Post-op Complications

Question 1

Impaired airway clearance

• Evidence

Answer 1

• non-effective, non-productive cough
• moist cough
• inspiratory coarse crackles
• impaired cough
• on suction

Question 2

Impaired airway clearance

• Patho cause

Answer 2

• resp depression
• pain
• resp inhibition
• impaired cough due to anaesthesia
• reduced cilial function (secondary to O2 therapy)
• anaesthetic
• resp infection
• thick secretions

Question 3

Impaired airway clearance

• Treatment

Answer 3

• Supported/assisted cough (remove)
• ACT’s (FET – low volume for mob and then high volume for secretion)
• P+V (mob)
• PD (mob)
• PEP devices (mob)
• Suction (removal)
• MHI (mob and remove)

Question 4

Impaired airway clearance

• OMs

Answer 4

• Sputum volume
• Cough effectiveness/productiveness
• Suction (suction less = airway clearance mechanisms is working)
• Auscultation

Question 5

Impaired ventilation

• Evidence

Answer 5

• Wheeze on ausc
• V/Q mismatch
• SOB
• Spirometry
• increased WOB (nasal flaring, Ax muscle use, increased RR)

Question 6

Impaired ventilation

• Patho cause

Answer 6

• Retained secretions
• airway obstruction (bronchoconstriction, tumour)
• weak resp muscles
• airway closes early due to parenchymal damage

Question 7

Impaired airway clearance

• Treatment

Answer 7

• Fix whatever is causing obstruction
• Strengthen resp muscles
• Position in high sitting to reduced WOB

Question 8

Impaired ventilation

• OMs

Answer 8

• Ausc
• CXR to check for obstruction
• spirometry
• observation of breathing

Question 9

Reduced lung volume

• Evidence

Answer 9

• CXR
• redued BS on Ausc
• reduced BBE

Question 10

Reduced lung volume

• Patho cause

Answer 10

• Atelectasis post surgically due to anaesthetic /pain meds causing resp depression
• obstruction
• restrictive
• non-complaint lungs (ie ARDS)
• resp depression

Question 11

Reduced lung volume

• Treatment

Answer 11

• Position(high siting)
• Pain Mx (ensure not to cause further resp depression if taking analgesics)
• TEE’s
• Incentive spirometry
• Stretch facilitation
• MHI

Question 12

Reduced lung volume

• OMs

Answer 12

• Ausc
• obs
• palpation
• CXR

Question 13

Impaired gas exchange

• Patho cause

Answer 13

• Impaired vent
• reduced volume
• retained secretions
• damage to gas exchange surface
• hyperinflation and gas trapping due to early airway closure

Question 14

Impaired gas exchange

• Treatment

Answer 14

• Fix the cause
• O2 – ensure fit and flow of device, notify Dr if any adjustments need to be made/are recommended
• Increased metabolic demand (i.e burns, deconditioning, increase WOB)

Question 15

Impaired gas exchange

• OMs

Answer 15

• ABG’s
• WOB
• observation (colour etc)

Question 16

Impaired gas exchange

• Evidence

Answer 16

• V/Q mismatch
• hypoxemic
• resp failure
• ABG’s

Question 17

Dyspnoea

• Evidence

Answer 17

• Subjective complaint
• increased RR
• Ax muscle use
• pause in middle of sentence/on activity that isn’t typically exhausting etc

Question 18

Dyspnoea

• Patho cause

Answer 18

• Reduced lung volume
• weak resp muscles
• impaired airflow
• impaired gas exchange
• fatigue/deconditioning
• Increased vent demands sue to infection/severe trauma

Question 19

Dyspnoea

• Treatment

Answer 19

• Positioning - recovery position –> reverse O/I axiohumeral muscle action
• BC
• Resolve causative issues (i.e clear secretions as mentioned above)

Question 20

Dyspnoea

• OMs

Answer 20

• Observation (Breathing pattern, during speaking etc)
• Subjective report

Question 21

Pain

• Evidence

Answer 21

• Complains it hurts
• reduced deep breaths
• cough isn’t effective etc

Question 22

Pain

• Patho cause

Answer 22

• Incision
• surgery
• trauma

Question 23

Pain

• Treatment

Answer 23

• Position
• Support wound when mobilising/coughing
• Time Rx with pain meds,
• advise them to deliver dose (if PCA) prior to Pt session

Question 24

Pain

• OMs

Answer 24

• Ask them (subjective report)
• need for PCA before Rx
• Cough effectiveness

Question 25

Reduced exercise tolerance - Evidence

Answer 25

* Will say * tired when walking small distance * increased WOB on mild exertion * fatigue, slow when walking * need to take breaks

Question 26

Reduced exercise tolerance - Patho cause

Answer 26

* Prolonged immobility * reduced WB/exercise/ movement * lung problems (reduced volume/ventilation/Retained secretions)

Question 27

Reduced exercise tolerance - Treatment

Answer 27

* Mobilise * Bed exercises (LL, UL, Circ)

Question 28

Reduced exercise tolerance - OMs

Answer 28

* Distance walked * BORG when walking/mobilising * observe resp pattern when mobilising

Question 29

Risk of DVT - Evidence

Answer 29

* Prolong immobility * CV risk factors * LL surgery * PVD

Question 30

Risk of DVT - Patho cause

Answer 30

Reduced venous return secondary to reduced LL muscle use as well as possible clot from surgery

Question 31

Risk of DVT - Treatment

Answer 31

* Circ exercises + mobilisation to increased active pump of venous blood, * Ted stocking --\> for external pressure on vessels

Question 32

Risk of DVT - OMs

Answer 32

* DVT check regularly * ultrasound if necessary

Question 33

Risk of pressure sore - Evidence

Answer 33

* Prolonged immobility * reduced bed mobility due to surgery * CV risk factors, especially PVD and diabetes * Age – fragile skin

Question 34

Risk of pressure sore - Patho cause

Answer 34

* Impaired circulation in LL * impaired sensation * fragile skin * prolonged immobility * may develop pressure areas, but have reduced healing capacity /reduced ability to feel/notice it and therefore it may develop into a pressure sore

Question 35

Risk of pressure sore - Treatment

Answer 35

* Regular position changes in bed to relieve pressure * Circ exercises to facilitate blood flow * Mobilisation to achieve the above 2 effects

Question 36

Risk of pressure sore - OMs

Answer 36

Regular observation and monitoring