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Cardiorespiratory Physiotherapy > Week 5 > Flashcards

Week 5 Flashcards

1
Q

Things to consider about surgery

A

post op pulmonary complications
-leading cause of morbidity and mortality

-increase length of stay

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2
Q

Risk factors

A 
smoking history
location of surgery - upper abdomen or thorax
prolonged anaestheasia - >180 mins
effective vs emergency surgery
somorbidities 
Obesity - BMI > 27
Age >60 
Pain
Meds
Immobility - pre and post op
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3
Q

Review locations of incisions

A

P.g. 5

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4
Q

Signs and symptoms

A

SpO2 38 after 1 day post op
sputum productive
abnormal lung auscultation
Raised WCC

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5
Q

Common complications

A 
Respiratory
complications
– Decreased
Ventilation
–
atelectasis
– Chest
infections
– Hypoxaemia
• Other
complications
– Fatigue
– Depression
– Fluid
imbalances
– Urine
retention,
constipation
– Wound
infection
or
dehiscence
– Hypothermia
– BP
disturbances
– Neurological
problems
– DVT
– Post-­‐op
bleeding
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6
Q

What is atelectasis

A

aveoli collapse

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7
Q

Types of atelectasis

A

micro

  • patchy areas of atelectasis
  • can progress to major
  • most post ops have

Plate

  • small areas of collapse
  • thin white lines on xray

Reabsorption /absorption

  • bronchus or bronchiole is blocked (sputum)
  • High FiO2 - decrease nitrogen
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8
Q

Risk factors for atelectasis

A 
surgical incision
previous respiratory condition
smoking history
obesity
age
impaired cognitive function
mechanical ventilation
body position
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9
Q

What is surfactant impairment

A 
surfactant impairment 
-surfactant covers alveolar surface
reduces the surface tension
stabilises the alveoli 
prevents collapse
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10
Q

Risk factors for surfactant impairement

A

GA
supplement oxygen
mechanical ventilation
infection

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11
Q

Risk factors for DVT’s

A 
DVT history
smoking history
immobility 
oral contraceptive 
obesity
LL surgery
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12
Q

Post op problems

A

pain
-may be the most important factor that causes ineffective ventilation and ineffective cough

Immobility
-causes: decreased lung volumes 
hypoxaemia
decreased CO, SV
Increased HR
Orthostatic intolerance
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13
Q

Pain management

A 
critical to optimize 
types
- narcotics - morphine 0 pethidine - fentanyl 
- complications -respiratory depression 
 - postural hypotension
-N&V
Drowsiness
itch
syncope

Epidural - nerve blocks - localised anaesthetics + opioids

  • complications
    • hypotension, urinary retention, motor block
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14
Q

Post op mobilisation aims

A

prevent immobilisation effects
increase minute ventilation
increases CO
Maintain strength

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15
Q

thing to consider regarding post op mobilisation

A 
incision location
level of pain
presence of adverse effects
presence of attachments
level of assistance available vs required
equipment available 
pre-existing conditions
premorbid mobility level
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16
Q

Pre op assessment required information

A 
presenting condition 
past medical history
social history
functional history
investigations
medical management 
planned surgical procedure
special orders
Pt's normal respiratory - breathlessness, cough, sputum
Pain
17
Q

Pre op physical assessment

A 
observation
palpation
auscultation 
cough
lower ribs
special assessment
18
Q

Pre op management aims and education

A 
aim - gain patients confidence
AX and prevent risks of developing post op complication
-respiratory 
-immobility
-DVT's 
Education
-role of physio
-expected post op presentation
effects of surgery
early mobilisation
pain relief importance
19
Q

Pre-op management

A

demonstrate

  • breathing exercises
  • circulation exercises
  • supported cough
  • bed mobility and transfers
  • post op exercises

+/- treatment
- may require airway clearance

20
Q

Post op assessment

A

required information

  • presenting condition
  • past medical history
  • functional ability
  • investigations
  • Medical management
  • Surgical procedure - found in operation note
    • post op orders
    • recovery notes
21
Q

Post op assessment operation note and post op orders

A

-procedure : incision, structures cut, wound closure, drains
-Anaethetic time and surgery time, recovery events
-management : return to ward , pain relief , initial post op course
-

Post op orders

  • physio orders - WB status, ROM
  • oxygen therapy
  • fluid orders
  • pain relief
  • suture , stable or dressing removal
22
Q

Peri or post op complications

A 
changes to planned procedure
large blood loss
cardiac complications
labile BP
GA complications 
aspiration
ventilation issues
pain control issues
investigations
23
Q

What are the differences between adult and children patients

A 
understanding 
behaviour
long term emotional disturbance
own belongings
involvement of family
age appropriate language
**Listen to the child**
24
Q

Rib cage and chest shape for children

A

Rib cage and chest shape
infants - cylindrical, soft and horizontal ribs (no bucket handle movement) poor intercostal development
-Age 3 yrs - adult chest wall shape achieved

Diaphragm
-infants - horizontal insertion - mechanical disadvantage, main muscle of inspiration

Preferential nasal breathing
- infants - shape and orientation of head and neck

25
Q

Further anatomical differences

A

alveoli -

  • at birth - 150 million alveoli
  • 3-4 years - 300-400 million alveoli (adult number)
  • alveolar growth continues until 7 years

Collateral ventilation
- starts to develop at 1-2 years and continue to develop until 6 years

Internal organs and lymphatic tissue

  • tonsils and adenoids - upper airway obstruction
  • heart and liver - less lung expansion

-Height and exposure to air pollution

26
Q

Physiological differences

A

respiratory compliance
-cartilaginous
Closing capacity (CC)
-CC> FRC in infants - closure can occur before the end of expiration
Ventilation and perfusion
-ventilation greater of upper most lung
- perfusion remains best in the dependant regions

27
Q

Further physiological differences

A

oxygen consumption, CO and response to hypoxia

  • sympathetic nervous system not developed in infants
  • infants response to hypoxia = bradycardia , decreased CO and pulmonary vasoconstriction - further causing hypoxia
28
Q

What is a neonate

A

new born child

29
Q

What to include in observation

A 
vital signs - HR, RR, SaO2, Temp, ABG's
Regularity and pattern of respiration - apnoeix spells
Thoracic cage shape and movement 
Feeding and eating
cyanosis 
attachements - 02
30
Q

Respiratory distress characteristics

A 
increased HR and RR
recession 
nasal flaring
grunting 
tracheal tug
stridor 
neck extension
head throbbing
31
Q

Auscultation

A

unreliable
no signs on auscultation secondaty to laminar flow and static secretions

important to use with palpation and possibly huff / cough

32
Q

Treatment

A 
airway clearance 
exercise
managing breathlessness 
posture
MSK
inhaled medication
33
Q

Airway clearance

A 
manual techniques - including suctioning '
ACBT
Postural drainage
FLutter 
PEP
Autogenic drainage
34
Q

Percussions and vibrations

A

short periords - 30sec /1min
not to vigorous
1 handed or fingers only usuallt
use easily with postural drainage

35
Q

considerations

A 
age of the infant/ child
pre or co-existing conditions
Aim of Rx
Outcome measures
acute vs long term
36
Q

Exercise

A

use as an adjunct to formal airway clearance techniques
benefits well known
Make it fun

37
Q

barriers to exercise

A 
parental involvement 
age of the child - adolescents 
enjoyment and self esteem 
individualised programme 
health benefits and perceptions 
part of airway clearance

Cardiorespiratory Physiotherapy (7 decks)

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