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CARDIO EOS > Surgery ILP > Flashcards

Surgery ILP Flashcards

1
Q

Pre-op medications implications for physio

A
  • patient may be drowsy, impaired coordination, impaired memory
  • may affect pre-op assessment
  • pts should be assessed/treated prior to medication
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2
Q

General Anaesthesia adverse effects

A 
Impaired ventilation 
- respiratory inhibition
- reduced FRC
- atelectasis 
- V/Q mismatch - hypoxaemia 
Impaired airway clearance 
- loss of cough 
- drying of cilia - impaired mucociliary clearance
- secretion retention
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3
Q

GA physiotherapy implications

A

GA has greater respiratory effects

  • > 20 minutes - greater chance of hypoxaemia
  • > 30 minutes - greater chance of DVT
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4
Q

Epidural anaesthesia

A
  • catheter in epidural space
  • blocks pain below level, muscle power should stay intact, respiratory system intact
  • can also be pt controlled (PCEA)
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5
Q

Epidural anaesthesia physio implications

A
  • catheter may remain in-situ for post-op pain management
  • pt - controlled bolus should be used 20 minutes prior to physio treatment
  • observe epidural site for signs of redness, leaking, swelling, haematoma, muscle strength in LL
  • report any new muscle loss to medical team
  • check BP for hypotension prior to mobilising
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6
Q

Spinal anaesthesia

A

Catheter in subarachnoid space, blocks sensory, motor and pain inputs of that level, respiratory system intact

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7
Q

Spinal anaesthesia physio implications

A

As dura is punctured pt may report a headache, caused by CSF leakage, pt remain in supine until symptoms resolve

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8
Q

Nerve block

A

Injections of local anaesthesia close to the nerve, motor and sensory block

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9
Q

Nerve block physio implications

A

Patients may have residual analgesia and loss of sensation and motor function in innervated area

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10
Q

Patient Controlled Analgesia (PCA)

A 
background infusion rate + pt controlled bolus with lockout period 
usually narcotics (morphine, fentanyl combined with ketamine and clonidine)
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11
Q

Narcotics adverse effects

A 
Respiratory depression (RR<8bpm)
Postural hypotension, syncope
Drowsiness
Nausea, vomiting
Paralytic Ileus
pruritis/itchiness
urinary retention
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12
Q

PCA - implications for physio

A
  • encourage pt to deliver pain relief at beginning of assessment and throughout management
  • Monitor pts respiratory rate and SpO2 to ensure breathing is not becoming depressed
  • carry vomit bag when mobilising
  • If drowsy and unable to mobilise notify medical staff for review of medication
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13
Q

Epidural side effects

A

Hypotension (SBP <90mmHg)
Sedation
Respiratory depression (<8bpm)
Motor and sensory loss of upper and lower limbs
Urinary retention
Infection, haemmorhage, inflammation, displacement of catheter
Epidural haematoma

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14
Q

Oesophagectomy

A

Oesophageal carcinoma or perforation
Removal of all or part of oesophagus
Ivor Lewis - upper abdominal incision, R) posterolateral thoracotomy
Thorascopic-assisted - abdominal incision and 4-5 port incisions posteriorly

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15
Q

Oesophagectomy physio implications

A
  • avoid HDT for gastric reflux
  • care with nasopharyngeal suction as anastomosis may be damaged
  • neck motion may be limited to prevent stress on anastomosis
  • present post-op with ICC
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16
Q

Pyloroplasty

A

pyloric muscle is divided and defect is sutured transversely, leaving larger gastric outlet

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17
Q

Nissen Fundoplication

A

anti-reflux surgery, gastric fundus mobilised and wrapped around lower oesophagus, eliminates reflux and heals oesophagitis
procedure is often laparoscopic
post-op protocol may dictate that no nausea or vomiting is allowed

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18
Q

Gastrectomy

A
  • removal of all or part of the stomach, closure of duodenum and anastomosis of oesophagus to jejunum
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19
Q

Cholycystectomy

A

Removal of gall bladder from liver bed
Open - performed via Kocher’s incision or R) paramedian incision - cystic duct is catheterised with a T tube - may be left in for 10 days to prevent stenosis of bile duct
Laparoscopic cholycystectomy now common

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20
Q

Whipple’s Procedure

A

usually for cancer of the head of pancreas
involves a large incision, removal of pancreas, common bile duct, part of stomach and duodenum with re-anastomosis of remaining portions

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21
Q

Whipple’s - implications for physio

A

Pt may be malnourished as a result of cancer spread

often have obstructive jaundice prior to surgery - high risk of post-op complications

22
Q

Hemicolectomy

A

resection of segment of colon with end to end anastomosis - no stoma formed

23
Q

Hemicolectomy - anterior resection

A

resection of rectal malignancy via a low midline incision - sigmoid colon and upper rectum with end to end anastomosis

