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DPT 629: Cardio > Surgeries > Flashcards

Surgeries Flashcards

1
Q

what are some indications for abdominal surgery?

A

GI

liver

pancreas

kidneys

gynecologic

obstetric

genitourinary

hernia

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2
Q

what is considered an abdominal surgery?

A

anything below the diaphragm and above the pubic bone

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3
Q

what is a hernia?

A

a hole in any portion of the abdominal wall that causes a portion of the GI tract to push through the hole

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4
Q

what incisions make up the “Mercedes Benz” incision?

A

Kocher and Chevron incisions

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5
Q

what is a Mercedes Benz incision reserved for?

A

liver transplants

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6
Q

what is a Kocher incision?

A

incision made in the upper R abdomen for access to the liver, gallbladder, or pancreas

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7
Q

what is a Chevron incision?

A

incision made in the upper L abdomen for access to the spleen

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8
Q

what is a midline incision?

A

incision made through the center of the abdomen for access to the pancreas, stomach, colon, small/large intestine, some gyno procedures, and some genitourinary procedures

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9
Q

what is one of the most common abdominal incisions?

A

the midline incision

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10
Q

what is a Gridiron and Lanz incision?

A

an incision in the lower R abdomen for access to the appendix

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11
Q

what is a Pfannestiel incision?

A

a horizontal incision made down near the pubic bone for a C-section or open hysterectomy

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12
Q

what should we look for in incisions?

A

bleeding, drainage, and s/s of infection

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13
Q

drainage is common following surgery on what organ?

A

the liver

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14
Q

why is incision drainage common following liver surgery?

A

bc the liver is responsible for protein synthesis, so lots of edema may form and cause LE edema or ascites

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15
Q

what kind of drainage is normal?

A

clear, orderless drainage

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16
Q

what kind of drainage is worrisome?

A

thick, discolored, smelly drainage

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17
Q

what are post-op complications following abdominal surgery?

A

illeus

wound dehiscence

wound infection

pneumonia

DVT/PE

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18
Q

what is an illeus?

A

when normal peristalsis (contract of the GI tract to move content) isn’t working leading to blockage when food enters the GI system and doesn’t move

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19
Q

t/f: pts with an illeus are often NPO with a nasogastric tube to draw content out of the stomach

A

true

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20
Q

what is one of the best ways to relieve an illeus?

A

to get up and walk

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21
Q

t/f: pts need to pass gas/have a bowel movt b4 rehab after abdominal surgery to make sure there is no illeus

A

true

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22
Q

what are some risks for wound dehiscence?

A

DM, obesity, coughing, straining, trunk flex/rot, lifting, engaging the abdominals

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23
Q

why is pneumonia a risk, esp with higher abdominal surgeries?

A

bc they are pain inhibited and don’t take deep breaths which leads to poor ventilation of the lower lobes, making them a breeding ground for bacterial growth

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24
Q

why are there strict dietary progressions to follow post-abdominal surgery?

