Post-Surgical Considerations

Question 1

Anesthesia can ________ breathing and can function as ________ lung disease

Answer 1

depress

restrictive

note: can lead to atelectasis

Question 2

What can you expect to see in a patient who has came off anesthesia

the effects are ____ dependent

Answer 2

weakness, fatigue, inability to ambulate very long

time dependent, the longer they were under anesthesia the more fatigue you can expect to see

Question 3

Part of the problem of patient’s under anesthesia is the ______, causing the diaphram to be pushed upward onto the lungs (restricting them)

Answer 3

Patient positioning

Note: airway may also be obstructed by tubes/fluids/secretions

Question 4

Anesthesia can reduce what capacities?

Answer 4

Total lung capacity

Functional Reserve capacity

Reserve Volume

Question 5

During anesthesia lung ________ is decreased

work of ____________________ is increased

Answer 5

Lung compliance - decreased

Work of breathing- increased

Note: Can lead to hypoxemi a

Question 6

Alveolar collapse leads to _______________

Answer 6

Intrapulmonary shunting

Question 7

Patient’s with low Ejection fraction are particularly at risk for complications from anesthesia due to ______________

Answer 7

Intra-operative CO2 consumption/delivery is decreased

Question 8

The template for progressing mobilization in surgical patients

Answer 8

Question 9

Before a patient can use Icentive Spirometry, first they need to be taught

Answer 9

Diaphramatic and segmental breathing

Question 10

Function and how to use incentive spirometry:

Answer 10

Patient takes SLOW deep breaths and aims for a goal of moving the yellow notch on the right upward. The yellow plug on the left should stay within the box on the left, this tells them that theyre breathing in at an appropriate speed.

Question 11

What is an Acapella used for?

Answer 11

Clearing secretions

Pt breaths in and then exhales into device, the device provides backwards pressure which lifts secretions out of airways

Question 12

You should only start using an inspiratory muscle trainer if…

Answer 12

Pt has mastered diaphramatic breathing w/ minimal accessory muscle use

and also (pt knows how to do pursed lip breathing if they’re a pink puffer)

Question 13

What is MIP and MEP?

Answer 13

MIP- Maximum inspiratory pressure

MEP- Maximal expiratory pressure

They are indications of peak inspiratory muscle STRENGTH

Note: Both obtained after 1 second of effort

Question 14

Positioning to max test inspiratory muscles?

Answer 14

Patient seated

nose clipped

Question 15

Inspiratory muscle trainer considerations

Answer 15

Only test max 3-4 times in a row, don’t keep repeating or patient may pass out

Alternative: Sniff pessure throough nose

Note: heck for a presence of a leak that may let pressure escape!

Question 16

Low MIP compared to norms is associated with

Answer 16

Higher likelihood of inspiratory muscle weakness

Question 17

If a patient is below norms on predicted MIP and MEP, then inspiratory muscle strength training is _____________

Answer 17

INDICATED

Question 18

The brain naturally wants to sent more muscles to __________ than skeletal muscles

Answer 18

Inspiratory muscles

Question 19

How can inspiratory muscle training increase skeletal muscle strength (example: legs)

Answer 19

If diaphram is fatigued the phrenic nerve senses the lactic acid levels and activates the sympathetic nervous system that reduces blood flow to extremities

less diaphram fatigue -> more blood flow to extremities

Question 20

Inspiratory muscle strength training parameters:

Answer 20

50-60% of MIP

twice per day (morning and evening 6 hours apart)

25-35 breaths per session

Question 21

Inspiratory muscle endurance training parameters

Answer 21

15-20% of MIP

30 mins per day

broken up into 60 sec intervals

Train twice per day 6 hours apart

Question 22

What does a high frequency chest wall oscilltation machine do

Answer 22

replaces vibration/percussion techniques

Question 23

What is a good precursor to getting a patient ready to walk, if they’re currently too weak to walk due to too much blood going to breathing muscles and not enough to legs?

Answer 23

Inspiratory muscle training!!