24
Q

Hemicolectomy - high anterior resection

A

sigmoid colon and upper rectum

25
Hemicolectomy - low anterior resection and ultra low anterior resection
lower rectum - anal sphincters are preserved Use jejunum to form J pouch - instead of rectum Temporary loop ileostomy often formed to enable healing of anastomosis
26
Abdominoperineal resection (APR)
removal of rectum and anus - low midline and perineal incisions usually have stoma and permanent colostomy
27
Abdominoperineal resection - implications for physiotherapy
pt in supine, sidelying or high sidelying avoid sitting in bed, over edge of bed to avoid pressure on perineal wound site encourage to mobilise Day 1 allowed to sit out of bed only with customised sitting pillow
28
Hartman's Procedure
for diverticular disease proximal colon is externalised through the formation of a colostomy distal end of rectum is oversewn to form a rectal stump rectum and colon may be rejoined and colostomy reversed at a later date
29
Total Colectomy + proctocolectomy
excision of the whole colon (total colectomy) + rectum (proctocolectomy) pt may have permanent ileostomy
30
Stoma
``` artificial opening between colon or ileum and the skin of the abdominal wall Types: terminal colostomy side colostomy loop colostomy defunctioning colostomy ileostomy ```
31
Colostomy and Ileostomy - implications for physio
Check level of fluid/gas before mobilising If full, notify nursing staff to empty When teaching pt supported cough, ensure not directly over stoma/bag
32
Vascular Surgery - general implications
- assess circulation and pulses - avoid scraping feet during exercises - adhere to ROM limitations - use correct footwear when walking - mobilise with reference to post-op claudication distance atient with PVD has sheepskin or bootees during their stay in hospital - complications include: post-op infection, aneurysm, thrombotic occlusion
33
Fem-pop bypass
- graft from femoral artery to popliteal via long incision or 3 small graft incisions - medial aspect of leg - Day 1 - chest care, mobilised Day 1 or Day 2 - Ensure no hip flexion >60 degrees with knee straight - care of incision when handling limb - inform pt of blood rush when sitting up - normal - when mobilising encourage normal gait
34
Aorto-bifemoral bypass
graft from lower aorta to femoral arteries via midline abdominal incision and uni/bilateral groin incisions
35
Aorto-iliac bypass
aorta to iliac arteries via abdominal incision
36
Femoro-femoral crossover
one femoral artery to another via C-shaped graft, two small vertical groin incisions, unilateral iliac artery occlusion
37
Axillo femoral bypass
axillary artery to ipsilateral femoral artery with additonal side limb to common femoral artery on contralateral side via unilateral subclavicular incision dividing pec major and minor, and two vertical groin incisions
38
Axillo-femoral bypass - implications for physiotherapy
avoid - shoulder flexion >90, hip flexion >60, sidelying avoid pressure on graft from hand placement eg. percs and vibes avoid use of overhead ring when mobilising advice re bras, belts and tight clothing not to constrict graft avoid using axillary crutches
39
Abdominal Aortic Aneurysm - implications
Pre-op - <6cm - limit cough/FET - >6cm - no cough Post-op - potential to develop respiratory failure - effective pain relief and wound support essential - No HDT - Mobilise once CV stable
40
NGT
used for drainage or feeding - used pre-op in pts with GIT obstruction to prevent aspiration or regurgitation - either on free drainage, regular aspiration or low pressure suction
41
NGT - implications
- often pinned to pillow - ensure NGT not pulled out - ensure tube is well secured with tape - not pulled out when mobilising - switch off NG feeds when suctioning or when in HDT - NG feeds can be disconnected when mobilising
42
Nasal Prongs
delivery of supplemental oxygen pts on narcotic infusion will receive supplemental O2 to help overcome effects of respiratory depression can be used to improve PaO2
43
O2 devices - implications
check device is worn correctly and correct concentration is being delivered monitor SpO2 with pulse oximeter mobilise pts with portable O2
44
In-dwelling catheter (IDC) + implications
used when pts cannot mobilise to toilet - ensure bag is not too full prior to mobilising - keep bag below level of catheter - do not pull out catheter when mobilising
45
IV line + implications
peripheral venous line - maintenance of fluids/medication - care with arm exercises - do not dislodge IV - care with bed mobility - limit movement of joints close to insertion of IV - if pt C/O pain at drip site report to medical team as thrombophlebitis may occur
46
ICC + implications
removes fluid or air from pleural space, re-establishes normal negative pressure in pleural space, promotes re-expansion of lungs - do not pull out - check whether fluid is swinging, draining or bubbling - keep bottle system below level of insertion - if bottle breaks: previously no bubbling - double clamp and replace, previously bubbling - no clamp and replace - if chest tube disconnects, reconnect and assess system
47
Wound drain
provides channel of exit from wound to prevent accumulation of fluid Open drain Closed drain Closed suction drain
48
Wound drain - implications
do not pull out infection can be a problem can mobilise with drain - keep below level of wound
49
Vacuum assisted closure (VAC)
negative pressure delivered uniformly to wound, wound is sealed over by a plastic film - prevents entry of bacteria, vacuum removes secretions and reduces infection
50
VAC - implications
- do not pull out - check if suction can be removed prior to mobilisation - ensure VAC unit is below level of wound - hissing noise = leaking dressing
51
Thromboembolic deterrent (TED) stockings
- remove to expose legs for DVT check - do not leave rolled around ankle - can ambulate in TEDs as long as shoes are also worn

CARDIO EOS (3 decks)

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