lecture 12 - Surgical Flashcards
Ectomy
To remove
eg. Lobectomy = removal of the lobe of the lung
oplasty
To reconstruct
eg. rhinoplasty = reconstruction of nose
Ostomy
To make an opening
eg. Tracheostomy = to make an opening in the trachea
Otomy
To cut into
Phlebotomy = cutting into a blood vessel
scopy
To examine by inserting a scope
eg. colonoscopy = examining the colon by inserting a scope
What are 4 common thoracic surgeries
What are 3 abdominal and thoracic incision examples
What are 3 goals of preoperative evaluation
ASA Physical Status Classification System Purpose
System is to assess and communicate a patients pre-anesthesia medical co-morbidities. It does not alone predict preoperative risk, but is used with other factors (type of surgery, frailty, level of deconditioning) that can be helpful in predicting perioperative risks
DONT STUDY
What are the 6 ASA Physical status classification system levels
DONT STUDY
What are some 10 examples of potential pre-operative investigations
What are 6 challenges of physiotherapist in the pre-operative period?
-Patients can be coming in for anything so might not be in scope of practice for PT’s
-Pre-operative clinics have reduced space
-Patients worried about surgery, not the functional aspects of surgery at this time
-Timing does not align with surgeries
-Negotiating with other healthcare providers for the patients time before surgery
-Funding not set up for many surgeries for prehab (no public coverage would have to be private)
What are major factors predisposing patients to develop cardiac and pulmonary complications (9)
What are the effects of anesthesia on the cardiovascular system (4)
What are the effects of anesthesia on the respiratory system (7)
Can anesthesia impact psychomotor function?
Yes
What are the 4 primary effects of upper abdominal or thoracic incisions on the pulmonary system and its impact
**Taken together, these changes result in decreased ventilation in the dependent lung zones -> leads to increased ventilation -perfusion mismatch and hypoxemia
NOTE: lower FRC is cause incision acts as a restriction to increase lung capacity
What are 5 important considerations for patients post-surgery
Describe airway and breathing changes due to incisions (summar)
What are the expected IPPA findings and factors that would put individual at risk for post-op cardiopulmonary complications?
**Do motor and sensory testing on patient’s with epidural to ensure the epidural is in the right spot and doesn’t cause loss of motor and sensory function
Negative Factors:
-Age
-General Anesthesia
-Past TIA
-Location of incision (abdominal)
-Bladder cancer
-Smoking
-Sedentary
-Length of surgery and in supine position (lying flat causes hypoventilation because abdomen pushes on lungs
-Stairs at house
Positive Factors:
-Independent without gait aid (can use gait aid but cant put weight through -> fitted properly)
-Pain is minimal
-Oriented and awake
I: Lines and tubes (nasal prongs, catheter, epidural, IV, SPO2, telemetry, arterial line, NG tube, incisional draining) Incision (sutures and dressings), might use accessory muscles and not diaphragm for breathing (dont want to pull on incision = apical instead of diaphragmatic breathing pattern -> shallower faster breaths), weak cough
P: Breath rate (incision may reduce), chest wall expansion (more pump-handle than bucket handle)
P: Would do if found something funny in auscultation (not a high priority) -> dull lower lobes
A: Fine crackles in lower lobes (atelectasis)
What is a bleb?
Bulged out alveoli that may burst and cause a pneumothorax
What are neurological post-surgical complications
What are cardiovascular and hematological post-surgical complications
What are respiratory post-surgical complications
Hypoxemia-> low levels of oxygen
Hypercapnia -> high levels of carbon dioxide
What are renal post-surgical complications
What are gastro-intestinal post-surgical complications
What are integumentary post-surgical complications
What are 6 other post-surgical complications that could occur
Atelectasis
What are 3 causes of atelectasis
What are 3 clinical presentations for atelectasis
What is the physiotherapy management for atelectasis
It depends on what we can treat:
-Breathing strategies to improve breathing and ventilation
-Get mucous plug out
-Cannot fix a collapsed lung. Only can work on it if pneumothorax is treated to help with lung expansion
-Cannot treat tumors or blockage
Pulmonary Edema
Hydrostatic pressure
Osmotic pressure
What are 3 factors that determine the flow of fluid in the lungs
Explain the Starling equation
DONT NEED TO KNOW
What is normal about the capillary endothelium in terms of osmotic and and hydrostatic pressure
What are 4 factors that can cause pulmonary edema to occur
What are 2 major types of pulmonary edema
What is the clinical presentation and course of pulmonary edema (5)
Orthopnea: Cant breathe well lying down
What does physiotherapy management look like for pulmonary edema?
Can suction to keep airway clear but will just keep coming back (maintenance). Needs to be treated before we can help them. Cannot treat pulmonary edema by itself as it needs to be addressed medically.
Pulmonary embolism and lung infarction
Where do pulmonary embolism (thrombi) mainly form
In the lower extremities (deep vein thrombosis)
What are 4 causes of deep vein thrombosis and pulmonary embolism
T or F: In some cases of pulmonary embolism/deep vein thrombosis lung tissue can be totally blocked
True <10% -> causes infarction and necrosis of lung parenchyma
What are 5 clinical presentations of pulmonary embolism and lung infarction
What is the physiotherapy management for pulmonary embolism and lung infarction?
We cant treat
Describe V/Q Mismatching between atelectasis, normal, and pulmonary embolism
Describe Dean’s Hierarchy for treatment of patients with impaired oxygen transport (post-op care)
What are 8 common postoperative PT treatment regimens
-Sitting up, maybe standing or walking
-Ankle and foot pumps
-Education on rehab process and your role
-Breathing exercises (decrease hypoventilation atelectasis)
What is the treatment for secretion retention
**Dont really need to know
What is the active cycle of breathing technique (ACBT)
Incorporates breathing control, thoracic expansion exercises and huffing to mobilize and clear bronchial secretions through:
1) Breathing control: Diaphragmatic breathing at normal volumes
2) Thoracic expansion: Deep inspiration and hold with unforced expiration
**Look at circle for steps
What is the proposed mechanism by which ACBT/FET results in secretion clearance?
Huffing = coughing with an open glottis
What are 2 techniques that PT’s use post-op on the chest?
- Percussion/Vibration
- Postural Drainage
Postural drainage
Uses gravity to drain bronchopulmonary segment (position depends on anatomical position of airways)
Describe positive expiratory pressure (PEP)
Helps remove secretion clearance
What are 3 types of PEP?
Describe the 5 steps to PEP
1) Inspiration: Through mask/mouthpiece to TV or slightly above
2) Expiration: Slightly active, through mouth against resistor to create back pressure
3) Breathe 12-15x with device
4) Huff/cough to clear secretions
5) Repeat 5-6 cycles or until secretions are cleared
What is oscillating PEP
What are the 6 steps to Oscillating PEP technique
What are 5 discharge criteria for post-operative PT
