wk4 introduction to major surgery Flashcards
-ectomy
removal of part e.g. appendicectomy
-gram
-an Xray picture e.g. bronchogram
-itis
inflammation e.g. appendicitis
-plasty
tissue repair, remodeling, reconstruction e.g. gastroplasty
-graphy
use of a radio opaque (dye used to outline the organs) contrast medium for Xray purposes. e.g. angiography
-oscopy
visual examination of an interior of an organ e.g. bronchoscopy
-ostomy
formation of an artificial opening to the skin surface e.g. colostomy
-osis
disease, abnormal increase e.g. cystic fibrosis
otomy
incision. e.g. laparotomy
arthro
-joint
chol
-bile
Mast
breast
nephro
kidney
procto
rectum (final straight portion of large intestine)
thoraco
thoracic
laparo
abdomen
cholecyst
gall bladder
Col
colon
Ileo
ileum (end of small intestine)
scopy / scopic surgery
minimally invasive surgery/key hole surgery - don’t get confused with ‘oscopy’ (visual examination from external)
Neuraxial anaesthesia
local anaesthetics around the nerves of the central nervous system .
i.e. spinal or epidural anaesthesia
Effect of general anaesthesia- relevant to PT
- 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
what are some complications of major surgery?
- wound complication
- Cardiovascular complication
- Haemorrhage
- DVT
- Pulmonary embolus
- Pulmonary complication
- Gastrointestinal complications
wound complications
- infection
- complete wound breakdown
- herniation (breakdown of underlying tissue)
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
Normal response to surgery is decreaed in Hb level.
Hb may take __/52 to return to pre op levels
6/52
Purpose and types of wound drainage
Purpose-prevent accumulation of fluid or air
Types- open/closed, active/passive
Risk factor for VTE (venous thromboembolism)
- THR/TKR without prophylaxisis
- long bone/ pelvic #
- > 60years
- immobilised px
- lengthy surgery
Diagnosis of DVT
- often asymptomatic
- unilateral tenderness/pain/swelling
- increase in temperature
- +ve homans sign (calf pain on passive dorsiflexion)
- confirmed by ultrasound
prevention of DVT
- early ambulation/mobilization (SOOB)
- wear elastic stocking
- avoid leg crossing
how to reduce risk of DVT
- minimal surgery time
- calf pumps in theatre
- have pre-op early anticoagulation (increase chance of bleeding during operation)
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)
Pulmonary embolus (PE) is most preventable cause of hospital death. True or False
True
1% of hospital inpatients deaths.
where does PE usually arise from? which vein?
popliteal vein & above
when does PE mostly occur?
2nd - 4th post op day
signs and symptoms of PE
- sudden onset
- SOB
- tachycardia
- hypotension
- central cyanosis
- haemoptysis (frank and fresh blood)
Early ambulation is one of treatment for PE. True or False?
DO NOT AMBULATE!! (not even leg exercise until get told its clear)
what are the treatment available for PE?
- anticoagulation
- O2
- pulmonary embolectomy or thrombolysis
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
role of PT preop
- risk assessment
- education
- prehab intervention (to dcr PPC)
role of PT postop
- prevention post op complication
- restore function
role of PT post discharge
- help to improve preop function level
- rehabilitation into community
- improve HRQoL
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)
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
Aetiology of risk of complication
- anasthesia
- position and immobility
- narcotic analgesia
- pain
- surgical technique/handiling
- sleep
- dehydration
- high FIO2
- diaphragm dysfunction
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)
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)
Goals of pre op intervention
- reduce overall mortality and morbidity
- improve informed consent
- quality of care initiatives
evidence of prehab inspiratory muscle training (IMT) for ppc
reduction in length of hospital stay (Mans et al,2012)
