Surgeries Flashcards
what are some indications for abdominal surgery?
GI
liver
pancreas
kidneys
gynecologic
obstetric
genitourinary
hernia
what is considered an abdominal surgery?
anything below the diaphragm and above the pubic bone
what is a hernia?
a hole in any portion of the abdominal wall that causes a portion of the GI tract to push through the hole
what incisions make up the “Mercedes Benz” incision?
Kocher and Chevron incisions
what is a Mercedes Benz incision reserved for?
liver transplants
what is a Kocher incision?
incision made in the upper R abdomen for access to the liver, gallbladder, or pancreas
what is a Chevron incision?
incision made in the upper L abdomen for access to the spleen
what is a midline incision?
incision made through the center of the abdomen for access to the pancreas, stomach, colon, small/large intestine, some gyno procedures, and some genitourinary procedures
what is one of the most common abdominal incisions?
the midline incision
what is a Gridiron and Lanz incision?
an incision in the lower R abdomen for access to the appendix
what is a Pfannestiel incision?
a horizontal incision made down near the pubic bone for a C-section or open hysterectomy
what should we look for in incisions?
bleeding, drainage, and s/s of infection
drainage is common following surgery on what organ?
the liver
why is incision drainage common following liver surgery?
bc the liver is responsible for protein synthesis, so lots of edema may form and cause LE edema or ascites
what kind of drainage is normal?
clear, orderless drainage
what kind of drainage is worrisome?
thick, discolored, smelly drainage
what are post-op complications following abdominal surgery?
illeus
wound dehiscence
wound infection
pneumonia
DVT/PE
what is an illeus?
when normal peristalsis (contract of the GI tract to move content) isn’t working leading to blockage when food enters the GI system and doesn’t move
t/f: pts with an illeus are often NPO with a nasogastric tube to draw content out of the stomach
true
what is one of the best ways to relieve an illeus?
to get up and walk
t/f: pts need to pass gas/have a bowel movt b4 rehab after abdominal surgery to make sure there is no illeus
true
what are some risks for wound dehiscence?
DM, obesity, coughing, straining, trunk flex/rot, lifting, engaging the abdominals
why is pneumonia a risk, esp with higher abdominal surgeries?
bc they are pain inhibited and don’t take deep breaths which leads to poor ventilation of the lower lobes, making them a breeding ground for bacterial growth
why are there strict dietary progressions to follow post-abdominal surgery?
to prevent the risk of an illeus
what must a pt demonstrate following GI surgery b4 progressing to the next level of diet progression?
tolerance by way of passing gas or having a bowel movt
we are looking for an absence of ____, _____, and _____ when progressing diet following GI surgery
nausea, pain, vomiting
if a pt experiences nausea, pain, or vomiting after progressing their diet following GI surgery, what should we do?
regress to the previous level
what is the order or diet progression following GI surgery?
NPO–>clear liquids–>full liquids –>pureed–>soft food–>regular diet
what are some examples of clear liquids?
water, ice chips, apple juice, broth
any see through liquid
what are some full liquids
yogurt
any liquid that can’t be seen through
what is the difference between pt controlled analgesia (PCA) and patient controlled epidural analgesia (PCEA)?
PCA is delivered through a regular IV
PCEA is delivered through a very small catheter into the epidural space of the SC
why are PCA/PCEA usually locked in a box?
bc it is usually some kind of narcotic being delivered through it
what is a “locked out” time frame in a PCA/PCEA?
after a pt pushes the button there is about 10-20 minutes where they can’t deliver another dose
who has to push the button on a PCA/PCEA?
the pt
can the PT push the button on the PCA/PCEA?
nope, but we can remind them that they can use it before mobilizing them
why is a PCA/PCEA shown to improve mental state following surgery?
bc it gives pts a sense of control over their pain levels
what are typical abdominal precautions?
avoid spine flexion and rotation
avoid lifting more than 10 lbs
t/f: typical abdominal precautions are the same as lumbar spinal precautions
true
why are there abdominal precautions following abdominal surgery?
to avoid wound dehiscence
how long do pts usually have abdominal precautions following abdominal surgery?
4-6 weeks
what conditions will make healing after abdominal surgery longer?
DM and chronic cardiac conditions
if a pt had a laparoscopic surgery, how long will they have abdominal precautions?
