surgical conditions Flashcards
perioperative and postop physio
Aims to prevent and or minimise the adverse physiological changes associated with major surgical procedures and to facilitate return to optimal function.
Prevent postoperative pulmonary complications.
Physiotherapy is not only for respiratory function but also for exercise capacity and functional recovery.
post op physio for post op pain
general anesthetic
recumbency and immobility
surgical conditions
abdominal surgery
ENT surgery
thoracic surgery
Cardiac surgery
oesophagectomy
To remove cancer of the oesophagus the surgeon might perform open surgery or keyhole surgery or a combination of keyhole and open surgery
Open surgery
The surgeon can make a cut into the neck, chest or abdomen. They make 2 or 3 cuts to reach the oesophagus.
The type of surgery depends on where the cancer is. It also depends to some extent on which the surgeon prefers. The types are
Keyhole surgery
4-8 incisions in the stomach
assessment - op notes
What was done?
Why was it done?
How long did it take?
Any intra op events?
Estimated Blood Loss?
Any post op instructions?
post op pain
Adequate pain management is important to:
Minimise secondary unwanted physiological effects e.g tachycardia
Minimise secondary respiratory dysfunction
Allow patient to commence rehabilitation
pain management
Oral IV Suppository PCA Epidural
Pain team maximise methods
Usually used in multiple methods
Possibly single most important aspect of postoperative care
physio - pain management
Always assess the adequacy of pain relief before treatment
Always check vital signs especially respiratory rate and blood pressure (hypotension is a common side effect of pain management)
If patient had a spinal block or epidural always check motor and sensory function of lower limbs before mobilisation
Always liaise with medical and nursing staff before treating a patient.
Consider any other side effects?
impaired respiratory function
Reduced lung volumes
Impaired mucocillary clearance
Impaired respiratory muscle function
common post op problems
Atelectasis
Ineffective cough
Retained Secretions
Hypoxaemia
↓Exercise tolerance
Postop hypoxaemia and atelectasis are seen as inevitable consequences of major surgery and are usually subclinical.
A postoperative pulmonary complication is a pulmonary abnormality that produces inevitable disease or dysfunction that adversely affects the clinical course
post op pulmonary complications
Respiratory infection
Pneumonia
Pneumothorax
Bronchospasm
Pleural effusion
Respiratory failure
length of stay
mortality
Risk factors for PPC
Patient Age (>50) Presence of perioperative respiratory problem e.g. COPD, Asthma Obesity Current smoking (last 8/52) Reduced level of perioperative activity
Surgical
Duration of anaesthetic >180 minutes
Type of surgery (upper abdominal)
physio treatment
common problems Atelectasis
Ineffective cough
Retained Secretions
Hypoxaemia
↓Exercise tolerance
Positioning
Education e.g. supported cough
Breathing exercises
Mobilising
why is cough more ineffective?
Decreased tidal volume
Thicker more tenacious secretions harder to move
Decreased surfactant
Decreased muco-cillary clearance- decreased cilia beat and wave
Decreased abdominal contraction
mobilising precautions
- What was done? Where will the pt be sore? -Are there any precautions?
- What drips and drains will you have to manage?
- Do you have enough personnel?
- Risk assessment
- Adverse events
patient - case study key points
Positioning is going to be a problem Positioning and cough – lack of awareness Education on positioning ACTB Educational breathing exercises Supported cough – educate on how to do Whats the best position for him Breahthing Mobilise is the best thing to do for someone post op
