wk4 introduction to major surgery Flashcards
1
Q
-ectomy
A
removal of part e.g. appendicectomy
2
Q
-gram
A
-an Xray picture e.g. bronchogram
3
Q
-itis
A
inflammation e.g. appendicitis
4
Q
-plasty
A
tissue repair, remodeling, reconstruction e.g. gastroplasty
5
Q
-graphy
A
use of a radio opaque (dye used to outline the organs) contrast medium for Xray purposes. e.g. angiography
6
Q
-oscopy
A
visual examination of an interior of an organ e.g. bronchoscopy
7
Q
-ostomy
A
formation of an artificial opening to the skin surface e.g. colostomy
8
Q
-osis
A
disease, abnormal increase e.g. cystic fibrosis
9
Q
otomy
A
incision. e.g. laparotomy
10
Q
arthro
A
-joint
11
Q
chol
A
-bile
12
Q
Mast
A
breast
13
Q
nephro
A
kidney
14
Q
procto
A
rectum (final straight portion of large intestine)
15
Q
thoraco
A
thoracic
16
Q
laparo
A
abdomen
17
Q
cholecyst
A
gall bladder
18
Q
Col
A
colon
19
Q
Ileo
A
ileum (end of small intestine)
20
Q
scopy / scopic surgery
A
minimally invasive surgery/key hole surgery - don’t get confused with ‘oscopy’ (visual examination from external)
21
Q
Neuraxial anaesthesia
A
local anaesthetics around the nerves of the central nervous system .
i.e. spinal or epidural anaesthesia
22
Q
Effect of general anaesthesia- relevant to PT
A
- paralysed cilial activity
- increase secretion production
- relaxation of chest wall and diaphragm
- Upward shift of diaphragm
* altered chest wall compliance- V/Q mismatch
- Upward shift of diaphragm
- alteration of surfactant composition (due to high FIO2 & anasthetic gases)
- decreased sigh mechanism (can’t expel Co2 well)
- Decrease FRC up to 20%
- surgery time >2 hours increase risk of PPC
23
Q
what are some complications of major surgery?
A
- wound complication
- Cardiovascular complication
- Haemorrhage
- DVT
- Pulmonary embolus
- Pulmonary complication
- Gastrointestinal complications
24
Q
wound complications
A
- infection
- complete wound breakdown
- herniation (breakdown of underlying tissue)
25
complication of major surgery - cardiovascular
- Hypotension (due to fluid loss, vasodilation)
- Pulmonary Oedema (due to over fluid replacement)
- Arrthmias (due to reduced oxygenation, fluid volume)
- MI
26
Normal response to surgery is decreaed in Hb level.
| Hb may take __/52 to return to pre op levels
6/52
27
Purpose and types of wound drainage
Purpose-prevent accumulation of fluid or air
Types- open/closed, active/passive
28
Risk factor for VTE (venous thromboembolism)
- THR/TKR without prophylaxisis
- long bone/ pelvic #
- >60years
- immobilised px
- lengthy surgery
29
Diagnosis of DVT
- often asymptomatic
- unilateral tenderness/pain/swelling
- increase in temperature
- +ve homans sign (calf pain on passive dorsiflexion)
- confirmed by ultrasound
30
prevention of DVT
- early ambulation/mobilization (SOOB)
- wear elastic stocking
- avoid leg crossing
31
how to reduce risk of DVT
- minimal surgery time
- calf pumps in theatre
- have pre-op early anticoagulation (increase chance of bleeding during operation)
32
Treatment of DVT
-early ambulation better than bed rest & elevation
-immediate anticoagulation
Aissaoui et al, 2009 (bed rest vs early amulation); Anderson et al, 2009 systemic review (early ambulation)
33
Pulmonary embolus (PE) is most preventable cause of hospital death. True or False
True
| 1% of hospital inpatients deaths.
34
where does PE usually arise from? which vein?
popliteal vein & above
35
when does PE mostly occur?
2nd - 4th post op day
36
signs and symptoms of PE
- sudden onset
- SOB
- tachycardia
- hypotension
- central cyanosis
- haemoptysis (frank and fresh blood)
37
Early ambulation is one of treatment for PE. True or False?
DO NOT AMBULATE!! (not even leg exercise until get told its clear)
38
what are the treatment available for PE?
- anticoagulation
- O2
- pulmonary embolectomy or thrombolysis
39
signs and symptoms of Paralytic ileus following a major Gastrointestinal surgery
no structural prob but bowel doesn't work correctly
ceased peristalsis
constipation/diarrhoea
SEVERE pain and cramping
40
role of PT preop
- risk assessment
- education
- prehab intervention (to dcr PPC)
41
role of PT postop
- prevention post op complication
| - restore function
42
role of PT post discharge
- help to improve preop function level
- rehabilitation into community
- improve HRQoL
43
What information should our education to px include?
- effects of anaesthesia, surgery and post op intervention (drains/ incisions/ body position etc)
- rationale for post op PT
- handling and moving, exercises (coughing, DBE)
44
Groups at risk of complication
```
site of incision e.g. UAS, Chest surgery
Age
co-morbidities e.g. COPD
BMI
Smokers (smlke past 8 wks)
alcohol/drug addiction
previous low level of mobility
```
45
Aetiology of risk of complication
- anasthesia
- position and immobility
- narcotic analgesia
- pain
- surgical technique/handiling
- sleep
- dehydration
- high FIO2
- diaphragm dysfunction
46
Is there any evidence for prehab for reducing PPC after major UAS?
px received preop teaching and a formal course of preop chest physio. --> reduced PPC esp HIGH risk patient meaning that effect of preop intervention for LOW risk px is not known. (Olsen et al, 1997)
47
evidence for prehab (IMT) for PPC following a CABG (Cardiac surgery)
significant reduction in PPC and Pneumonia rate
| But only in HIGH risk patients. (Huzlebos et al, 2006)
48
Goals of pre op intervention
- reduce overall mortality and morbidity
- improve informed consent
- quality of care initiatives
49
evidence of prehab inspiratory muscle training (IMT) for ppc
reduction in length of hospital stay (Mans et al,2012)