2 weeks
what are abdominal binders?
a compression garment that is worn post abdominal surgery to provide support, compression, and pain relief
t/f: abdominal binders can be ordered to be worn all the time or when out of bed
true
can PT suggest an abdominal binder is not ordered already by the surgeon?
yup
t/f: in females, abdominal binders tend to rise up bw the ribs and pelvis making it ineffective
true
do abdominal binders tend to work better in males or females?
males
t/f: early mobility is the gold standard for any kind of abdominal surgery
true
what are the benefits of early mobility following abdominal surgery?
shorter LOS
decreased rates of DVT/PE
improved recovery of peristalsis (dec rate of illeus)
dec rate of pulmonary complications
when is early mobility started following abdominal surgery?
once the pt is awake, coherent, and has full sensation
what is a typical order for early mobility?
ambulate 5x/day
if someone is scared to get up and moving, what can we do?
explain the benefits of moving
do breathing exercises
talk to the pt
if a person is moving too much and is worn out, what can we do?
breathing exercises
pt education
RPE (3-4/10)
what RPE is the goal with early mobility?
3-4/10
how can we use pain relief techniques post abdominal surgery?
splinting over the incision
paired breathing (inhale to prepare, exhale with movt)
what are some post op pulmonary techniques we can use?
incentive spirometer
stacked breathing if the pt has pulmonary complications
why do we often give pts post abdominal surgery a walker the first time we get them up?
to prevent abdominals working too hard
what two things should we know about orthopedic surgeries?
WB and mobility orders
when does PT typically start after a TKA?
day 0
t/f: pts post TKA may be d/c day 0
true
t/f: TKA is typically 24 admit
true
if a pt had a femoral nerve block, what should we check?
quads fxn
what 2 anesthetic/analgesic blocks cause BL effects post TKA?
spinal block
epidural
t/f: adductor canal block effects quad fxn
false
what are the typical WB precautions following TKA?
WBAT with an AD
what are the AROM goals post TKA?
0-90 deg
what is involved in mobility training post-TKA?
bed mobility
transfers
walking
stairs
car transfers
what do we want to promote post TKA?
knee extension
to promote knee extension post-TKA, what can we teach?
no towel/pillow under the knee
no sitting in knee flexion more than 30 minutes
t/f: exercises are not a huge emphasis for acute post TKA
true
when does PT typically start post THA?
day 0
t/f: pts post THA may d/c day 0
true
t/f: THA is typically a <24 hours admit
true
what anesthesias/analgesia may be used post TKA?
femoral nerve block
adductor canal block
spinal block
epidural
what anesthesia/analgesia may be used post THA?
spinal algesia
epidural analgesia
femoral nerve block
obturator nerve block
what are posterior hip precautions?
no hip flexion >90 deg
no hip add
no hip IR
what are anterior hip precautions?
no hip ext beyond neutral
no hip ER
why do we often say that there are no anterior hip precautions?
bc the precautions are unusual movts that pts don’t typically have to do
what are typical WB orders post THA?
WBAT with an AD
what are the components of education post THA?
hip precautions as relevant
ambulation program
exercises (basic and simple)
s/s of infection, DVT
what is the most common unplanned ortho procedure?
hip fx fixation
t/f: pts need to WB to promote healing with a dynamic hip screw
true
are there hip precautions with parallel implants, sliding hip screws, or intermedulary nails?
nope
what are the likely precautions following hemi or total arthroplasty?
posterior hip precautions
t/f: there is a high risk of dislocation if not following hip precautions
true
why is it harder to get a good fit for an arthroplasty following hip fracture than with elective surgery?
bc of poor bone quality and lack of pre-planning
where do we typically see hip fractures?
in the elderly
hip fx usually results from ____
falls
t/f: there is a high rate of morbidity and one year mortality following hip fx
true
t/f: WB are the same for each procedure
false, they vary
t/f: hip fx are often complicated by comorbidity
true
t/f: there is a high fall risk following hx surgery
true
t/f: there is more risk for dislocation with hx fracture surgery than elective hip surgery
true
what is polytrauma?
multiple injuries to multiple systems caused by some traumatic event (most often MVA, fall, or violence)
what are the effects of blood loss to look out for?
dizziness, fatigue, light headedness, heavy limbs, OH
what are critical hemoglobin levels?
less than 7
