Week 5 Flashcards

1
Q

Things to consider about surgery

A

post op pulmonary complications
-leading cause of morbidity and mortality

-increase length of stay

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2
Q

Risk factors

A
smoking history
location of surgery - upper abdomen or thorax
prolonged anaestheasia - >180 mins
effective vs emergency surgery
somorbidities 
Obesity - BMI > 27
Age >60 
Pain
Meds
Immobility - pre and post op
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3
Q

Review locations of incisions

A

P.g. 5

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4
Q

Signs and symptoms

A

SpO2 38 after 1 day post op
sputum productive
abnormal lung auscultation
Raised WCC

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5
Q

Common complications

A
Respiratory
complications
– Decreased
Ventilation
–
atelectasis
– Chest
infections
– Hypoxaemia
• Other
complications
– Fatigue
– Depression
– Fluid
imbalances
– Urine
retention,
constipation
– Wound
infection
or
dehiscence
– Hypothermia
– BP
disturbances
– Neurological
problems
– DVT
– Post-­‐op
bleeding
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6
Q

What is atelectasis

A

aveoli collapse

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7
Q

Types of atelectasis

A

micro

  • patchy areas of atelectasis
  • can progress to major
  • most post ops have

Plate

  • small areas of collapse
  • thin white lines on xray

Reabsorption /absorption

  • bronchus or bronchiole is blocked (sputum)
  • High FiO2 - decrease nitrogen
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8
Q

Risk factors for atelectasis

A
surgical incision
previous respiratory condition
smoking history
obesity
age
impaired cognitive function
mechanical ventilation
body position
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9
Q

What is surfactant impairment

A
surfactant impairment 
-surfactant covers alveolar surface
reduces the surface tension
stabilises the alveoli 
prevents collapse
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10
Q

Risk factors for surfactant impairement

A

GA
supplement oxygen
mechanical ventilation
infection

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11
Q

Risk factors for DVT’s

A
DVT history
smoking history
immobility 
oral contraceptive 
obesity
LL surgery
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12
Q

Post op problems

A

pain
-may be the most important factor that causes ineffective ventilation and ineffective cough

Immobility
-causes: decreased lung volumes 
hypoxaemia
decreased CO, SV
Increased HR
Orthostatic intolerance
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13
Q

Pain management

A
critical to optimize 
types
- narcotics - morphine 0 pethidine - fentanyl 
- complications -respiratory depression 
 - postural hypotension
-N&V
Drowsiness
itch
syncope

Epidural - nerve blocks - localised anaesthetics + opioids

  • complications
    • hypotension, urinary retention, motor block
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14
Q

Post op mobilisation aims

A

prevent immobilisation effects
increase minute ventilation
increases CO
Maintain strength

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15
Q

thing to consider regarding post op mobilisation

A
incision location
level of pain
presence of adverse effects
presence of attachments
level of assistance available vs required
equipment available 
pre-existing conditions
premorbid mobility level
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16
Q

Pre op assessment required information

A
presenting condition 
past medical history
social history
functional history
investigations
medical management 
planned surgical procedure
special orders
Pt's normal respiratory - breathlessness, cough, sputum
Pain
17
Q

Pre op physical assessment

A
observation
palpation
auscultation 
cough
lower ribs
special assessment
18
Q

Pre op management aims and education

A
aim - gain patients confidence
AX and prevent risks of developing post op complication
-respiratory 
-immobility
-DVT's 
Education
-role of physio
-expected post op presentation
effects of surgery
early mobilisation
pain relief importance
19
Q

Pre-op management

A

demonstrate

  • breathing exercises
  • circulation exercises
  • supported cough
  • bed mobility and transfers
  • post op exercises

+/- treatment
- may require airway clearance

20
Q

Post op assessment

A

required information

  • presenting condition
  • past medical history
  • functional ability
  • investigations
  • Medical management
  • Surgical procedure - found in operation note
    • post op orders
    • recovery notes
21
Q

Post op assessment operation note and post op orders

A

-procedure : incision, structures cut, wound closure, drains
-Anaethetic time and surgery time, recovery events
-management : return to ward , pain relief , initial post op course
-

Post op orders

  • physio orders - WB status, ROM
  • oxygen therapy
  • fluid orders
  • pain relief
  • suture , stable or dressing removal
22
Q

Peri or post op complications

A
changes to planned procedure
large blood loss
cardiac complications
labile BP
GA complications 
aspiration
ventilation issues
pain control issues
investigations
23
Q

What are the differences between adult and children patients

A
understanding 
behaviour
long term emotional disturbance
own belongings
involvement of family
age appropriate language
**Listen to the child**
24
Q

Rib cage and chest shape for children

A

Rib cage and chest shape
infants - cylindrical, soft and horizontal ribs (no bucket handle movement) poor intercostal development
-Age 3 yrs - adult chest wall shape achieved

Diaphragm
-infants - horizontal insertion - mechanical disadvantage, main muscle of inspiration

Preferential nasal breathing
- infants - shape and orientation of head and neck

25
Further anatomical differences
alveoli - - at birth - 150 million alveoli - 3-4 years - 300-400 million alveoli (adult number) - alveolar growth continues until 7 years Collateral ventilation - starts to develop at 1-2 years and continue to develop until 6 years Internal organs and lymphatic tissue - tonsils and adenoids - upper airway obstruction - heart and liver - less lung expansion -Height and exposure to air pollution
26
Physiological differences
respiratory compliance -cartilaginous Closing capacity (CC) -CC> FRC in infants - closure can occur before the end of expiration Ventilation and perfusion -ventilation greater of upper most lung - perfusion remains best in the dependant regions
27
Further physiological differences
oxygen consumption, CO and response to hypoxia - sympathetic nervous system not developed in infants - infants response to hypoxia = bradycardia , decreased CO and pulmonary vasoconstriction - further causing hypoxia
28
What is a neonate
new born child
29
What to include in observation
``` vital signs - HR, RR, SaO2, Temp, ABG's Regularity and pattern of respiration - apnoeix spells Thoracic cage shape and movement Feeding and eating cyanosis attachements - 02 ```
30
Respiratory distress characteristics
``` increased HR and RR recession nasal flaring grunting tracheal tug stridor neck extension head throbbing ```
31
Auscultation
unreliable no signs on auscultation secondaty to laminar flow and static secretions important to use with palpation and possibly huff / cough
32
Treatment
``` airway clearance exercise managing breathlessness posture MSK inhaled medication ```
33
Airway clearance
``` manual techniques - including suctioning ' ACBT Postural drainage FLutter PEP Autogenic drainage ```
34
Percussions and vibrations
short periords - 30sec /1min not to vigorous 1 handed or fingers only usuallt use easily with postural drainage
35
considerations
``` age of the infant/ child pre or co-existing conditions Aim of Rx Outcome measures acute vs long term ```
36
Exercise
use as an adjunct to formal airway clearance techniques benefits well known Make it fun
37
barriers to exercise
``` parental involvement age of the child - adolescents enjoyment and self esteem individualised programme health benefits and perceptions part of airway clearance ```