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AC- Simon > wk4 introduction to major surgery > Flashcards

wk4 introduction to major surgery Flashcards

1
Q

-ectomy

A

removal of part e.g. appendicectomy

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2
Q

-gram

A

-an Xray picture e.g. bronchogram

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3
Q

-itis

A

inflammation e.g. appendicitis

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4
Q

-plasty

A

tissue repair, remodeling, reconstruction e.g. gastroplasty

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5
Q

-graphy

A

use of a radio opaque (dye used to outline the organs) contrast medium for Xray purposes. e.g. angiography

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6
Q

-oscopy

A

visual examination of an interior of an organ e.g. bronchoscopy

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7
Q

-ostomy

A

formation of an artificial opening to the skin surface e.g. colostomy

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8
Q

-osis

A

disease, abnormal increase e.g. cystic fibrosis

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9
Q

otomy

A

incision. e.g. laparotomy

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10
Q

arthro

A

-joint

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11
Q

chol

A

-bile

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12
Q

Mast

A

breast

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13
Q

nephro

A

kidney

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14
Q

procto

A

rectum (final straight portion of large intestine)

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15
Q

thoraco

A

thoracic

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16
Q

laparo

A

abdomen

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17
Q

cholecyst

A

gall bladder

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18
Q

Col

A

colon

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19
Q

Ileo

A

ileum (end of small intestine)

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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
  • 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
Q

complication of major surgery - cardiovascular

A
  • Hypotension (due to fluid loss, vasodilation)
  • Pulmonary Oedema (due to over fluid replacement)
  • Arrthmias (due to reduced oxygenation, fluid volume)
  • MI
26
Q

Normal response to surgery is decreaed in Hb level.

Hb may take __/52 to return to pre op levels

A

6/52

27
Q

Purpose and types of wound drainage

A

Purpose-prevent accumulation of fluid or air

Types- open/closed, active/passive

28
Q

Risk factor for VTE (venous thromboembolism)

A
  • THR/TKR without prophylaxisis
  • long bone/ pelvic #
  • > 60years
  • immobilised px
  • lengthy surgery
29
Q

Diagnosis of DVT

A
  • often asymptomatic
  • unilateral tenderness/pain/swelling
  • increase in temperature
  • +ve homans sign (calf pain on passive dorsiflexion)
  • confirmed by ultrasound
30
Q

prevention of DVT

A
  • early ambulation/mobilization (SOOB)
  • wear elastic stocking
  • avoid leg crossing
31
Q

how to reduce risk of DVT

A
  • minimal surgery time
  • calf pumps in theatre
  • have pre-op early anticoagulation (increase chance of bleeding during operation)
32
Q

Treatment of DVT

A

-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
Q

Pulmonary embolus (PE) is most preventable cause of hospital death. True or False

A

True

1% of hospital inpatients deaths.

34
Q

where does PE usually arise from? which vein?

A

popliteal vein & above

35
Q

when does PE mostly occur?

A

2nd - 4th post op day

36
Q

signs and symptoms of PE

A
  • sudden onset
  • SOB
  • tachycardia
  • hypotension
  • central cyanosis
  • haemoptysis (frank and fresh blood)
37
Q

Early ambulation is one of treatment for PE. True or False?

A

DO NOT AMBULATE!! (not even leg exercise until get told its clear)

38
Q

what are the treatment available for PE?

A
  • anticoagulation
  • O2
  • pulmonary embolectomy or thrombolysis
39
Q

signs and symptoms of Paralytic ileus following a major Gastrointestinal surgery

A

no structural prob but bowel doesn’t work correctly
ceased peristalsis
constipation/diarrhoea
SEVERE pain and cramping

40
Q

role of PT preop

A
  • risk assessment
  • education
  • prehab intervention (to dcr PPC)
41
Q

role of PT postop

A
  • prevention post op complication

- restore function

42
Q

role of PT post discharge

A
  • help to improve preop function level
  • rehabilitation into community
  • improve HRQoL
43
Q

What information should our education to px include?

A
  • 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
Q

Groups at risk of complication

A 
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
Q

Aetiology of risk of complication

A
  • anasthesia
  • position and immobility
  • narcotic analgesia
  • pain
  • surgical technique/handiling
  • sleep
  • dehydration
  • high FIO2
  • diaphragm dysfunction
46
Q

Is there any evidence for prehab for reducing PPC after major UAS?

A

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
Q

evidence for prehab (IMT) for PPC following a CABG (Cardiac surgery)

A

significant reduction in PPC and Pneumonia rate

But only in HIGH risk patients. (Huzlebos et al, 2006)

48
Q

Goals of pre op intervention

A
  • reduce overall mortality and morbidity
  • improve informed consent
  • quality of care initiatives
49
Q

evidence of prehab inspiratory muscle training (IMT) for ppc

A

reduction in length of hospital stay (Mans et al,2012)

AC- Simon (12 decks)

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