Week 2- Pre & Post Surgical Ax Flashcards
(48 cards)
What are the 6 core cardiorespiratory problems?
- Respiratory Failure (Type 1 and Type 2 Respiratory Failure)
- Increased Work of Breathing/Breathlessness
- Sputum Retention
- Loss of Volume
- Pain
- Reduced Exercise Tolerance
What are the 5 additional concerns that may impact on treatment?
- Anxiety;
- Cognition;
- Functional and mobility limitations;
- Social problems;
- Consciousness i.e. ventilated and sedated in ITU.
What are clinic signs and symptoms in cardio respiratory?
- Cough
- Wheeze
- Tachycardia
- Bradycardia
- Cyanosis
- Oedema
- Increased respiratory rate
- Low SpO2
- Polycythemia
- Sputum colour
- Syncope
Before treating a patient what do you need to ask yourself?
- what problems does this patient have?
- can I treat these problems?
- is the patient likely to respond to Physiotherapy?
What is the definition of clinical reasoning?
A structured process, through interaction with the patient and others in the multidisciplinary team, the structures meaning, goals and health management strategies, that are based on clinical data, client/ patient choices and professional judgement and knowledge
What is the cycle of clinical reasoning process
Where to you gain information to identify the patients main problems and determine goals of Physiotherapy management?
- background information
- medical chart
- bed chart
- subjective assessment followed by an objective assessment
What is the flow of treating a patient
When does a physio see a surgical patient?
+/- pre admission clinic
+/- pre operatively
Post operatively
What surgical patients do physios see?
Prioritise patients who are at high risk
- patient related risks
- procedure related risks
What information in required in the pre operation assessment
- Presenting condition
- Past medical history
- Social history
- Functional history
- Investigations
- Medical management
- Planned Surgical Procedure
- Special Orders
- Patient’s normal respiratory – breathlessness, cough, sputum
- Pain
What needs to included in a pre operation physical assessment?
- observation
- palpation
- auscultation
- cough
- lower limbs
- special assessment
Remember to prioritise and modify depending on the patient’s presentation
What should you education the patient around in regards to pre op management?
- role of physio
- expected post op presentation
- effects of surgery
- early mobilisation
- pain relief importance
What is the aim of pre op management?
- gain patients confidence
- ax and prevent risks of developing post op complications
- respiratory
- immobility
- DVT’s
What are post op complications?
- changes to planned procedure
- large blood loss
- cardiac complications
- labile BP
- GA complications
- Aspiration
- ventitlation issues
- pain control issues
- investigations
What should be included in the post op patient interview
- pain: at rest, movement, effect of pain relief
- cough: productive, pain
- SOB: current vs normal
- confirm information gathered from medical chart: past medical history, smoking history, social history, functional history, current history
- special post surgical questions: N&V, dizziness, drowsy, pins and needles, numbness
What to include in the post op physical assessment
- observation: environment, patient
- palpation
- Auscultation
- Cough: justify timing
- Lower limbs: DVT, circulation
- special assessments: strength, numbness
What should you document in post op management
- distance mobilised
- assistance required
- tolerance
- effect: important to re-assess
- adverse events: dizziness, N&V
Why have orthopaedic surgery?
- degenerative disease (OA)
- trauma (fractures, dislocations)
- pain
- reconstruction (knee, shoulder)
- pathological process (Ca, RA)
- Prophylaxis/ Function (spinal scoliosis)
Why in the objective assessment is the environment important?
Safety concern: a clustered environment is unsafe to mobilise a patient
Look for:
- walking aids, chairs to sit out in.. PLAN
- apparatus (IV poles, O2, drains, catheter, compression stockings, pumps, pillows, slings, splints)
What attachments need to be considered?
-IV lines: where? _wound drains: where, what, on suction? -NGT- suction? -Colostomy/ ileostomy: check leakage, may need to be emptied prior to moving -Check length of tubing
What is included in the circulatory assessment
• For patients at risk of deep vein thromboses
• Commonly seen in the calf and assessed by looking for:
-Swelling of the calf
- Redness of the calf
- Localised pain/tenderness
- Increased temperature on palpation
- Positive Homan’s sign (calf pain on passive ankle dorsiflexion)
What is the neurological assessment
• Modified neurological assessment is required in the presence of spinal or epidural anaesthetic. It will help assess patient’s ability to mobilise and should include:
- Hip,knee,anklestrength&sensation
• Full neurological assessment (reflexes, power, sensation) if
indicated by the subjective examination - especially in the presence of spinal injury
What is the musculoskeletal assessment
• Major joints in unaffected limbs as required
-normal range of motion, no tenderness or swelling
• Cardinal signs of Orthopaedic Musculoskeletal Assessment
- Mobility Level (Independence)
- Range of motion
- Muscle Strength
- Balance
