case 1

Question 1

what would you do day 1 of post surgery

Answer 1

ICU
effect on ERAS pathways (enhance recovery after surgery pathway)
plan elective
abdominal system point of view
education from physio about post recovery

Question 2

components of multi respiratory system assessment

Answer 2

respiratory
cardiovascular
neuro
renal
CNS
abdominal
attachments

Question 3

Aims of day 1 following post surgery

Answer 3

pain management
get them sitting up in bed or chair—> aim to increase FRC
range of motion exercises on the site of incision
teach supportive cough while holding/protecting incision site

Question 4

ways in which to increase FRC of a post operative patient

Answer 4

sitting up in a chair or bed

Question 5

what is a laparotomy?

Answer 5

surgical procedure that opens up the abdomen to expose the organs
exploratory- to see what is going on inside the body and take tissue samples for diagnosis

Question 6

incision site for laparotomy

Answer 6

incision through the abdomen wall
open up the peritoneal cavity— includes the abdomen and pelvis

Question 7

why would someone need a laparotomy

Answer 7

abdominal pain
c section
might to remove cancer of an organ

Question 8

what is functional residual capacity

Answer 8

the volume of air left in the lung after a normal passive exhalation - functional- doing something, residual left out- so when you breathe out..functional passive how you function regularly.

Question 9

why is FRC important

Answer 9

It is a reflection of how elastic your lungs are, the ability of it to remain open after exhalation, the less elastic your lungs are the harder for it to breathe

Question 10

How surgery reduces FRC

Answer 10

during general anaesthtic FRC is reduced by 20%
reduction is greater in obese patients and those with COPD - is COPD a type of respiratory failure.

Question 11

components of type I respiratory failure

Answer 11

hypoaxemia - PaO2 of < 8KPa /60 mmHg
normocapnia PaCO2 < 6KPa /45 mmHg

Question 12

causes of type 1 respiratory failure

Answer 12

ventilation/perfusion mismatch- the volume of air following in an out of the lungs do not match the volume of blood flowing in and out of the tissues.
PaO2 falls and PaCo2 rises.
rise in PaCO2 increase the patient aveolar ventilation — this corrects the PaCO2 but not the PaO2 because of the shape of the dissociation curves

Question 13

minor complications following a laporatomy

Answer 13

infection
bruising and bleeding around the infection site
trouble with coughing - pain post op affect mobility
naseau and vomiting
prolong surgery anesthetic time

Question 14

serious complications following laporatomy

Answer 14

damage to organ and major artery
blood clot
serious alergic reactions to general ansethetic

Question 15

effects of general anesthesia in surgery

Answer 15

disruption of normal repsiratory muscle function —> Reduce tidal volume and FRC by 40% 4 days post op—>
reduce lung compliance and increase airway resistance—> lead to atlectasis —> reduce mucocillary clearance—> disruption of normal respiratory muscle function

Question 16

assessment of surgical patient

Answer 16

respiratory assessment and ACTs airway clearance therapy
mobility assessment, early mobilizaiton is key
shoulder ROm exercises
patient goal setting- motivation
combine with doctor advice proving activities, pacing, exercises
diaries

Question 17

why should you immediately mobilize post op

Answer 17

encourages larger deeper breathes- increases tidal volume and respiratory rate
increase collateral ventilation
upright positioning improves FRC

Question 18

post operative precaustions

Answer 18

suction may accidently enter the esophagus and damage the anatomosis
positive pressure may cause damage to the anastomosis— limit IPPB up to 40
head down position may cause reflux of gastric contents and daamge anastomosis

Question 19

performing a cough assist

Answer 19

instruct patient to take three deep breaths in an out and out and on the fourth one push down and up.
cough on the 4th breath and at the same time apply an inward and upward pressure

Question 20

safe way to cough after abdominal surgery

Answer 20

support your wound firmly with a towel or pillow
loosen phlem by doing a huff

Question 21

what is a huff

Answer 21

forced breathing through open mouth as if fogging up a mirrow