Pre and Post-Op Ax Flashcards
1
Q
Pain is responsible for…
A
- poor cough
- impaired ability to breath deeply
- respiratory distress
2
Q
Narcotic complications
A
- resp depression
- postural hypotension
- nausea, vomiting
- drowsiness
- paralytic ileus
- pruritis
- urinary retention
3
Q
Post-op P/E
A
- observation
- environment
- attachments
- medication
- wound location and dressings
- palpation
- auscultation
- +/- cough
- LL
- DVT
- circulation
- special Ax
- epidural (site, sensation, muscle strength)
- readiness to mobilise
4
Q
IV considerations
A
- which arm?
- check length
- do not dislodge
- check if attached to patient/bed
5
Q
Wound drain considerations
A
- where
- what
- drainage
- suction
- check length
- do not dislodge
- check if attached to patient/bed
6
Q
NGT considerations
A
- suction?
- check length
- do not dislodge
- check if attached to patient/bed
7
Q
Colostomy/ileostomy considerations
A
- check leakages
- may need to empty prior to mobilising/rolling
- check length
- do not dislodge
- check if attached to patient/bed
8
Q
Effect of surgery on resp function
A
- decreased lung volumes
- decreased VC
- decreased FRC
- increased CC
- decreased mucociliary function
- decreased diaphragm excursion
9
Q
Signs of PPCs (4+)
A
- CXR evidence
- temp >38º after day 1
- raised WCC
- SpO2 <90% ORA
- new production of yellow/green sputum
- Dx of pneumonia/chest infection
- readmission/long stay in ICU w resp problems
- new auscultation signs
10
Q
Cause of absorption atelectasis
A
- blockage of bronchus/bronchiole
- high FiO2 (decreased nitrogen)
11
Q
Causes of surfactant atelectasis
A
- anaesthesia
- supp O2 (dry)
- mechanical ventilation
12
Q
Risk factors for atelectasis
A
- surgery
- no deep breaths/sighs
- pain
- increased secretions
- decreased surfactant
- poor positioning
- oxygen therapy
- mechanical ventilation
- smoking history
- obesity
13
Q
Risk factors for impaired muscociliary clearance
A
- drying of mucosa
- dehydration
- high FiO2
- positive pressure ventilation
- ETT
- atelectasis, decreased lung volume
- decreased cough effectiveness
- lack of sleep
14
Q
Patient specific PPC risk factors
A
- age >60y
- resp or cardiac disease
- smoking history
- functional status
- ASA score 3-5
- impaired nutritional status
- cancer
- immunocompromised
- impaired cognitive function
- serum albumin <3g/dL
- sleep apnea
15
Q
Surgical PPC risk factors
A
- GA
- drying of cilia
- secretion retention
- loss of cough refex
- decreased FRC
- resp inhibition
- atelectasis
- decreased alveolar ventilation
- Surgery
- type (abdominal, Tx, neuro, head and neck, vascular, aortic aneurysm
- duration >3h
- emergency (vs elective)
16
Q
Post-op P/I
A
- special Qs
- nausea
- vomiting
- drowsiness
- dizziness
- pain
- at rest/mvt/cough
- timing and nature of pain relief
- cough
- performed?
- productive?
- SOB
- current vs usual
- smoking history
- +/- epidural Qs
- P/N
- numbness
- weakness
- heaviness
- headache
17
Q
Pre-op P/I
A
- main problem
- breathlessness
- cough, sputum, wheeze
- pain
- PMHx
- FHx
- SHx
- special Qs
18
Q
Pre-op P/E
A
- observation
- palpation
- auscultation
- cough
- LL
- bed mobility and function
- special Ax
19
Q
Pre-op education
A
- role of PT
- expected post-op presentation
- effects of surgery/GA/pain on CR system
- early mob program
- importance of pain relief
20
Q
Pre-op demonstation
A
- breathing ex
- supported cough
- FET
- circulation ex
- bed mob and transfers
- specific ex
21
Q
DVT risk factors
A
- DVT history
- smoking Hx
- immobilisation
- oral contraceptions
- previos pelvic or LL surgery
- malignancy
22
Q
Effects of immobility
A
- decreased lung volume
- hypoxaemia
- deconditioning
- decreased CO/SV, increased HR
- orthostatic intolerance
- pressure changes
- MSK changes
