surgical patient Flashcards
what should management be?
- holistic
what does management include? (7)
- planning
- organising
- directing
- re- evaluating
- co- ordinating
- monitoring
- multi- disciplinary
what systems are included in a multi- system assessment?
- respiratory
- cardiovascular
- nervous system
- renal system
- bloods
- drugs
how do you assess the respiratory system?
- self ventilated or mechanically ventilated
- respiratory rate
- oxygen saturation
- Fi02
- auscultation
- chest x-ray
- arterial blood gases
what is the definition of Fi02?
- fraction of inspired air
- estimation of the oxygen content a person inhales
what is the normal Fi02?
- concentration of oxygen at room air is 21%
what does the cardiovascular system assess?
- heart rate
- blood pressure
- temperature
- capillary refill time
what does the nervous system assess?
- GCS
- RASS
- ACVPU
what is GCS?
- Glasgow Coma Scale
- measures how conscious you are
what is the scoring of GCS?
- can get a score from 3-15
- a score of 15 means you’re fully awake, responsive and have no problems with thinking
- score of 8 or fewer means you’re in a coma
what is RASS?
- Richmond Agitation Sedation Scale
- assesses alertness and agitated behaviour in critically ill patients
what are the scores in RASS?
- 0 = alert and calms
4 to -5 with 4 being violent and -5 being unarousable (no response to voice or physical stimulation)
what does ACVPU stand for?
- alert
- conscious
- voice
- pain
- unresponsive
what are the measurements taken from the bloods?
- haemoglobin
- platelets
- white blood cells
- c- reactive protein
- sodium
- potassium
what does the renal system assess?
- urea
- creatine
how much urine is normal?
- 1/2 per 1 ml kg/ hr
why is drug history important?
- infusions
- supported/ unsupported
- dilators
where do gases move to?
- move from an area of high pressure to an area of low pressure
what surrounds the lungs? what is it?
- visceral pleura
- serous membrane
what goes around the visceral pleura?
- parietal pleura
what does the visceral and parietal pleura form?
- they form a single cerous membrane but it folds on itself
what is between the visceral and parietal pleura?
- pleural cavity
what connects the ribs? how many are there?
- intercostal muscles
- three muscles
what is the normal atmospheric pressure?
- 760mmHg
what is the pressure inside the lungs known as? what is it normally?
- intrapulmonary pressure
- 760 mmHg
what is the pressure in the pleural cavity called?
- intrapleural pressure
- 756mmHg
what happens when intrapulmonary volume changes?
- intrapulmonary pressure also changes
what happens to the volume and pressure in inspiration?
- intrapulmonary volume increases due to contraction of intercostals and diaphragm (moves down)
- intrapulmonary pressure decreases so oxygen flows into the lung from the air
what happens to the volume and pressure in expiration?
- muscles relax (diaphragm moves up)
- intrapulmonary volume decreases so intrapulmonary pressure increases
- oxygen moves up and out of the lungs to the air
what is the most important lung volume? why?
- functional residual capacity
- it is where gaseous exchange occurs
what happens if there is no residual volume left?
- results in lung collapse
what is a cough?
- short explosive expulsion of air
what is the main layer in the respiratory tract that contributes to coughing? what does it contain?
- mucosa layer
- contains goblet cells, which release mucus
what is the first layer of mucosa made up of? what are these cells?
- pseudostratified columnal epithelium
- cells are ciliated
what is below the mucosa layer?
- basement membrane
- as well as smooth muscle
what is below the mucosa and basement membrane? what does it contain?
- submucosa
- contains immune cells e.g., mast cells specialised for defence & allergic response
what is below the submucosa?
- cartilage
- part of the trachea
what nerves innervate the area?
- sensory nerve fibres
- RAS, SAS and C- fibres
what does RAS stand for?
- rapidly adapting
what does SAS stand for?
- slowly activating
what are the six impacts of anaesthesia on the respiratory system?
- respiratory muscle tone and lung function
- compliance and resistance
- airway closure
- dead space
- ventilation and perfusion rate
- alectasis
how does anaesthesia affect the respiratory muscle tone and lung function?
- in the adult human, the resting lung volume is reduced by 0.8-1.0L by changing body position from up right to supine
- can further decrease by 0.4-0.5L with the induction of general anaesthesia
what are the 8 types of incisions?
- liver surgery/ transplant
- renal transplants
- duodenal surgery
- major abdominal trauma
- appendectomy
- cholecystectomy
- urology procedures
- sigmoid colostomy
