surgical patient Flashcards
(82 cards)
1
Q
what should management be?
A
- holistic
2
Q
what does management include? (7)
A
- planning
- organising
- directing
- re- evaluating
- co- ordinating
- monitoring
- multi- disciplinary
3
Q
what systems are included in a multi- system assessment?
A
- respiratory
- cardiovascular
- nervous system
- renal system
- bloods
- drugs
4
Q
how do you assess the respiratory system?
A
- self ventilated or mechanically ventilated
- respiratory rate
- oxygen saturation
- Fi02
- auscultation
- chest x-ray
- arterial blood gases
5
Q
what is the definition of Fi02?
A
- fraction of inspired air
- estimation of the oxygen content a person inhales
6
Q
what is the normal Fi02?
A
- concentration of oxygen at room air is 21%
7
Q
what does the cardiovascular system assess?
A
- heart rate
- blood pressure
- temperature
- capillary refill time
8
Q
what does the nervous system assess?
A
- GCS
- RASS
- ACVPU
9
Q
what is GCS?
A
- Glasgow Coma Scale
- measures how conscious you are
10
Q
what is the scoring of GCS?
A
- can get a score from 3-15
- a score of 15 means you’re fully awake, responsive and have no problems with thinking
- score of 8 or fewer means you’re in a coma
11
Q
what is RASS?
A
- Richmond Agitation Sedation Scale
- assesses alertness and agitated behaviour in critically ill patients
12
Q
what are the scores in RASS?
A
- 0 = alert and calms
4 to -5 with 4 being violent and -5 being unarousable (no response to voice or physical stimulation)
13
Q
what does ACVPU stand for?
A
- alert
- conscious
- voice
- pain
- unresponsive
14
Q
what are the measurements taken from the bloods?
A
- haemoglobin
- platelets
- white blood cells
- c- reactive protein
- sodium
- potassium
15
Q
what does the renal system assess?
A
- urea
- creatine
16
Q
how much urine is normal?
A
- 1/2 per 1 ml kg/ hr
17
Q
why is drug history important?
A
- infusions
- supported/ unsupported
- dilators
18
Q
where do gases move to?
A
- move from an area of high pressure to an area of low pressure
19
Q
what surrounds the lungs? what is it?
A
- visceral pleura
- serous membrane
20
Q
what goes around the visceral pleura?
A
- parietal pleura
21
Q
what does the visceral and parietal pleura form?
A
- they form a single cerous membrane but it folds on itself
22
Q
what is between the visceral and parietal pleura?
A
- pleural cavity
23
Q
what connects the ribs? how many are there?
A
- intercostal muscles
- three muscles
24
Q
what is the normal atmospheric pressure?
A
- 760mmHg
25
what is the pressure inside the lungs known as? what is it normally?
- intrapulmonary pressure
- 760 mmHg
26
what is the pressure in the pleural cavity called?
- intrapleural pressure
- 756mmHg
27
what happens when intrapulmonary volume changes?
- intrapulmonary pressure also changes
28
what happens to the volume and pressure in inspiration?
- intrapulmonary volume increases due to contraction of intercostals and diaphragm (moves down)
- intrapulmonary pressure decreases so oxygen flows into the lung from the air
29
what happens to the volume and pressure in expiration?
- muscles relax (diaphragm moves up)
- intrapulmonary volume decreases so intrapulmonary pressure increases
- oxygen moves up and out of the lungs to the air
30
what is the most important lung volume? why?
- functional residual capacity
- it is where gaseous exchange occurs
31
what happens if there is no residual volume left?
- results in lung collapse
32
what is a cough?
- short explosive expulsion of air
33
what is the main layer in the respiratory tract that contributes to coughing? what does it contain?
- mucosa layer
- contains goblet cells, which release mucus
34
what is the first layer of mucosa made up of? what are these cells?
- pseudostratified columnal epithelium
- cells are ciliated
35
what is below the mucosa layer?
- basement membrane
- as well as smooth muscle
36
what is below the mucosa and basement membrane? what does it contain?
- submucosa
- contains immune cells e.g., mast cells specialised for defence & allergic response
37
what is below the submucosa?
- cartilage
- part of the trachea
38
what nerves innervate the area?
- sensory nerve fibres
- RAS, SAS and C- fibres
39
what does RAS stand for?
- rapidly adapting
40
what does SAS stand for?
- slowly activating
41
what are the six impacts of anaesthesia on the respiratory system?
- respiratory muscle tone and lung function
- compliance and resistance
- airway closure
- dead space
- ventilation and perfusion rate
- alectasis
42
how does anaesthesia affect the respiratory muscle tone and lung function?
