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DPT 629: Cardio > Surgeries > Flashcards

Surgeries Flashcards

1
Q

what are some indications for abdominal surgery?

A

GI

liver

pancreas

kidneys

gynecologic

obstetric

genitourinary

hernia

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2
Q

what is considered an abdominal surgery?

A

anything below the diaphragm and above the pubic bone

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3
Q

what is a hernia?

A

a hole in any portion of the abdominal wall that causes a portion of the GI tract to push through the hole

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4
Q

what incisions make up the “Mercedes Benz” incision?

A

Kocher and Chevron incisions

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5
Q

what is a Mercedes Benz incision reserved for?

A

liver transplants

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6
Q

what is a Kocher incision?

A

incision made in the upper R abdomen for access to the liver, gallbladder, or pancreas

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7
Q

what is a Chevron incision?

A

incision made in the upper L abdomen for access to the spleen

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8
Q

what is a midline incision?

A

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

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9
Q

what is one of the most common abdominal incisions?

A

the midline incision

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10
Q

what is a Gridiron and Lanz incision?

A

an incision in the lower R abdomen for access to the appendix

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11
Q

what is a Pfannestiel incision?

A

a horizontal incision made down near the pubic bone for a C-section or open hysterectomy

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12
Q

what should we look for in incisions?

A

bleeding, drainage, and s/s of infection

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13
Q

drainage is common following surgery on what organ?

A

the liver

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14
Q

why is incision drainage common following liver surgery?

A

bc the liver is responsible for protein synthesis, so lots of edema may form and cause LE edema or ascites

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15
Q

what kind of drainage is normal?

A

clear, orderless drainage

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16
Q

what kind of drainage is worrisome?

A

thick, discolored, smelly drainage

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17
Q

what are post-op complications following abdominal surgery?

A

illeus

wound dehiscence

wound infection

pneumonia

DVT/PE

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18
Q

what is an illeus?

A

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

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19
Q

t/f: pts with an illeus are often NPO with a nasogastric tube to draw content out of the stomach

A

true

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20
Q

what is one of the best ways to relieve an illeus?

A

to get up and walk

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21
Q

t/f: pts need to pass gas/have a bowel movt b4 rehab after abdominal surgery to make sure there is no illeus

A

true

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22
Q

what are some risks for wound dehiscence?

A

DM, obesity, coughing, straining, trunk flex/rot, lifting, engaging the abdominals

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23
Q

why is pneumonia a risk, esp with higher abdominal surgeries?

A

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

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24
Q

why are there strict dietary progressions to follow post-abdominal surgery?

A

to prevent the risk of an illeus

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25
Q

what must a pt demonstrate following GI surgery b4 progressing to the next level of diet progression?

A

tolerance by way of passing gas or having a bowel movt

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26
Q

we are looking for an absence of ____, _____, and _____ when progressing diet following GI surgery

A

nausea, pain, vomiting

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27
Q

if a pt experiences nausea, pain, or vomiting after progressing their diet following GI surgery, what should we do?

A

regress to the previous level

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28
Q

what is the order or diet progression following GI surgery?

A

NPO–>clear liquids–>full liquids –>pureed–>soft food–>regular diet

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29
Q

what are some examples of clear liquids?

A

water, ice chips, apple juice, broth

any see through liquid

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30
Q

what are some full liquids

A

yogurt

any liquid that can’t be seen through

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31
Q

what is the difference between pt controlled analgesia (PCA) and patient controlled epidural analgesia (PCEA)?

A

PCA is delivered through a regular IV

PCEA is delivered through a very small catheter into the epidural space of the SC

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32
Q

why are PCA/PCEA usually locked in a box?

A

bc it is usually some kind of narcotic being delivered through it

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33
Q

what is a “locked out” time frame in a PCA/PCEA?

A

after a pt pushes the button there is about 10-20 minutes where they can’t deliver another dose

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34
Q

who has to push the button on a PCA/PCEA?

A

the pt

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35
Q

can the PT push the button on the PCA/PCEA?

A

nope, but we can remind them that they can use it before mobilizing them

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36
Q

why is a PCA/PCEA shown to improve mental state following surgery?

A

bc it gives pts a sense of control over their pain levels

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37
Q

what are typical abdominal precautions?

A

avoid spine flexion and rotation

avoid lifting more than 10 lbs

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38
Q

t/f: typical abdominal precautions are the same as lumbar spinal precautions

A

true

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39
Q

why are there abdominal precautions following abdominal surgery?

A

to avoid wound dehiscence

40
Q

how long do pts usually have abdominal precautions following abdominal surgery?

A

4-6 weeks

41
Q

what conditions will make healing after abdominal surgery longer?

A

DM and chronic cardiac conditions

42
Q

if a pt had a laparoscopic surgery, how long will they have abdominal precautions?

A

2 weeks

43
Q

what are abdominal binders?

A

a compression garment that is worn post abdominal surgery to provide support, compression, and pain relief

44
Q

t/f: abdominal binders can be ordered to be worn all the time or when out of bed

A

true

45
Q

can PT suggest an abdominal binder is not ordered already by the surgeon?

