524: cardioresp > surgery > Flashcards

surgery Flashcards

(73 cards)

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1
Q

how does surgery and anesthesia impair oxygen delivery?

A

it impacts ventilation, perfusion, hemoglobin and blood, and cardiac output and the net result is reduced oxygen delivery to tissues

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2
Q

what does -ecotomy mean?

A

to remove

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3
Q

what does -gram mean?

A

a radiographic picture of a tissue or organ

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4
Q

what does -oscopy mean?

A

to examine by inserting a scope

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5
Q

what does -otomy mean?

A

to cut into (to make an incision)

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6
Q

what does -plasty mean?

A

to reconstruct

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7
Q

common lung surgeries

A

lobectomy, pneumonectomy, segmental resection, wedge resection, lung biopsy, and lung volume reduction surgery

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8
Q

what is a lobectomy?

A

a resection of one or more lobes of the lung and the bronchus leading to the lube is cut and stapled; done as a result of carcinoma

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9
Q

what is a pneumonectomy?

A

a total excision of one lung done for extensive carcinoma where mainstem bronchus is stapled off and diaphragm rises post-op

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10
Q

what is a segmental resection?

A

a removal of a segment of a lobe and is done for localized lesions (abscesses, benign tumors, cysts, TB)

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11
Q

what is a wedge resection?

A

a removal of a small area of the lung and is done for large bullae cysts, biopsies, peripheral tumors, and localized fungus disease

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12
Q

what is a lung biopsy?

A

a surgical removal of lung tissue done for diagnostic purposes

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13
Q

what is lung volume reduction surgery?

A

a removal of badly affected portion of emphysematous lung and purpose is to reduce hyperinflation and improve lung mechanics of the remaining tissue

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14
Q

what are 3 common cardiac surgeries?

A

coronary artery bypass graft, valve repair/replacement, and pacemaker

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15
Q

what is a coronary artery bypass graft?

A

a procedure that uses saphenous vein or internal mammary artery to bypass narrowed coronary arteries and restore blood flow to heart muscle

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16
Q

what is a valve repair/replacement?

A

is repair or replacement of a dysfunctional heart valve and could be done with a mechanical or biological valve

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17
Q

what is a pacemaker device?

A

sends electrical impulses through electrodes to contract the heart muscles and is used to maintain HR when the SA is sick or there is a block

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18
Q

what is an ICD device?

A

implantable cardioverter defibrillator insertion and this looks like a pacemaker but is slightly larger and can send an energy shock that resets abnormal heartbeats to normal

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19
Q

pacemaker and ICD restrictions in first 24 hours

A

avoid moving your shoulder on the side of insertion but you can bend your elbow

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20
Q

pacemaker and ICD restrictions in the first two weeks

A

don’t lift your affected arm over your head but you can move your arm freely below the shoulder

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21
Q

pacemaker and ICD restrictions in the first four weeeks

A

don’t lift anything heavier than 10 lbs and avoid sports and vigorous activities but most normal activities can be resumed

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22
Q

pacemaker and ICD restrictions in the first 8 weeks

A

avoid any kind of shoveling

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23
Q

what is an anterolateral thoracotomy?

A

submammary incision extending from near midline to the 4th or 5th intercostal space at the midaxillary line

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24
Q

what muscles are cut in an anterolateral thoracotomy?

