Implications Flashcards
1
Q
Oesophagectomy
A
- No HDT
- Care with nasopharyngeal suction
- Limit neck motion
- Presents with ICC
2
Q
Nissen fundoplication
A
No nausea or vomiting
3
Q
Whipple’s procedure
A
- Patient may be malnourished due to cancer spread
- High risk of post-operative complications
4
Q
Abdominoperineal resection
A
- Must stay in supine, side-lying or high side-lying
- Must avoid sitting (except SOOB with customised sitting cushion)
- Encourage to mobilise day 1
- Transfer supine to standing and avoid symmetrical sitting positions
5
Q
Stoma
A
- Check level of fluid or gas in the colostomy bag prior to mobilising
- If full, notify nursing staff
- Supported cough only over wound, do not compress on stoma and bag
6
Q
General vascular surgery implications
A
- Assess circulation and pulses as part of assessment
- Monitor for signs of acute ishaemia
- Care during treatment with regard to exercises
- Adhere to any ROM limitations
- Use correct footwear
- Mobilse with reference to post-op claudication distance
- Patient with PVD should have sheepskin or bootees
- Complications:
- Post-op infection
- Aneurysm
- Thrombotic occlusion
7
Q
Fem-pop bipass
A
- Often see day 1 for chest care
- Mobilise day 1 or 2 depending on swelling and graft integrity
- Hip cannot exceed 60˚ fx when knee is extended
- Care when handling limb - avoid pressure over incision and graft sites
- Explain blood rushing sensation when they first sit up
- Encourage a normal gait pattern
8
Q
Axillo-femoral bypass
A
- Avoid shoulder fx >90˚
- Avoid hip fx >60˚
- Avoid sidelying
- Avoid pressure on graft during Ax/Rx
- Avoid use of overhead ring
- Advice re belts and bras (do not constrict flow in the graft
- Avoid constrictive clothing
- Avoid using axillary crutches with mobilisation
9
Q
Abdominal aneurysm repair
A
Preoperative:
- <6cm - limit cough/FET
- >6cm - no cough
Postoperative:
- High risk
- Potential to develop resp failure - intensive treatment for at least 5 days
- Effective pain relief and wound support
- No HDT
- Mobilise once CV stable, depending on condition
10
Q
Nasogastric tube
A
- Often pinned to pillow à DO NOT DISLODGE when sitting patient forward
- Ensure tube is well secured before mobilising
- Switch off NG feeds when suctioning or in HDT to avoid aspiration
- NG feeds can often be disconnected to mobilise à nursing staff
11
Q
Oxygen devices
A
- Check devices is being worn correctly
- Check correct concentration os being delivered
- Monitor SpO2 with pulse oximeter
- Mobilise post-op patients with portable O2 (if appropriate)
- If removed to mobilise, use portable pulse oximeter and ensure replaced on return
12
Q
Urinary catheter
A
- Ensure bag is not too full prior to mobilising
- Do not pull catheter out when mobilising
- Keep bag below level of the catheter
13
Q
Intravenous drip
A
- Care with arm exercises (do not dislodge)
- Care with bed mobility à limit movements on joints close to insertion (risk of tissuing)
- If patients c/o pain at drip site, report to medical team (sign of thrombophlebitis)
14
Q
Intercostal catheter
A
- Do not dislodge
- Check whether fluid is swinging, draining or bubbling
- Keep bottle system below level of insertion
- If bottle breaks, previously no bubbling: double clamp, quickly change bottles
- If bottle breaks, previously bubbling: no clamp, quickly change bottles
- If accidently disconnected, reconnect and assess system
15
Q
Wound drain
A
- Do not dislodge
- Care of infection - safe, appropriate handling
- Keep below level of wound
16
Q
Vaccum assited closure (VAC) system
A
- Do not dislodge
- Check with medical/nursing staff whether suction can be removed prior to mobilisation
- Ensure VAC unit is below level of wound to avoid reflux of drainage
- Beware of hissing noise (may indicated dressing is leaking)
17
Q
TED stockings
A
- Remove to expose legs for assessment of DVT and circulation
- Do not leave rolled around ankle as this can create a tourniquet
- Patient can ambulate with TEDs as long as shoes are worn
18
Q
Atelectasis
A
- Optimise pain relief
- Techniques to improve ventilation
- Encourage bed mobility and ambulation
19
Q
Pneumonia
A
- Optimise positioning
- Techniques to mobilise and remove secretions
- Supported cough
- Encourage bed mobility and ambulation
20
Q
Pulmonary oedema
A
- No role for PT
21
Q
Nausea and vomiting
A
- Time session with ant-emetic medication
- Ensure vomit bag handy
- If severe, do not mobilise
22
Q
DVT
A
- Prevent with circulatory exercise and early ambulation
- If present, rest in bed and consult medical staff prior to ambulation
23
Q
Acute ishaemia
A
- Monitor and maintain circulation
- Notify nursing and medical staff
- Document findings
24
Q
Wound dehiscence
A
- Always check prior to sitting/moving patient
- In an emergency
- Lie flat, elevate feet if necessary
- Hold wound with towel/sheet/pillowcase
- Summon help
- Patient usually returned to theatre asap
25
Q
Paralytic ileus
A
- Encourage standing or high sitting
- Encourage mobility to decrease collapse and start bowels moving again
26
Q
Post-op haemorrhage
A
- Lie patient flat
- Elevate feet if necessary
- Summon help
- Remain with patient until help arrives
27
Q
Perotinitis
A
- Time Rx with pain relief
- Maintain pulmonary function
- Short, frequent Rx
- High sitting might be difficult - consider standing
- Consider long-term re-conditioning program
28
Q
Ascites
A
- Maintain patient’s pulmonary function/prevent collapse
- Short, frequent Rx
