CVR - surgery pt Flashcards
What are the aims of pre-op physio review?
Understand pts per-op mobility, functional level and social circumstances
Identify pts at high risk of post-op respiratory complications
Teach bed exercises
What are the aims of a post-op physio assessment/review?
Improve V/Q mismatch
Prevent/minimise atelectasis by restoring FRC
Maintain effective clearance of bronchial secretions
Restore mobility and confidence
What precautions should be taken after surgery?
No pushing through arms
No pulling
No lifting heavyweights
What physio options are available after surgery?
- positioning
- mobilise
- ACBT
- humidification
- incentive spirometry
- intermittent positive pressure breathing
- continuous positive airway pressure
- suctioning
What are the benefits of positioning post-op pts?
- avoid slumping and encourage high sitting
- increases:
1. Tidal volume
2. Total lung capacity
3. Vital capacity
4. FRC
5. Mobilisation of secretions
What are the benefits of mobilising post-op pts?
Combines the advantages of an upright posture with a natural increase in tidal volume (deep breathing)
All post-op pts should be out of bed on the first day and mobilised ASAP
Increase mobilisation of secretions
Why is ACBT used and what does it include?
ACBT is used to mobilise and clear excess secretions
Technique compromises a cycle of:
- breathing control
- thoracic expansion exercises (deep breathing)
- forced expiration technique (huffs)
What additional points can be added to the ACBT for post-op pts?
- breathing control as before
- thoracic expansion exercises have an additional sniff and 3-second hold
- forced expiratory technique have a splinted huff and cough
Why do you add an extra sniff to the TEE for post-op pts?
Achieves an additional increase in lung volume
Aims to decrease atelectasis (collapse or closure of a lung) and restore lung volume
Why do you use splinting when performing ACBT + FET
Pts can use a pillow or towel to support their wound as many post-op pts are reluctant to cough due to pain or fear of bursting their stitches
What causes dehydration in post-op pts?
- dry theatre gases
- restricted fluid intake
- dry oxygen
What are the most common humidification methods?
Systemic humidification by oral hydration intake is the most effective form of humidification
When this is ineffective:
- nebulised humidification
- humidified oxygen are used
What are the benefits of incentive spirometry and who would it benefit?
Provides pt with visual feedback on inspiratory effort and volume.
The purpose of incentive spirometry is to facilitate a sustained slow deep breath.
It is designed to encourage patients to take slow, deep breaths.
May be appropriate for lung re-expansion following major thoracic surgery
What are the differences between IPPB and CPAP?
Patient triggered inspiratory positive pressure device only during inspiration
Continuous positive airway pressure provides a constant flow of gas throughout inspiration and expirations
When would suctioning be used and what are the 3 main ways of carrying it out?
Occasionally used on no-intubated patients who have retained secretions and where previous treatments have failed
Used when pts have an inability to cough effectively and expectorate secretions
- nasopharyngeal
- oropharyngeal
- mini-tracheostomy
