case 2

Question 1

what is an annyurism

Answer 1

an increase in the diameter of blood vessels by 50% or more

Question 2

what happens in an open AAA repair

Answer 2

the surgeon makes an incision down the midline of the patient’s stomach
clap would be place above and below the annyurism to restrict blood flow
prosthetic graft material is used to replace the annyurism/tissue

Question 3

incision site of an open AAA repair

Answer 3

down the midline of the stomach

Question 4

treatment after AAA repair

Answer 4

education on risk factors and stop smoking
cardio vascular fitness at 60% of heart rate for 45 min working up to 80%
use group training for social benefit and support

Question 5

outcome measures after AAA repair

Answer 5

wellbeing subjective measure health related quality of life
cardio pulmonary exercise test of six minute walk test to establish cardiovascular fitness before and after surgery
chester hop test, can change for different levels of fitness - reliale and can be used in a small area

once max cardiovascular is achieve continue walking using a heart rate monitor - aim to work at 70% of maximum heart rate

Question 6

what is FiO2

Answer 6

the fraction of inspired oxygen

Question 7

how does SpO2 affect FiO2

Answer 7

SpO2 depicts the current oxygen saturation SpO2 is considered low and required supplemental oxygen.

Question 8

why are post operative patients susceptible to hypoxemia

Answer 8

incomplete lung re expansion
reduced chest wall
reduce diaphgram acivity due to surgical incision site

Question 9

components of assessment following cardiac surgery

Answer 9

cardio respiratory system
mobility review
monitoring of pain management
sternal complications
falls risks

Question 10

risks factors of open AAA surgery

Answer 10

wound infection
infection of the graft
blood clots
heavy bleeding
heart attack or stroke
erectile dysfunciton or ejaculaiton problems

Question 11

pre operative treatment options for AAA repair

Answer 11

deep breathing an meditation exercises to help with blood pressure
BP and pain meds
Control anxiety to lower BP

exercise- considering patient tolerance and critical heart rate rhythm below the risks of provoking an annuyrism

education around smoking and diet, keeping food journals

Question 12

what important information do you need to know before the surgery

Answer 12

incision type, and site
GA details
NM blockade

Question 13

what does day 1 of post operative look like

Answer 13

get moving with BP and heart rate monitor - case study heart rate is already high, not get moving
posiitoning to increase FRC

education around obesity diet and smoking
supportive cough
ACBT
breathlessness management- pacing position of ease
careful monitoring- risks of respiratory failure

ventilators and propylatic assisted cough machine

Question 14

why would you want to carefully monitor this patient after day 1 post op

Answer 14

risk of respiratory failure due to history if TIA and smoking

Question 15

why is ACBT important after day 1 of post surgery

Answer 15

increase secretion load
pain from incision - take special care , maximize huffing rather than coughing
key hole breathing

Question 16

why would you want to limit deep breathing exercises on day 1 post op

Answer 16

the lungs are already hyperinflated

Question 17

what would you want to know from surgeons following AAA repair day 1

Answer 17

how anagesia will be administered

Question 18

type of anesthesia

Answer 18

drip fed, epidural , spinal block

Question 19

what is an AAA

Answer 19

abdominal aortic annuyrism- swelling of the aorta.
abdominal aorta is in the tummy

Question 20

outcome measures of treatment following AAA

Answer 20

FEV1/FEV ratio
VAS pain
self reported dyspnea
ascultation
palpation
functional test- time up and go
LARS questionnare score, incontinence

Question 21

what functional test is used as an outcome measure

Answer 21

time up and go

Question 22

what factors put this patient at risk for pulmonary complication post op

Answer 22

smoker
Age - 73 years
weakened exercise tolerance - effects of anesthesia will cause exercise tolerance to decrease further
obesity

Question 23

how obesity can lead to post pulmonary complication post op

Answer 23

reduced FRC at baseline —> second to compression atelectasis
lead to reduced lung compliance

Question 24

how does weakened exercise tolerance put someone at risk of pulmonary complications

Answer 24

likely to fatigue quicker during exercise
more likely to go into respiratory distress
at an increased risk for respiratory failure

Question 25

how does age put a patient at risk for post pulmonary complications

Answer 25

decrease FRC as they get older
reduce lung compliance and higher closing volume

Question 26

why would smoking place this patient at risk for pulmonary complications

Answer 26

smoking impairs mucocillary transport —> likely to have an element of chronic bronchitis and long term secretion —> more liekly to have infections and exagerations
smoking damage also lead to poor V/Q—> causes tar, scarring and emphysemma

Question 27

what is the FEV1/FVC ratio in normal patients

Answer 27

80%

Question 28

what is FVC

Answer 28

forced vital capacity- the total amount of air that can be expired in one breath

Question 29

what would a FEV1/FVC ratio of <0.7 indicate

Answer 29

FVC is smaller than FEV1
obstructive lung disease- outcome measure- alot of sputum

Question 30

what would a FEV1/FVC ration > 0.7 indicate

Answer 30

both values are less than 80% but FVC is smaller than FEV1 significantly
indicate a restrictive lung disease

Question 31

FEV1/FVC ratio greater than 80% indicate what type of lung disease

Answer 31

obstructive