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*Complex Patient - Physiotherapy > Week 2- Pre & Post Surgical Ax > Flashcards

Week 2- Pre & Post Surgical Ax Flashcards

1
Q

What are the 6 core cardiorespiratory problems?

A
  1. Respiratory Failure (Type 1 and Type 2 Respiratory Failure)
  2. Increased Work of Breathing/Breathlessness
  3. Sputum Retention
  4. Loss of Volume
  5. Pain
  6. Reduced Exercise Tolerance
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2
Q

What are the 5 additional concerns that may impact on treatment?

A
  • Anxiety;
  • Cognition;
  • Functional and mobility limitations;
  • Social problems;
  • Consciousness i.e. ventilated and sedated in ITU.
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3
Q

What are clinic signs and symptoms in cardio respiratory?

A
  • Cough
  • Wheeze
  • Tachycardia
  • Bradycardia
  • Cyanosis
  • Oedema
  • Increased respiratory rate
  • Low SpO2
  • Polycythemia
  • Sputum colour
  • Syncope
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4
Q

Before treating a patient what do you need to ask yourself?

A
  • what problems does this patient have?
  • can I treat these problems?
  • is the patient likely to respond to Physiotherapy?
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5
Q

What is the definition of clinical reasoning?

A

A structured process, through interaction with the patient and others in the multidisciplinary team, the structures meaning, goals and health management strategies, that are based on clinical data, client/ patient choices and professional judgement and knowledge

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6
Q

What is the cycle of clinical reasoning process

A
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7
Q

Where to you gain information to identify the patients main problems and determine goals of Physiotherapy management?

A
  • background information
  • medical chart
  • bed chart
  • subjective assessment followed by an objective assessment
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8
Q

What is the flow of treating a patient

A
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9
Q

When does a physio see a surgical patient?

A

+/- pre admission clinic
+/- pre operatively
Post operatively

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10
Q

What surgical patients do physios see?

A

Prioritise patients who are at high risk

  • patient related risks
  • procedure related risks
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11
Q

What information in required in the pre operation assessment

A
  • Presenting condition
  • Past medical history
  • Social history
  • Functional history
  • Investigations
  • Medical management
  • Planned Surgical Procedure
  • Special Orders
  • Patient’s normal respiratory – breathlessness, cough, sputum
  • Pain
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12
Q

What needs to included in a pre operation physical assessment?

A
  • observation
  • palpation
  • auscultation
  • cough
  • lower limbs
  • special assessment

Remember to prioritise and modify depending on the patient’s presentation

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13
Q

What should you education the patient around in regards to pre op management?

A
  • role of physio
  • expected post op presentation
  • effects of surgery
  • early mobilisation
  • pain relief importance
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14
Q

What is the aim of pre op management?

A
  • gain patients confidence
  • ax and prevent risks of developing post op complications
  • respiratory
  • immobility
  • DVT’s
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15
Q

What are post op complications?

A
  • changes to planned procedure
  • large blood loss
  • cardiac complications
  • labile BP
  • GA complications
  • Aspiration
  • ventitlation issues
  • pain control issues
  • investigations
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16
Q

What should be included in the post op patient interview

A
  • pain: at rest, movement, effect of pain relief
  • cough: productive, pain
  • SOB: current vs normal
  • confirm information gathered from medical chart: past medical history, smoking history, social history, functional history, current history
  • special post surgical questions: N&V, dizziness, drowsy, pins and needles, numbness
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17
Q

What to include in the post op physical assessment

A
  • observation: environment, patient
  • palpation
  • Auscultation
  • Cough: justify timing
  • Lower limbs: DVT, circulation
  • special assessments: strength, numbness
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18
Q

What should you document in post op management

A
  • distance mobilised
  • assistance required
  • tolerance
  • effect: important to re-assess
  • adverse events: dizziness, N&V
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19
Q

Why have orthopaedic surgery?

A
  • degenerative disease (OA)
  • trauma (fractures, dislocations)
  • pain
  • reconstruction (knee, shoulder)
  • pathological process (Ca, RA)
  • Prophylaxis/ Function (spinal scoliosis)
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20
Q

Why in the objective assessment is the environment important?

A

Safety concern: a clustered environment is unsafe to mobilise a patient

Look for:

  • walking aids, chairs to sit out in.. PLAN
  • apparatus (IV poles, O2, drains, catheter, compression stockings, pumps, pillows, slings, splints)
21
Q

What attachments need to be considered?

A 
-IV lines: where?
_wound drains: where, what, on suction?
-NGT- suction?
-Colostomy/ ileostomy: check leakage, may need to be emptied prior to moving
-Check length of tubing
22
Q

What is included in the circulatory assessment

A

• For patients at risk of deep vein thromboses
• Commonly seen in the calf and assessed by looking for:
-Swelling of the calf
- Redness of the calf
- Localised pain/tenderness
- Increased temperature on palpation
- Positive Homan’s sign (calf pain on passive ankle dorsiflexion)

23
Q

What is the neurological assessment

A

• Modified neurological assessment is required in the presence of spinal or epidural anaesthetic. It will help assess patient’s ability to mobilise and should include:
- Hip,knee,anklestrength&sensation

• Full neurological assessment (reflexes, power, sensation) if
indicated by the subjective examination - especially in the presence of spinal injury

24
Q

What is the musculoskeletal assessment

A

• Major joints in unaffected limbs as required
-normal range of motion, no tenderness or swelling

• Cardinal signs of Orthopaedic Musculoskeletal Assessment

  • Mobility Level (Independence)
  • Range of motion
  • Muscle Strength
  • Balance
25
Q

What is included the examination of a specific body region post op?

