Exam case studies Flashcards
1
Q
54 year old lady who underwent elective L hemi-colectomy
A
- Removes the left-hand portion of the colon (large intestine)
- altered diet/drinks prior to surgery- dehydration
- can be performed via a laparotomy
2
Q
55 year old gentleman with oesophageal carcinoma undergoing an oesophagogastrostomy
A
- removal of the lower portion of the oesophagus and the stomach
- if thoracic extension for oesophagogastrostomy is involved a left thoracotomy is performed
- undernourished preoperatively- affect anastomotic healing and postoperative progress
- head-down position is avoided to prevent gastric reflux and potential aspiration
3
Q
23 year old woman with asthma who yesterday delivered a baby via C-section
A
- spinal block: access limb sensation and motor
* Pubic incision
4
Q
Mr C admitted to hospital with a diagnosis of acute pneumonia affected left lower lobe
A
- lung inflammation caused by a bacterial/viral infection, in which alveoli fill with sputum and may consolidate
- sputum sample- indicate antibiotics
- positioning- (lateral) side lying on R, 30 degrees tilted and arm lifted above head
5
Q
62 year old gentleman who underwent an emergency laparotomy for a burst duodenal ulcer
A
- duodenal ulcer: peptic ulcer that develops in the small intestine
- open sore occurs when protective mucus lining of the wall of the intestine breaks down
- caused by a bacterium called helicobacter pylon
- or long-term NSAIDS e.g. aspirin- increases risk
- Laparotomy: one large incision in the abdomen
- Midline (incision runs down the middle of the abdomen) standard incision for laparotomy.
6
Q
21 year old with CF in hospital awaiting a heart lung transplant
A
- thoracic organ transplantation is indicated in patients with end-stage diseases where survival is limited and quality of life poor
- performed via a median sternotomy or a clamshell incision (transverse sternotomy)
- preoperative management- optimise physical and functional performance and quality of life. Addressing the deconditioning results for CF
- exercise training, psychosocial support
7
Q
A 68 year old man following a CABG x3 yesterday
A
- A coronary artery bypass graft is a surgical procedure used to treat coronary heart disease: triple bypass
- Diverts blood around severely narrowed/blocked arteries to improve blood flow and O2 supply to the heart
- blood vessel from another part of the body (chest, internal mammary artery) attached above and below coronary artery blockage.
- number of grafts needed depend on how severe the disease is and number of coronary arteries narrowed
- usually takes between 3-6 hours
treatment-
- education on lifestyle changes- healthy diet and regular exercise
- cardiac rehabilitation- incorporate thoracic exercises as they reduce sternal pain
- patients with sternal instability should be prescribed bilateral upper limb exercises
- treadmill training
8
Q
A 62 year old female with diabetes has undergone a R below knee amputation
A
85% Type II diabetes
- factors lead to amputation- neuropathy, circulation problems, foot ulcers, other damage to foot
- look out for any signs of damage to the foot
- metabolic disease that causes hypo/hyper blood glucose levels. insufficient production/use of insulin
9
Q
A 40 year old women with alpha 1-antirypsin deficiency emphysema has had lung volume reduction surgery and is 4 days post operation
A
LVR
- approach which removes most damaged areas of the lung. Removing the enlarged lung air sacs that occur in emphysema. less air is trapped so breathing is more efficiency
- improvements in dyspnoea and lung function for around 3.5 years
- reduction in hyperventilation, allows increase in inspiratory muscle strength and decreases elastic load imposed by chest wall
Alpha 1-antitryspin deficiency-
- rare, inherited condition
- lack of the enzyme inhibitor AAT
- increased risk of lung disease. more likely to develop COPD at a younger age and may progress more rapidly
- enzymes break down surrounding healthy lung (alveoli)- as lack of AAT to prevent this
- education on stopping smoking?