A

to prevent the risk of an illeus

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25
what must a pt demonstrate following GI surgery b4 progressing to the next level of diet progression?
tolerance by way of passing gas or having a bowel movt
26
we are looking for an absence of ____, _____, and _____ when progressing diet following GI surgery
nausea, pain, vomiting
27
if a pt experiences nausea, pain, or vomiting after progressing their diet following GI surgery, what should we do?
regress to the previous level
28
what is the order or diet progression following GI surgery?
NPO-->clear liquids-->full liquids -->pureed-->soft food-->regular diet
29
what are some examples of clear liquids?
water, ice chips, apple juice, broth any see through liquid
30
what are some full liquids
yogurt any liquid that can't be seen through
31
what is the difference between pt controlled analgesia (PCA) and patient controlled epidural analgesia (PCEA)?
PCA is delivered through a regular IV PCEA is delivered through a very small catheter into the epidural space of the SC
32
why are PCA/PCEA usually locked in a box?
bc it is usually some kind of narcotic being delivered through it
33
what is a "locked out" time frame in a PCA/PCEA?
after a pt pushes the button there is about 10-20 minutes where they can't deliver another dose
34
who has to push the button on a PCA/PCEA?
the pt
35
can the PT push the button on the PCA/PCEA?
nope, but we can remind them that they can use it before mobilizing them
36
why is a PCA/PCEA shown to improve mental state following surgery?
bc it gives pts a sense of control over their pain levels
37
what are typical abdominal precautions?
avoid spine flexion and rotation avoid lifting more than 10 lbs
38
t/f: typical abdominal precautions are the same as lumbar spinal precautions
true
39
why are there abdominal precautions following abdominal surgery?
to avoid wound dehiscence
40
how long do pts usually have abdominal precautions following abdominal surgery?
4-6 weeks
41
what conditions will make healing after abdominal surgery longer?
DM and chronic cardiac conditions
42
if a pt had a laparoscopic surgery, how long will they have abdominal precautions?
2 weeks
43
what are abdominal binders?
a compression garment that is worn post abdominal surgery to provide support, compression, and pain relief
44
t/f: abdominal binders can be ordered to be worn all the time or when out of bed
true
45
can PT suggest an abdominal binder is not ordered already by the surgeon?
yup
46
t/f: in females, abdominal binders tend to rise up bw the ribs and pelvis making it ineffective
true
47
do abdominal binders tend to work better in males or females?
males
48
t/f: early mobility is the gold standard for any kind of abdominal surgery
true
49
what are the benefits of early mobility following abdominal surgery?
shorter LOS decreased rates of DVT/PE improved recovery of peristalsis (dec rate of illeus) dec rate of pulmonary complications
50
when is early mobility started following abdominal surgery?
once the pt is awake, coherent, and has full sensation
51
what is a typical order for early mobility?
ambulate 5x/day
52
if someone is scared to get up and moving, what can we do?
explain the benefits of moving do breathing exercises talk to the pt
53
if a person is moving too much and is worn out, what can we do?
breathing exercises pt education RPE (3-4/10)
54
what RPE is the goal with early mobility?
3-4/10
55
how can we use pain relief techniques post abdominal surgery?
splinting over the incision paired breathing (inhale to prepare, exhale with movt)
56
what are some post op pulmonary techniques we can use?
incentive spirometer stacked breathing if the pt has pulmonary complications
57
why do we often give pts post abdominal surgery a walker the first time we get them up?
to prevent abdominals working too hard
58
what two things should we know about orthopedic surgeries?
WB and mobility orders
59
when does PT typically start after a TKA?
day 0
60
t/f: pts post TKA may be d/c day 0
true
61
t/f: TKA is typically 24 admit
true
62
if a pt had a femoral nerve block, what should we check?
quads fxn
63
what 2 anesthetic/analgesic blocks cause BL effects post TKA?
spinal block epidural
64
t/f: adductor canal block effects quad fxn
false
65
what are the typical WB precautions following TKA?
WBAT with an AD
66
what are the AROM goals post TKA?
0-90 deg
67
what is involved in mobility training post-TKA?
bed mobility transfers walking stairs car transfers
68
what do we want to promote post TKA?
knee extension
69
to promote knee extension post-TKA, what can we teach?
no towel/pillow under the knee no sitting in knee flexion more than 30 minutes
70
t/f: exercises are not a huge emphasis for acute post TKA
true
71
when does PT typically start post THA?
day 0
72
t/f: pts post THA may d/c day 0
true
73
t/f: THA is typically a <24 hours admit
true
74
what anesthesias/analgesia may be used post TKA?
femoral nerve block adductor canal block spinal block epidural
75
what anesthesia/analgesia may be used post THA?
spinal algesia epidural analgesia femoral nerve block obturator nerve block
76
what are posterior hip precautions?
no hip flexion >90 deg no hip add no hip IR
77
what are anterior hip precautions?
no hip ext beyond neutral no hip ER
78
why do we often say that there are no anterior hip precautions?
bc the precautions are unusual movts that pts don't typically have to do
79
what are typical WB orders post THA?
WBAT with an AD
80
what are the components of education post THA?
hip precautions as relevant ambulation program exercises (basic and simple) s/s of infection, DVT
81
what is the most common unplanned ortho procedure?
hip fx fixation
82
t/f: pts need to WB to promote healing with a dynamic hip screw
true
83
are there hip precautions with parallel implants, sliding hip screws, or intermedulary nails?
nope
84
what are the likely precautions following hemi or total arthroplasty?
posterior hip precautions
85
t/f: there is a high risk of dislocation if not following hip precautions
true
86
why is it harder to get a good fit for an arthroplasty following hip fracture than with elective surgery?
bc of poor bone quality and lack of pre-planning
87
where do we typically see hip fractures?
in the elderly
88
hip fx usually results from ____
falls
89
t/f: there is a high rate of morbidity and one year mortality following hip fx
true
90
t/f: WB are the same for each procedure
false, they vary
91
t/f: hip fx are often complicated by comorbidity
true
92
t/f: there is a high fall risk following hx surgery
true
93
t/f: there is more risk for dislocation with hx fracture surgery than elective hip surgery
true
94
what is polytrauma?
multiple injuries to multiple systems caused by some traumatic event (most often MVA, fall, or violence)
95
what are the effects of blood loss to look out for?
dizziness, fatigue, light headedness, heavy limbs, OH
96
what are critical hemoglobin levels?
less than 7

DPT 629: Cardio (12 decks)

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