Implications

Question 1

Oesophagectomy

Answer 1

• No HDT
• Care with nasopharyngeal suction
• Limit neck motion
• Presents with ICC

Question 2

Nissen fundoplication

Answer 2

No nausea or vomiting

Question 3

Whipple’s procedure

Answer 3

• Patient may be malnourished due to cancer spread
• High risk of post-operative complications

Question 4

Abdominoperineal resection

Answer 4

• Must stay in supine, side-lying or high side-lying
• Must avoid sitting (except SOOB with customised sitting cushion)
• Encourage to mobilise day 1
• Transfer supine to standing and avoid symmetrical sitting positions

Question 5

Stoma

Answer 5

• Check level of fluid or gas in the colostomy bag prior to mobilising
• If full, notify nursing staff
• Supported cough only over wound, do not compress on stoma and bag

Question 6

General vascular surgery implications

Answer 6

• Assess circulation and pulses as part of assessment
• Monitor for signs of acute ishaemia
• Care during treatment with regard to exercises
• Adhere to any ROM limitations
• Use correct footwear
• Mobilse with reference to post-op claudication distance
• Patient with PVD should have sheepskin or bootees
• Complications:
  
  • Post-op infection
  • Aneurysm
  • Thrombotic occlusion

Question 7

Fem-pop bipass

Answer 7

• Often see day 1 for chest care
• Mobilise day 1 or 2 depending on swelling and graft integrity
• Hip cannot exceed 60˚ fx when knee is extended
• Care when handling limb - avoid pressure over incision and graft sites
• Explain blood rushing sensation when they first sit up
• Encourage a normal gait pattern

Question 8

Axillo-femoral bypass

Answer 8

• Avoid shoulder fx >90˚
• Avoid hip fx >60˚
• Avoid sidelying
• Avoid pressure on graft during Ax/Rx
• Avoid use of overhead ring
• Advice re belts and bras (do not constrict flow in the graft
• Avoid constrictive clothing
• Avoid using axillary crutches with mobilisation

Question 9

Abdominal aneurysm repair

Answer 9

Preoperative:

• <6cm - limit cough/FET
• >6cm - no cough

Postoperative:

• High risk
• Potential to develop resp failure - intensive treatment for at least 5 days
• Effective pain relief and wound support
• No HDT
• Mobilise once CV stable, depending on condition

Question 10

Nasogastric tube

Answer 10

• Often pinned to pillow à DO NOT DISLODGE when sitting patient forward
• Ensure tube is well secured before mobilising
• Switch off NG feeds when suctioning or in HDT to avoid aspiration
• NG feeds can often be disconnected to mobilise à nursing staff

Question 11

Oxygen devices

Answer 11

• Check devices is being worn correctly
• Check correct concentration os being delivered
• Monitor SpO2 with pulse oximeter
• Mobilise post-op patients with portable O2 (if appropriate)
• If removed to mobilise, use portable pulse oximeter and ensure replaced on return

Question 12

Urinary catheter

Answer 12

• Ensure bag is not too full prior to mobilising
• Do not pull catheter out when mobilising
• Keep bag below level of the catheter

Question 13

Intravenous drip

Answer 13

• Care with arm exercises (do not dislodge)
• Care with bed mobility à limit movements on joints close to insertion (risk of tissuing)
• If patients c/o pain at drip site, report to medical team (sign of thrombophlebitis)

Question 14

Intercostal catheter

Answer 14

• Do not dislodge
• Check whether fluid is swinging, draining or bubbling
• Keep bottle system below level of insertion
• If bottle breaks, previously no bubbling: double clamp, quickly change bottles
• If bottle breaks, previously bubbling: no clamp, quickly change bottles
• If accidently disconnected, reconnect and assess system

Question 15

Wound drain

Answer 15

• Do not dislodge
• Care of infection - safe, appropriate handling
• Keep below level of wound

Question 16

Vaccum assited closure (VAC) system

Answer 16

• Do not dislodge
• Check with medical/nursing staff whether suction can be removed prior to mobilisation
• Ensure VAC unit is below level of wound to avoid reflux of drainage
• Beware of hissing noise (may indicated dressing is leaking)

Question 17

TED stockings

Answer 17

• Remove to expose legs for assessment of DVT and circulation
• Do not leave rolled around ankle as this can create a tourniquet
• Patient can ambulate with TEDs as long as shoes are worn

Question 18

Atelectasis

Answer 18

• Optimise pain relief
• Techniques to improve ventilation
• Encourage bed mobility and ambulation

Question 19

Pneumonia

Answer 19

• Optimise positioning
• Techniques to mobilise and remove secretions
• Supported cough
• Encourage bed mobility and ambulation

Question 20

Pulmonary oedema

Answer 20

• No role for PT

Question 21

Nausea and vomiting

Answer 21

• Time session with ant-emetic medication
• Ensure vomit bag handy
• If severe, do not mobilise

Question 22

DVT

Answer 22

• Prevent with circulatory exercise and early ambulation
• If present, rest in bed and consult medical staff prior to ambulation

Question 23

Acute ishaemia

Answer 23

• Monitor and maintain circulation
• Notify nursing and medical staff
• Document findings

Question 24

Wound dehiscence

Answer 24

• Always check prior to sitting/moving patient
• In an emergency
  
  • Lie flat, elevate feet if necessary
  • Hold wound with towel/sheet/pillowcase
  • Summon help
  • Patient usually returned to theatre asap

Question 25

Paralytic ileus

Answer 25

* Encourage standing or high sitting * Encourage mobility to decrease collapse and start bowels moving again

Question 26

Post-op haemorrhage

Answer 26

* Lie patient flat * Elevate feet if necessary * Summon help * Remain with patient until help arrives

Question 27

Perotinitis

Answer 27

* Time Rx with pain relief * Maintain pulmonary function * Short, frequent Rx * High sitting might be difficult - consider standing * Consider long-term re-conditioning program

Question 28

Ascites

Answer 28

* Maintain patient’s pulmonary function/prevent collapse * Short, frequent Rx