surgical patients Flashcards
1
Q
key points with regard to analgesia?
A
- always assess the adequacy of pain relief before treatment
- Always note if the patient has pinpoint pupils and is drowsy
- always check vital signs, RR and BP as hypotension is a common side effect of pain management. Most important in position changes
- Spinal block/epidural always assess motor and sensory function of lower limbs
- Ask patient if they need to use their PCA or PECA before physiotherapy treatment session or ask about analgesia before treatment
2
Q
Effects of surgery on lung volumes?
A
- reduction in vital capacity- can reduce to 40%
- reduction in FRC- gradually reduce to be 70% at 24 hours post-surgery
- These changes may persist for 5-10 days following surgery
- Anaesthesia, surgery and recumbency reduce FRC with mechanical disruptions of the thorax and abdomen, shallow breathing, pain and inhibition of diaphragmatic function being major contributors
- The relationship between FRC and CC- if alters with FRC falling below CC- changes in ventilation that occur perioperatively and lead to reduced compliance, altered V/Q, arterial hypoxaemia and atelectasis.
3
Q
Effect on Mucociliary clearance?
A
- Anaesthesia, intubation, mechanical ventilation result in reduced lung volumes and reduced cough effectiveness- cause significant insult to the mucociliary escalator
4
Q
Effect on respiratory muscle function?
A
- diaphragmatic function reduced following abdominal and thoracic surgery
- reasons- pain, reduction in VC, incisions and postoperative hypoxaemia
- may last up to 1 week
5
Q
Risk factors of developing a postoperative pulmonary complication?
A
- duration of anaesthesia (>180 minutes)
- emergency surgery
- Type of surgery performed (upper abdominal)
- presence of preoperative respiratory problems e.g. COPD
- current smoking (within last 8 weeks)
- reduced level of preoperative activity