A

pec major, serratus anterior, and intercostals

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25
problems associated with anterolateral thoractomy
limitations of shoulder movements
26
what is a posteolateral thoracotomy?
incisions extends laterally from an area between the scapula and vertebrae to the anterior axillary line at the 5th intercostal space
27
what muscles are cut in a posterolateral thoracotomy?
traps, lat dorsi, serratus anterior, and rhomboids
28
problems associated with a posterolateral thoracotomy
scoliosis towards the operated side and scapular instability
29
what is a thoracoabdominal incision?
an incision from the 8th or 9th intercostal space at posterior axillary line to the midline of the abdomen and this allows for access to the diaphragm, esophagus, biliary tract, and kidneys
30
what muscles are cut in a thoracoabdominal incision?
lat dorsi, serratus anterior, external oblique, and rectus abdominis
31
problems associated with a thoracoabdominal incision
difficulty coughing, deep breathing, thoracic expansion, and a forward flexion posture
32
what is a median sternotomy?
a vertical incision of the sternum frequently used to access the mediastinum and no muscles are cut
33
problems associated with a median sternotomy
kyphosis and splinting due to pain and reduced chest expansion
34
restrictions for 6-12 weeks following median sternotomy
don't push to stand up from sitting or sit up from lying, no lifting, pushing or pulling more than 10 lbs, no reaching over 90 degrees over head, no reaching behind back, and no driving
35
what is the effect on anesthesia on the respiratory system?
decreased functional residual capacity (can lead to atelectasis and shunting), decreased respiratory drive, respiratory muscle weakness, decreased or abolished cough reflex, decreased lung compliance and increased resistance, and hypoxemia
36
effects of anesthesia on the cardiovascular system?
hypotension, hypovolemia, dysrhythmias, and risks of MI or ischemia
37
why does atelectasis happen after surgery?
due to supine positioning, diaphragmatic inhibition, shallow breathing due to pain, and reduced signs and deep breaths
38
physiologically what does atelectasis result from?
decreased FRC, increased closing volume, and when FRC< closing volume this leads to airway closure, alveolar collapse, shunting, and hypoxemia
39
what does FRC represent?
the lung volume at end expiration and this is a buffer against airway closure
40
why is FRC reduced after surgery?
due to anesthesia, supine positioning, abdominal pressure, pain and splinting
41
what increases length of hospital stay and mortality post-op?
pulmonary complications (mainly atelectasis) and DVTS
42
what is a DVT?
a blood clot (thrombus) in a deep vein, usually in the legs
43
signs and symptoms of a DVT
unilateral leg pain, unilateral leg swelling, localized warth, red, and pain on passive DF
44
what is the danger of DVT?
can lead to a pulmonary embolism which can be fatal
45
DVT prevention
early mobilization, LE exercises, bed exercises, and compression stockings
46
patient related risk factors for surgery
pre-existing pulmonary or cardiac or neuromuscular diseases, >60 years, decreased pre-op PA, active smoking, presence of skeletal deformities, and malnutrition
47
what locations of surgery are the most dangerous?
aortic repairs > thoracic > upper abdominal > lower abdominal > non-abdominal/thoracic
48
what length of surgery is considered high risk?
>3 hours
49
what is the perioperative period?
refers to the time from admission to discharge
50
what does pre-op PT improve?
aerobic reserve, respiratory muscle performance, and patient understanding and participation
51
post-op PT goals
enable safe and comfortable movement, restore lung function, prevent secondary complications, rebuild functional capacity, and protect posture and chest mobility
52
what is a peripheral IV line?
delivers fluids, antibiotics, and analgesics
53
what is a central venous line?
delivers vasoactive drugs, nutrition, and measure CVP (central venous pressure)
54
what is an arterial line?
continuous BP monitoring and ABG sampling
55
what is a chest tube?
drains air/fluid from pleural space
56
what is CPAP/BiPAP/ventilator?
supports breathing and alveolar recruitment
57
what is a nasogastric tube?
gastric decompression and feeding
58
what is a PCA (pain pump)?
patient-controlled analgesia
59
what is an epidural catheter?
regional pain control (thoracic/abdominal surgery) and this may cause hypotension
60
what is JP drain/hemovac/pigtail drain?
remove surgical site fluid
61
what are sequential compression devices (SCDs)?
prevents DVT via venous return
62
what is abdominal/chest binder?
supports incisions and reduces pain
63
precautions with femoral attachments
may limits hip flexion and sitting may be contraindicated in certain centers
64
precautions with epidural catheters
avoid movement at the insertion site and check lower limb strength before mobilization
65
what exercises should be encouraged with a chest tube?
shoulder ROM exercises on the side of the insertion
66
what to assess for discharge?
mobility, breath sounds, secretion clearance, O2 saturation, and RR
67
what is hemodynamic instability?
a state of unstable BP with insufficient blood flow, failure to maintain adequate tissue perfusion, and a state of a failing circulatory system
68
other names for hemodynamic instability?
perfusion failure, circulatory failure, circulatory shock, and hypoperfusion
69
what does hemodynamic instability result from?
inadequate CO, abnormal vascular tone, impaired circulating volume, and failure of compensatory mechanisms
70
early signs of hemodynamic instability
tachycardia (or bradycardia in those on beta blockers), narrow pulse pressure (<25% of systolic), delayed capillary refill, mild dizziness, and restlessness or anxiety
71
late signs of hemodynamic instability
hypotension, cold extremities, cyanosis, oliguria, loss or altered state of consciousness, chest pain/SOB, and diaphoresis
72
questions to ask during subjective related to hemodynamic instability
dizziness, lightheadedness, palpitations, unusual weakness, mental status changes, and syncope or near syncope
73
524: cardioresp
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