
    d. pathological.

33. Sympathectomy abolishes -- sweating in
    areas supplied by postganglionic fibers.
    a. eccrine
    b. apocrine

34. -- medications used to treat hyperhidrosis,
    such as atropine, oxyphencyclamine, glycopyrrolate,
    and propantheline bromide, inhibit
    -- effects but often cause dry mouth,
    blurred vision, or constipation.
    a. Anticholinergic/sympathetic
    b. Cholinergic/parasympathetic
    c. Anticholinergic/parasympathetic
    d. Cholinergic/sympathetic

35. Botulinum toxin used for hyperhidrosis is a potent
    neurotoxin that blocks the -- terminals
    and may be effective only at the site of injection.
    a. parasympathetic
    b. cholinergic
    c. anticholinergic
    d. sympathetic