case study 4 - Cholecystectomy Flashcards
what is a Cholecystectomy
surgery to remove the gallbladder.
where in the body is the gallbladder
a pear-shaped organ that sits just below the liver on the upper right side of the abdomen.
what does the gallbladder do
collects and stores a digestive fluid made in the liver called bile.
what are the two types of surgery to remove the gallbladder
- keyhole (laparoscopic)
- open surgery (laparotomy)
where will the incision be from the cholecystectomy?
incision in your abdomen below your ribs on your right side.
what is bile
a fluid that is made and released by the liver and stored in the gallbladder. Bile helps with digestion. It breaks down fats into fatty acids
what is a bladder stone
hard lumps of minerals that can form inside the bladder when it’s not completely empty of urine.
symptoms of bladder stone
- bladder pain
- lower abdominal pain
- dark coloured urine
what is cellulitus
deep bacterial infection of the skin
how does cellulitus present
- redness
- swelling
- pain in area
- restricted ROM
what is the semi-recumbent position.
30-45 degree tilt of upper torso to help prevent ventilator acquired pneumonia
- open airways
what will lower lobe haziness present as on x-ray and why may she have this?
- haziness (white shadow across lower lobes)
- due to surgery she is liekly to have swelling in the lower abdominal region, in turn affecting lungs expansion
what is respiratory alkanosis fully compensated
- ph fine
- co2 fine
- bicarbonate low
- hyperventilation
What is patient controlled Anesthesia?
a type of pain management that lets you decide when you will get a dose of pain medicine.
How could you treat cellulitis in right lower limb
- keep leg elevated using cushion to reduce swelling and can alleviate pain
- drink plenty of fluids
- do foot pump exercises to maintain rom in ankle
what is cellulitis caused by
- usually by a bacterial infection
what is a ventilator
- machine that mechanically helps you breath
- can be invasive (intubated) or non-invasive (CPAP)
how would you assess secretion retention in lower lobes of lungs?
- auscultation (hear fine crackles lower lobes or diminished sounds)
- would be beneficial for chest x-ray
- risk of atelectasis
- vocal fremitus
- cough strength
how would you treat lower lobe secretion retention?
- due to surgery being yesterday, not acceptable to use postural drainage/chest percussion
- Teach ACBT techniques (thoracic expansion, diaphragmatic, FET)
- supported cough
what evidence supports the use of ACBT for secretion retention
- Zisi et al 2022
- explain aim, method, findings, conclusion
- ACBT is effective in increasing the expectorated sputum volume, in reducing viscoelasticity of the secretion.
- Amiel will therefore be able to clear secretions
How would you assess decreased exercise tolerance
- dysnoea scale
- respiratory rate (likely to be increased)
- outcome measure 30 second chair sit and stand - for her age 70 should be able to do 13. (use borg scale before and after or dyspneoa (breathlessness) scale)
How would you assess decreased chest expansion
- observe respiratory rate (likely to be increased)
- borg scale
- palpate accessory muscles looking for hypertrophy
How would you treat decreased chest expansion
- ACBT (thoracic expansion, FET and diaphragmatic)
- dyspneoa relieving positions
- do marching on the spot for 30 seconds, then perform the ACBT (supported by evidence from Bailey et al 2007)
what evidence supports the use of ACBT for chest expasnion
incentive spirometer, Zisi et al
what is haziness in chest x-ray
fluid collection between the lung and the chest wall appearing whiter than the lungs and making the sharp lung borders on the film hazier
- likely to be pleural effusion
what is pleural effusion
buildup of fluid between the layers of tissue that line the lungs and chest cavity.
what is cholecistis
inflammation caused by gallbladder stones
what is cholelithiasis
hardened depositis of digestive fluid formed in gallbladder (stones)
what is consolidation in chest
The consolidated parts of your lung look white, or opaque, on a chest X-ray.
- likely to be build of of fluid in small air sacs, such as pus, water, blood leading to pneumonia etc.
what are some post operative abdominal complications
- shock
- wound infection
- DVT
- pulmonary embolism
- urinary retention
- atelectasis
