Case 4 - Bruce - Reduced Lung Vol (Post Surg) Flashcards
What is a laparotomy?
A surgical procedure that involves making an incision in the abdomen to examine the abdominal organs.
What would you hear on auscultation?
Diminished/absent breath sounds.
What would we see on a CXR?
Small volume linear shadows, usually peripherally or at the lung bases (atelectasis) or a collapse.
What is Ventilation?
V = ventilation in a normal patient occurs just above the basal regions due to lung weight, partially open airways and the pressures generated by tidal volume breathing.
What is perfusion?
Q = the amount of blood flowing through the capillaries in the lungs, in an upright adult gravity has the most influence.
VQ mismatch
Obstruction of the airway = reduced V therefore VQ ratio decreases.
Obstruction of the circulation = reduced Q therefore VQ ratio increases.
What is meant by compliant lungs?
How easily the lungs stretch. If a lung is compliant there’s a large change in volume for a relatively small change in intra-pulmonary pressure. If not compliant, a small increase in volume despite large change in intra-pulmonary pressure.
Sitting/standing upright for VQ matching
VQ greatest in basal areas of lung, Pt has bilateral reduced lung volume. Prone may be uncomfortable due to op.
Other benefits of sitting upright
Improved lung expansion (diaphragm has more room to expand downwards), promoted mobility and strength.
Benefits of mobility for lung volume
Deeper breathing, improves O2 uptake and CO2 removal, increased muscle strength elicited by mobilising and general exercise helps strengthen the respiratory muscles, subsequently assisting deeper breathing and cough production.
How to do TEE?
Breathe in slowly through nose, deep into the chest (hand on chest moves out, hand on belly may move).
Exhale through pursed lips, hand on chest moves in (do not force air out).
Prescription: 1-2x to avoid hyperventilation (he has low O2), BC in between, practice 5-10 min several times a day.
How does deep breathing help lung volume?
Deeper breathes that ensures even air distribution throughout the lung, particularly in the dependent lung (improves VQ matching and basal ventilation). Breathing through full vital capacity and holding for 3-5 seconds ensures full inflation of the lungs, opening alveoli which have low volume and stimulating surfactant production.
Precautions for deep breathing
Don’t force expiration, don’t prolong expiration, no more than 3-4 reps without BC, avoid use of accessory muscles.
What causes atelectasis post surgery?
Occurs post-operatively from airway collapse is due to a combination of airway compression, alveolar gas resorption intra-operatively, and impairment of surfactant production.
What is a surfactant in the lungs?
Mixture of proteins and fats that lines the lungs’ air sacs, or alveoli, to help with breathing. Reduces surface tension in the alveoli.
