Post-Surgical Considerations Flashcards
Anesthesia can ________ breathing and can function as ________ lung disease
depress
restrictive
note: can lead to atelectasis
What can you expect to see in a patient who has came off anesthesia
the effects are ____ dependent
weakness, fatigue, inability to ambulate very long
time dependent, the longer they were under anesthesia the more fatigue you can expect to see
Part of the problem of patient’s under anesthesia is the ______, causing the diaphram to be pushed upward onto the lungs (restricting them)
Patient positioning
Note: airway may also be obstructed by tubes/fluids/secretions
Anesthesia can reduce what capacities?
Total lung capacity
Functional Reserve capacity
Reserve Volume
During anesthesia lung ________ is decreased
work of ____________________ is increased
Lung compliance - decreased
Work of breathing- increased
Note: Can lead to hypoxemi a
Alveolar collapse leads to _______________
Intrapulmonary shunting
Patient’s with low Ejection fraction are particularly at risk for complications from anesthesia due to ______________
Intra-operative CO2 consumption/delivery is decreased
The template for progressing mobilization in surgical patients
Before a patient can use Icentive Spirometry, first they need to be taught
Diaphramatic and segmental breathing
Function and how to use incentive spirometry:
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.
What is an Acapella used for?
Clearing secretions
Pt breaths in and then exhales into device, the device provides backwards pressure which lifts secretions out of airways
You should only start using an inspiratory muscle trainer if…
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)
What is MIP and MEP?
MIP- Maximum inspiratory pressure
MEP- Maximal expiratory pressure
They are indications of peak inspiratory muscle STRENGTH
Note: Both obtained after 1 second of effort
Positioning to max test inspiratory muscles?
Patient seated
nose clipped
Inspiratory muscle trainer considerations
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!
Low MIP compared to norms is associated with
Higher likelihood of inspiratory muscle weakness
If a patient is below norms on predicted MIP and MEP, then inspiratory muscle strength training is _____________
INDICATED
The brain naturally wants to sent more muscles to __________ than skeletal muscles
Inspiratory muscles
How can inspiratory muscle training increase skeletal muscle strength (example: legs)
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
Inspiratory muscle strength training parameters:
50-60% of MIP
twice per day (morning and evening 6 hours apart)
25-35 breaths per session
Inspiratory muscle endurance training parameters
15-20% of MIP
30 mins per day
broken up into 60 sec intervals
Train twice per day 6 hours apart
What does a high frequency chest wall oscilltation machine do
replaces vibration/percussion techniques
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?
Inspiratory muscle training!!
