Very specific Flashcards
1
Q
PPC S & S
A
- CXR evidence of atelectasis/consolidation
- Temp >38 after Day 1
- Raised WCC
- SpO2 <90% ORA
- New production of yellow/green sputum
- Dx of pneumonia/chest infection
- Prolonged stay >36hrs
2
Q
PPC Risk factors
A
- Surgical incision Upper abdominal incision
- Splinting/pain
- Supine/slumped
- Secretion
- Surfactant
- Shallow breathing
- Supplemental O2
- Smoking history
- Size
- Mech vent
3
Q
PPC Patient related risks
A
- Age>60
- Resp or cardiac disease
- Smoking history
- Impaired functional status
- ASA comorbidity score
- Malnutrition
4
Q
Explain a CABG
A
- Anaethesia, Artery or vein harvested and grafted to aorta and coronary arteries, cardiopulmonary bypass
- Saphenous vein:
5
Q
Precautions for Median Sternotomy
A
- Minimise pressure through UL
- Bilateral rather than unilateral UL activities
- Avoid reaching backwards when possible
- No weight for 1 month, limited weight elbows by side
- No heavy lifting or work for 3 months
- No driving 6 weeks
- Sternal support for cough
- Ladies wear bra esp bigger cup
6
Q
Explain Oesopagectomy
A
- Upper abdominal associated with high chance of PPC’s
- Removal of all of part of the oesophagus stomach is then pulled up and re-anastomosed to the end of the oesophagus
- Ivor Lewis upper abdominal + R) postural lateral thoracotomy
7
Q
Contraindications of Oesophagectomy
A
- Head down tilt avoided to prevent gastric reflux which may lead to aspiration or infection of wound site
- Care with nasopharyngeal suction, as the anastomosis may be damaged with insertion of the catheter
- Neck motion may be limited to prevent stress on the anastomosis
8
Q
Likely attachments
A
NGT ICC IDC Wound drainage Peripheral line Central line TED Oxygen device
9
Q
Implications of NGT
A
- Often pinned to pillow ensure NGT is not pulled out when sitting patient forward
- Ensure tube to well secured to patient’s nose with appropriate tape, and will not slip out when mobilising
- Switch off NG feeds when suctioning patient or when in HDT to avoid aspiration
- NG feeds can often be disconnected to mobilise patient. This should be done by nursing staff as flushing of line required prior to reconnection
10
Q
Implications of ICC
A
- Can use portable suction to mobilise patient
- Check with medical team if not sure about disconnecting
- Keep bottle below insertion level into patient’s chest wall so no danger of fluid entering pleural cavity
- If ICC dislodged from chest wall apply pressure,
- Do not pull out during the course of your management
- Check whether the fluid is swinging, draining or bubbling
- If the bottle breaks, if previously no bubbling double clamp, quickly change bottles; if previously bubbling do not clamp, quickly change the bottle
11
Q
Peripheral line
A
Don’t bend joint
Don’t dislodge
12
Q
Central line
A
- Care with line, do not dislodge
- Inaccurate in Hypoxaemia, Hypercarbia, Acidosis, A-a gradient of 50-150mmHg
- Don’t percuss over line
- Disconnection air embolus patient head down
- If CVP < 5cmH2O Hypovolaemic
o May not tolerate MHI or mobilisation - Atrial arrhythmias may occur with positioning if CVL slides into R atrium e.g. side lying
- Pneumothorax may occur after insertion wait for CXR to confirm before using positive pressure
13
Q
Wound drains
A
- Do not pull out during the course of your management
- Infection can be a problem, ensure safe, appropriate handling of this equipment
- Can mobilise patients with drainage bag keep below level of wound
14
Q
IDC
A
- Ensure bag is not too full prior to mobilising
- Do not pull catheter out when mobilising
- Keep bag below level of the catheter
15
Q
TED
A
- Remove to expose legs for assessment of DVT and circulation
- Do not leave rolled around the ankle as this can create a tourniquet and impair circulation
- Patient can ambulate in TEDs as long as shoes are worn
