Cardio Resp Problems and surgery

Question 1

Reduced ventilation outcome measure

Answer 1

Asucultation

Question 2

Reduced air entry outcome measure

Answer 2

palpation, x-ray, spirometry, ABGs

Question 3

Dyspnea outcome measure

Answer 3

Inspection, Dyspnea measure, patient report

Question 4

Impaired secretion clearance outcome measure

Answer 4

Auscultation, sputum and cough asessment, tactile fremitus, chest X ray, subjective report

Question 5

Decreased endurance outcome measure

Answer 5

Subjetive patient report of fatigue
Exercise test - 6MWT
Borg RPE scale

Question 6

Airflow limitation outcome measure

Answer 6

Spirometry - reduced FEV1/FVC ration
Inspection (barrel chest, prolonged expiration, pursed lip breathing)
WHeeze on auscultation
X ray (horzontal rubs, flattened diaphragm,)
Narrow mediastinum

Question 7

Reduced chest expansion outcome measure

Answer 7

Chest expansion

Question 8

Lobectomy

Answer 8

resection of one or more lobes of the lung
a. For carcinoma
b. Bronchus leading to lobe are cut and stapled
Remaining lung expands to fill space

Question 9

Pneumectomy

Answer 9

total removal of one lung
a. For extensive carcinoma
b. Mainstem bronchus stapled off
c. Diaphragm rises and mediastinal structures shift to empty side

Question 10

Segmental resection

Answer 10

a. Removal of a segment of a lobe
Done for localized lesion (cyst, benign tumor)

Question 11

Wedge resection

Answer 11

Removal of small area of lung
For large bullae cyst, biopsies, fungal disease

Question 12

Lung biopsy

Answer 12

surgical removal of lung tissue for diagnosis

Question 13

Lung volume reduction

Answer 13

removal of badly affected portion of emphysematous lung to reduce hyperinflation and improve lung mechanics

Question 14

Coronary artery bypass surgery

Answer 14

saphenous vein or internal mammary artery is used to bypass narrowed coronary artery and restore blood flow to heart

Question 15

Valve repair/replacement

Answer 15

mechanical or biological valve repairs or replaces dysfunctional valve

Question 16

Pacemaker/Implantable cardioverter defibrilator insertion

Answer 16

a. PM: electrical impulse sent to contract heart
ICD: sends shock to reset an abnormal heart to normal

Question 17

Anterolateral thoracotomy

Answer 17

sub mammary incision from midline to 4th or 5th intercostal space at midaxillary line
- Muscles cut: pec major, serratus, intercostal
-problems :Limits shoulder movement

Question 18

Posterolateral thoracotomy

Answer 18

from area between scap and vertebrae to anterior axillary line at 5th intercostal space
Muscle cut: trap, lat, serratus, rhomboid
Problems: Scapular instability, scoliosis to operated side

Question 19

Thoracoabdomina

Answer 19

8th or 9th intercostal space at posterior axillary line to midline of abdomen
Muscle cut: lat, serratus, ext oblique, rectus abd
Problems: Difficulty coughing, deep breathing and thoracic expansion + Leads to forward flexion posture (splinting)

Question 20

Median sternotomy

Answer 20

vertical incision of sternum
- Used to access mediastinum
- No muscle cut
Problems: Kyphosis and splinting due to pain, reduced chest expansion

Question 21

Effects of anaesthesia on respiratory system

Answer 21

1. Decreased FRC –> atelectasis and shunting
   
   2. Decreased respiratory drive (decreased central chemoreceptor sensitivity –> decreased ventilation)
   3. Respiratory muscle weakness
   4. Decreased cough (increased risk of aspiration)
   5. Decreased lung compliance
2. Hypoxemia

Question 22

Effects of anaesthesia on cardiovascular system

Answer 22

1. Hypo or hypertension
   
   2. Hypovolemia
   3. Dysrhythmias
      Risk of myocardial ischemia and infarct

Question 23

Deep Venous Thrombosis (Signs, prevention treatment)

Answer 23

Thromboembolism - when blood clot breaks off and travels to obstruct a blood vessel
- Pulmonary Thromboembolism is blocking lungs

Signs and symptoms: Unilateral leg pain or swelling, Localized warmth, Erythema (red)
, Pain on passive DF (positive homans test)

Prevent via: Early mobilization, Lower extremity exercises, Bed exercises, Graduated compression stockings

Treatment: Blood thinning
Monitor

Question 24

Atelectasis definition and causes

Answer 24

partial or complete collapse of lung or lung section *Occurs within 24-48hrs after surgery)

Causes: hypoventilation, Decreased FRC, Airway restriction by retained secretions from
1) Reduced ciliary function
2) Reduced cough reflex
3) Pain

Can lead to V/Q mismatch –> hypoxemia

Question 25

Risk for post operative complications patient related

Answer 25

• Pre existing pulmonary or cardiac or neuromuscular disease
  
  • Over 60
  • Decreased PA
  • Active smoker
  • Skeletal deformities (kyphosis)
    Malnutrition

Question 26

Surgery related post of risks

Answer 26

• Type/location
  ○ Aortic>thoracic>upper abdominal > lower abdominal > non abdominal or thoracic
  
  • Duration of anaesthesia (>3 hrs increases risk)
    General anaesthesia has more risk than epidural

Question 27

Perioperative goals

Answer 27

1. Decrease post op complications
   
   2. Decrease hospital stay length
   3. Increase self efficacy
      Decrease anxiety

Question 28

Pre operative goals

Answer 28

1. Develop rapport
   
   2. Assess patient (cough, cognitive status, risk)
   3. Create post op goals
   4. Educate
   5. Describe and demo post op interventions
      a. Breaths
      b. secretion clearance (coughing and hughing)
      c. Circulatory exercises (ankle pumps)
      d. Positions and transfers
      Early mobilization

Question 29

Post operative goals

Answer 29

1. Optimize pain management
   
   2. Promote lung expansion and prevent atelectasis
   3. Facilitate secretion clearance
   4. Prevent circulatory complications (reduced DVT)
   5. Restore exercise tolerance
   6. Maximize chest mobility
   7. Maintain and restore ROM and strength
      Preserve skin integrity