- in the adult human, the resting lung volume is reduced by 0.8-1.0L by changing body position from up right to supine
- can further decrease by 0.4-0.5L with the induction of general anaesthesia
43
what are the 8 types of incisions for abdominal surgery?
- liver surgery/ transplant
- renal transplants
- duodenal surgery
- major abdominal trauma
- appendectomy
- cholecystectomy
- urology procedures
- sigmoid colostomy
44
what is the advantage of laparoscopic surgery?
+ less pain due to small incision
45
what is the disadvantage of laparoscopic surgery?
- if there is any complications, may have to perform an open surgery afterwards
46
what is the advantage of open surgery?
+ more access
47
what is the disadvantage of open surgery?
- risk of infection
48
what screening tool can be used post- operation?
- Southampton physiotherapy post- operative screening tool
49
what are the 8 factors of the SPPOST?
- oxygen
- respiratory conditions
- respiratory rate
- BMI
- age
- exercise tolerance
- duration of surgery
50
what happens if a patient scores 10+ on the SPPSOST?
- they are at higher risk of developing PPC
51
what happens if the patient has a score of below 9 on the SPPOST?
- nurse manages the patient
- no physio contact
52
what increases with age? what does this lead to?
- closing capacity
- leads to collapse
53
what is closing capacity?
- lung volume at which small airway closure begin to occur
54
what are the 6 type of incisions for cardio- thoracic surgery?
- sternotomy
- clam shell incision
- thoracotomy
- thoracoabdominal incision
- axillary thoracotomy
- anterior mediastinotomy
55
what is a lobectomy?
- part of the lung is removed
56
what is pleurodesis?
- sticks your lung to your chest wall
57
what does CABG stand for?
- coronary artery bypass grafting
58
what does CABG create? what is an example of when it is used?
- creates a new path for blood to go around a blocked or partially blocked artery e.g., CHD
59
what is thoracotomy?
- minimally invasive incision to the chest wall
- where a thin plastic tube is placed into the pleural space
60
what is segmentectomy?
- removal of part of one of the lobes of the lung to entirely remove a cancerous tumour
61
what is thoracoscopy?
- procedure looks at the space inside the chest
62
what is pneumonectomy?
- removes one of your lungs due to cancer, injury or some other condition
63
what are the signs of post- operative pulmonary complications? (8)
- temperature over 38 degrees
- white cell count over 11.2
- physician diagnosis of pneumonia/ chest infection
- chest X-ray findings of atelectasis
- production of purulent sputum (yellow/ green)
- positive results upon sputum analysis
- Sp02 under 90%
- re admission to or prolonged stay in intensive care unit
64
what is the benefit of a multi- system assessment?
- allows better understanding before seeing the patient e.g., respiratory system notes
65
what are the two treatment options for optimising chest expansion and clearing sputum?
- early mobilisation
- ACBT
66
how do you deal with pain management after surgery?
- encourage use of patient- controlled analgesia
- ensure regular pain relief prescribed
67
how do you facilitate nutrition and rehydration?
- adequate positioning
68
what does early mobilisation and ACBT improve? (4)
- ventilation
- muscle strength
- functional capacity
- functional independence
69
what does early mobilisation and ACBT reduce?
- reduces risk of postoperative complications
70
what does later mobilisation increase risk of? (3)
- post- operative pulmonary complications
- deep vein thrombosis
- ileus
71
what is the likelihood of developing PPC for each day not mobilised?
- three times more likely to develop PPC for each day not mobilised
72
why does PPC occur when there is a delayed time to mobilise?
- delayed optimal ventilation/ perfusion
- delayed sputum clearance
73
what does PPC increase risk of?
- increased risk of prolonged atelectasis
74
what does a lack of mobility do to blood flow?
- sluggish blood flow
75
what slows down in the gut after late mobilisation? what is this due to?
- peristalsis slows down in the gut
- due to reduced mobility/ anaesthetic/ medication
76
what are the two positive pressure adjuncts that physios use?
- IPPB
- NIPPY
77
what are the benefits of IPPB? (7)
+ patient triggered
+ pressure cycled
+ improved distribution of ventilation
+ mobilise secretions
+ reduced work of breathing
+ increased expiratory flow for cough
+ enhance distribution of inhaled medication
78
what are the benefits of NIPPY? (3)
+ provide the same benefits as IPPB
+ provide insufflation and exsufflation
+ support cough
79
what is continuous positive airway pressure?
- sends a continuous pressure of air throughout respiratory cycle (insp and exps)
80
what does CPAP provide?
- provide PEEP
- alveoli pressure above atmospheric pressure at the end of expiration
81
what does CPAP help to maintain?
- helps maintain a patent airway
82