A

yup

46
Q

t/f: in females, abdominal binders tend to rise up bw the ribs and pelvis making it ineffective

A

true

47
Q

do abdominal binders tend to work better in males or females?

A

males

48
Q

t/f: early mobility is the gold standard for any kind of abdominal surgery

A

true

49
Q

what are the benefits of early mobility following abdominal surgery?

A

shorter LOS

decreased rates of DVT/PE

improved recovery of peristalsis (dec rate of illeus)

dec rate of pulmonary complications

50
Q

when is early mobility started following abdominal surgery?

A

once the pt is awake, coherent, and has full sensation

51
Q

what is a typical order for early mobility?

A

ambulate 5x/day

52
Q

if someone is scared to get up and moving, what can we do?

A

explain the benefits of moving

do breathing exercises

talk to the pt

53
Q

if a person is moving too much and is worn out, what can we do?

A

breathing exercises

pt education

RPE (3-4/10)

54
Q

what RPE is the goal with early mobility?

A

3-4/10

55
Q

how can we use pain relief techniques post abdominal surgery?

A

splinting over the incision

paired breathing (inhale to prepare, exhale with movt)

56
Q

what are some post op pulmonary techniques we can use?

A

incentive spirometer

stacked breathing if the pt has pulmonary complications

57
Q

why do we often give pts post abdominal surgery a walker the first time we get them up?

A

to prevent abdominals working too hard

58
Q

what two things should we know about orthopedic surgeries?

A

WB and mobility orders

59
Q

when does PT typically start after a TKA?

A

day 0

60
Q

t/f: pts post TKA may be d/c day 0

A

true

61
Q

t/f: TKA is typically 24 admit

A

true

62
Q

if a pt had a femoral nerve block, what should we check?

A

quads fxn

63
Q

what 2 anesthetic/analgesic blocks cause BL effects post TKA?

A

spinal block

epidural

64
Q

t/f: adductor canal block effects quad fxn

A

false

65
Q

what are the typical WB precautions following TKA?

A

WBAT with an AD

66
Q

what are the AROM goals post TKA?

A

0-90 deg

67
Q

what is involved in mobility training post-TKA?

A

bed mobility

transfers

walking

stairs

car transfers

68
Q

what do we want to promote post TKA?

A

knee extension

69
Q

to promote knee extension post-TKA, what can we teach?

A

no towel/pillow under the knee

no sitting in knee flexion more than 30 minutes

70
Q

t/f: exercises are not a huge emphasis for acute post TKA

A

true

71
Q

when does PT typically start post THA?

A

day 0

72
Q

t/f: pts post THA may d/c day 0

A

true

73
Q

t/f: THA is typically a <24 hours admit

A

true

74
Q

what anesthesias/analgesia may be used post TKA?

A

femoral nerve block

adductor canal block

spinal block

epidural

75
Q

what anesthesia/analgesia may be used post THA?

A

spinal algesia

epidural analgesia

femoral nerve block

obturator nerve block

76
Q

what are posterior hip precautions?

A

no hip flexion >90 deg

no hip add

no hip IR

77
Q

what are anterior hip precautions?

A

no hip ext beyond neutral

no hip ER

78
Q

why do we often say that there are no anterior hip precautions?

A

bc the precautions are unusual movts that pts don’t typically have to do

79
Q

what are typical WB orders post THA?

A

WBAT with an AD

80
Q

what are the components of education post THA?

A

hip precautions as relevant

ambulation program

exercises (basic and simple)

s/s of infection, DVT

81
Q

what is the most common unplanned ortho procedure?

A

hip fx fixation

82
Q

t/f: pts need to WB to promote healing with a dynamic hip screw

A

true

83
Q

are there hip precautions with parallel implants, sliding hip screws, or intermedulary nails?

A

nope

84
Q

what are the likely precautions following hemi or total arthroplasty?

A

posterior hip precautions

85
Q

t/f: there is a high risk of dislocation if not following hip precautions

A

true

86
Q

why is it harder to get a good fit for an arthroplasty following hip fracture than with elective surgery?

A

bc of poor bone quality and lack of pre-planning

87
Q

where do we typically see hip fractures?

A

in the elderly

88
Q

hip fx usually results from ____

A

falls

89
Q

t/f: there is a high rate of morbidity and one year mortality following hip fx

A

true

90
Q

t/f: WB are the same for each procedure

A

false, they vary

91
Q

t/f: hip fx are often complicated by comorbidity

A

true

92
Q

t/f: there is a high fall risk following hx surgery

A

true

93
Q

t/f: there is more risk for dislocation with hx fracture surgery than elective hip surgery

A

true

94
Q

what is polytrauma?

A

multiple injuries to multiple systems caused by some traumatic event (most often MVA, fall, or violence)

95
Q

what are the effects of blood loss to look out for?

A

dizziness, fatigue, light headedness, heavy limbs, OH

96
Q

what are critical hemoglobin levels?

A

less than 7

DPT 629: Cardio (12 decks)

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