A
  • observation (swelling, wound ooze…)
  • active movement (as indicated)
  • passive movement (as Indicated)
  • muscle strength (as indicated)
  • sensation (checked in neurological)
26
Q

What is included in the functional assessment post op?

A
  • bed mobility
  • transfers
  • mobility
  • stairs
27
Q

What is the difference between assistance/ supervision/ independent ?

A

Assistance

  • therapist manual hand on assistance
  • 1x assist, 2x assist

Supervision
-requires verbal cues, no manual hands on assistance required

Independent
-patient can perform task without manual hands on assistance or verbal cues

28
Q

Outcome measures

A

-used to measure effectiveness of treatment

examples:
- Goniometry assessment of ROM
- Mobility progression (aid, distance, stairs, level of assistance)
- timed up and go (TUG)

29
Q

Who is at risk with surgery?

A
  • smoking history
  • location of surgery: upper abdomen or thorax
  • prolonged anaesthesia > 180mins
  • elective vs emergency surgery
  • comorbidities
  • obesity: BMI > 27
  • Age > 60 years
  • Pain
  • medications
  • immobility: pre and post op
30
Q

What are the surgery effects on respiratory function?

A

Leads to sputum retention and loss of volume

31
Q

Abdominal surgery impacts on ventilation

A
32
Q

What are common respiratory complications?

A
  • loss of volume: Atelectasis
  • chest infection
  • hypoxaemia
  • other complications
33
Q

What are common complications

A
  • fatigue
  • depression
  • fluid imbalance
  • urine retention, constipation
  • would infection or dehiscence
  • hypothermia
  • BP disturbances
  • neurological problems
  • DVT
  • post op bleeding
34
Q

What are signs and symptoms that their is a post surgical chest infection

A
  • SpO2 <90% on 2 consecutive days
  • chest x-ray findings
  • temp .38 degrees after dat 1 post op
  • sputum productive
  • abnormal lung auscultation
  • raised WCC
35
Q

What are the two types of Atelectasis?

A

Obstructive
-bronchial obstruction occurs and there is progressive collapse of the airways distal to the obstruction

Non-obstructive

  • compressive (surgery; tumour; pneumothorax; haemothorax; abdominal content weight; pleural effusion)
  • passive (loss of negative pressure in pleural space)
  • adhesive loss of pulmonary surfactant)
  • Cicatrizing (wound that leads to scarring)
36
Q

What are clinical signs of Atelectasis

A
  • reduced PaO2
  • reduced lung compliance
  • reduced FRC
  • non-productive cough, tachycardia, tachypnoea, wheeze, chest pain
  • changes on chest x-ray and auscultation and percussion note
37
Q

What are Atelectasis risk factors?

A

-surgical incision
-previous respiratory condition
Smoking history
-obesity
-age
-impaired cognitive function
-mechanical ventilation
-body position

38
Q

What is surfactant impairment

A
  • surfactant covers alveolar surface
  • reduces the surface tension
  • stabilises the alveoli
  • prevents collapse
39
Q

What are risk factors of surfactant impairment?

A
  • GA
  • Supplemental oxygen
  • mechanical ventilation
  • Infection
40
Q

What reduces mucociliary clearance?

A

Decreased cilial beating

  • temporary eg decreased ventilation, lack of sleep, decreased cough effectiveness, dehydrated, pollutants
  • permanent eg smoking, disease state

Increased sputum volume/ thickness

  • disease state
  • dehydration
  • infection
41
Q

What re risk factors of a DVT

A
  • DVT history
  • smoking
  • immobility
  • oral contraceptive
  • obesity
  • LL surgery
42
Q

What are post op problems

A
  • pain
  • may be the most important factor which causes: loss of volume and an ineffective cough
  • immobilty, which can cause
  • loss of volume
  • hypoxeamia
  • decreased CO, SV
  • increase hR
  • orthostatic intolerance
43
Q

Slow acting pain management routes

A
  • oral (paracetamol, endone, targin, panadeine forte, tramadol)
  • subcutaneous narcotic (eg morphine)
  • Intramusclar narcotic (eg morphine)
44
Q

What needs to be considered in pain management

A
  • timing, frequency and does (medications)
  • routes eg oral, subcutaneous narcotic, intramuscular narcotic, intravenous, epidural, nerve block, PCA
  • operative anaesthetic (spinal wears off 3-4hrs vs general likely to have respiratory complications)

Note plan your treatment around these pain managements where possible

45
Q

What are common pain managements

A

-NSAIDs
-Prescribed pain medication
_Patient controlled analgesia
_intercostal blocks
-Spinal blocks
-epidurals
-antiemetics
-ITU
-neuromuscular blocking agent

46
Q

What are side effects of narcotic analgesia

A
  • drowsiness and reduced central respiratory drive therefore require supplementary o2 at rest
  • nausea and vomiting
47
Q

What are things to consider when mobilising post op

A
  • incision location
  • level of pain
  • presence of adverse effects
  • presence of attachments
  • level of assistances that requires and available
  • equipment available
  • pre-existing conditions
  • premorbid mobility level
48
Q

What rehabilitation targets decreased exercise tolerance?

A
  • pulmonary rehabilitation
  • cardiac rehabilitation
  • neurological rehabilitation

*Complex Patient - Physiotherapy (13 decks)

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