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
