case 1 Flashcards
(21 cards)
what would you do day 1 of post surgery
ICU
effect on ERAS pathways (enhance recovery after surgery pathway)
plan elective
abdominal system point of view
education from physio about post recovery
components of multi respiratory system assessment
respiratory
cardiovascular
neuro
renal
CNS
abdominal
attachments
Aims of day 1 following post surgery
pain management
get them sitting up in bed or chair—> aim to increase FRC
range of motion exercises on the site of incision
teach supportive cough while holding/protecting incision site
ways in which to increase FRC of a post operative patient
sitting up in a chair or bed
what is a laparotomy?
surgical procedure that opens up the abdomen to expose the organs
exploratory- to see what is going on inside the body and take tissue samples for diagnosis
incision site for laparotomy
incision through the abdomen wall
open up the peritoneal cavity— includes the abdomen and pelvis
why would someone need a laparotomy
abdominal pain
c section
might to remove cancer of an organ
what is functional residual capacity
the volume of air left in the lung after a normal passive exhalation - functional- doing something, residual left out- so when you breathe out..functional passive how you function regularly.
why is FRC important
It is a reflection of how elastic your lungs are, the ability of it to remain open after exhalation, the less elastic your lungs are the harder for it to breathe
How surgery reduces FRC
during general anaesthtic FRC is reduced by 20%
reduction is greater in obese patients and those with COPD - is COPD a type of respiratory failure.
components of type I respiratory failure
hypoaxemia - PaO2 of < 8KPa /60 mmHg
normocapnia PaCO2 < 6KPa /45 mmHg
causes of type 1 respiratory failure
ventilation/perfusion mismatch- the volume of air following in an out of the lungs do not match the volume of blood flowing in and out of the tissues.
PaO2 falls and PaCo2 rises.
rise in PaCO2 increase the patient aveolar ventilation — this corrects the PaCO2 but not the PaO2 because of the shape of the dissociation curves
minor complications following a laporatomy
infection
bruising and bleeding around the infection site
trouble with coughing - pain post op affect mobility
naseau and vomiting
prolong surgery anesthetic time
serious complications following laporatomy
damage to organ and major artery
blood clot
serious alergic reactions to general ansethetic
effects of general anesthesia in surgery
disruption of normal repsiratory muscle function —> Reduce tidal volume and FRC by 40% 4 days post op—>
reduce lung compliance and increase airway resistance—> lead to atlectasis —> reduce mucocillary clearance—> disruption of normal respiratory muscle function
assessment of surgical patient
respiratory assessment and ACTs airway clearance therapy
mobility assessment, early mobilizaiton is key
shoulder ROm exercises
patient goal setting- motivation
combine with doctor advice proving activities, pacing, exercises
diaries
why should you immediately mobilize post op
encourages larger deeper breathes- increases tidal volume and respiratory rate
increase collateral ventilation
upright positioning improves FRC
post operative precaustions
suction may accidently enter the esophagus and damage the anatomosis
positive pressure may cause damage to the anastomosis— limit IPPB up to 40
head down position may cause reflux of gastric contents and daamge anastomosis
performing a cough assist
instruct patient to take three deep breaths in an out and out and on the fourth one push down and up.
cough on the 4th breath and at the same time apply an inward and upward pressure
safe way to cough after abdominal surgery
support your wound firmly with a towel or pillow
loosen phlem by doing a huff
what is a huff
forced breathing through open mouth as if fogging up a mirrow
