cardiorespiratory > week 10 > Flashcards

week 10 Flashcards

(48 cards)

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1
Q

Reasons for Thoracic Surgery

A

lung parenchyma disease
- lung cancer
* Emphysematous bullae
* Cystic fibrosis
Pleural disorders
* Pleural effusion
* Pneumothorax
* Empyema
Other
* Myasthenia gravis
* Hiatus hernia
* Cancer of oesophagus
* Pulmonary embolism

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2
Q

Surgery by

A

– Open thoracotomy (large thoracic incision) or
– Video assisted thorascopic surgery

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3
Q

Thoracic Surgery: Pathophysiology

A
  • Lung tissue handled:
  • increase risk of atelectasis
  • Pleural space opened:
  • Pleural effusion, pneumothorax, pleural drains (ICC)
  • Lateral position:
  • Non-operated lung: dependent
  • Operated lung: deflated
  • Respiratory muscles:
  • Direct damage to muscle / nerves
  • Lobectomy
  • Limited effect on lung function & exercise capacity in the long term
  • Pneumonectomy
  • reduced FEV1 & FVC
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4
Q

Intercostal catheters (ICC) and
Underwater Sealed Drains

A

From the intrapleural space, intercostal catheters drain
* Air (apically placed): pneumothorax
* Fluid/blood (basally placed): haemothorax
* As the chest wall and pleura are cut during thoracic surgery, air and fluid enters
the pleural space and will need removing postoperatively
* ICC drain air and/or fluid from the pleural space to
* Re-establish normal negative pressure in the pleural space
* Re-expand the lung

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5
Q

Parameters to Monitor with UWSD & ICC
re swing and indicates what

A

– Indicates the change in intrapleural pressure during breathing
– The water in the water seal chamber will rise and fall (swing) with respiration. This will
diminish as the pneumothorax resolves
– Look at the UWSD chamber & at the fluid in the intercostal catheter

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6
Q

Parameters to Monitor with UWSD & ICC
re bubble

A

– Indicates air is leaving the pleural space during expiration

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7
Q

Parameters to Monitor with UWSD & ICC
re drain

A

– Fluid leaving the pleural space
– Nursing staff measure the hourly volume & colour/type of fluid drain

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8
Q

If UWSD is tipped over

A

Return to upright & ask patient to take a deep breath

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9
Q

If ICC is disconnected from UWSD

A

Reconnect & assess

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10
Q

If ICC dislodged from chest wall

A

Apply firm pressure over the exit poin

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11
Q

Prolonged bypass induces cytokine activation and an inflammatory response, leading to

A
  • Red cell damage and haemoglobinuria
  • Thrombocytopenia
  • Clotting abnormalities
  • Reduced pulmonary gas exchange
  • Risk of cerebrovascular accidents
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12
Q

Cardioplegia

A
  • Cold solution (4 degrees Celsius) high in K+
    is infused into the coronary arteries to induce
    asystole
  • Body becomes hypothermic
  • Iced normal saline placed directly on heart
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13
Q

Cardiac Surgery: Pathophysiology

A
  • Left LL atelectasis is common
  • Asymptomatic unless develop fever, sputum, decrease PaO2
  • increase risk of pulmonary problems:
  • Longer bypass time or
  • Direct nerve damage
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14
Q

Cardiac Surgery: Pathophysiology Causes

A
  • Lungs deflated during surgery
  • Heart sitting on deflated L lung base during surgery
  • Cardioplegic solution (alveolar oedema)
  • Ice can damage the phrenic nerve
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15
Q

Coronary Artery Bypass Grafting

A
  • GA
  • Harvest grafts
  • Venous (eg saphenous vein)
  • Arterial (eg internal mammary artery)
  • Cardiopulmonary Bypass
    ±
  • Hypothermia
  • Cardioplegia
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16
Q

Coronary Artery Bypass Grafts (CABG)
* Internal Mammary (IMA)

A
  • Higher pulmonary complication rates → reduction in lung function
  • Increased risk of
  • Pleural effusion
  • Phrenic nerve injury affecting diaphragmatic function
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17
Q

Coronary Artery Bypass Grafts (CABG)- Bilateral IMA

A

Potential for poorer sternal healing, especially if diabetic

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18
Q

Coronary Artery Bypass Grafts (CABG)
* Radial artery

A
  • Risk of gapping of incision site
  • reduced circulation
  • Mild pain, paresthesia, weakness: transient
    and self-limiting
  • Encourage exercises to facilitate circulation, return of ROM and muscle power
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19
Q

Coronary Artery Bypass Grafts (CABG)
* Saphenous vein

A
  • Few restrictions to activity
  • reduced venous return, some problems with venous pooling
  • No special precautions
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20
Q

Valve Repair / Replacement
* Open:

Study These Flashcards
A
  • GA
  • Sternotomy
  • Cardiopulmonary Bypass
    ±
  • Hypothermia
  • Cardioplegia
21
Q

Valve Repair / Replacement Transcatheter valve implantation

Study These Flashcards
A

Various methods including via the groin or small chest incisions

22
Q

Valve Repair / Replacement
Valves types

Study These Flashcards
A
  • Biological (human, animal)
  • Mechanical (plastic, metal)
23
Q

Non-Pulmonary Complications Following Cardiac Surgery. CV

Study These Flashcards
A
  • Low CO: eg from peri-operative MI, LV dysfunction, arrhythmias
24
Q

Non-Pulmonary Complications Following Cardiac Surgery. Chest Wall

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A
  • Wound infection
  • Delayed union
  • Sternal wound dehiscence/ instability
  • Chest wall pain
25
Non-Pulmonary Complications Following Cardiac Surgery. other
* Renal failure * Multisystem failure
26
Pulmonary Complications Following Cardiac Surgery
* Pleural effusion * Pneumothorax * LLL collapse / consolidation * Respiratory infection
27
Post-operative assessment
* Intraoperative and post operative status eg blood loss, complications, time under GA (eg review operation report), CV stability * Objective assessment of all systems
28
Post-operative care – once/twice/three x/day
* Early mobility/ambulation * Deep breathing exercises (with holds) * Wound support * Discharge advice & education
29
The main aims of pre-operative physiotherapy are to
1. Assess the patient to gain an understanding of their baseline. 2. Educate and teach the patient about what to expect from post-operative physiotherapy interventions and how these can reduce the risk of developing a PPC.
30
Pre-operative assessments can occur in:
* Outpatient settings: in dedicated pre-operative clinics * Inpatient settings: on the surgical wards prior to the patient undergoing surgery
31
Types of patients who receive pre-operative assessments depends on:
* The type of surgery * The patient’s predicted risk of PPC (use of screening tools) * Staffing and resources * Access to patients pre-operatively
32
Pre-operative Physiotherapy Assessments Subjective Assessment
* General health * Respiratory history, including known conditions, medications, sputum load * Smoking history * Social History, including family supports, home set up including stairs, hobbies, occupation * Premorbid mobility, including endurance and gait aids used * Falls history
33
Pre-operative Physiotherapy Assessments Objective Assessment
* Observation of breathing pattern * Palpation * Auscultation * Cough assessment * Mobility assessment, where indicated
34
Pre-operative Physiotherapy Education
* Importance of early mobilisation and role of physiotherapy in preventing PPC * Any post-operative movement restrictions or protocols (eg. sternal precautions) * Recovery and graded return to ADLs, work and leisure activities
35
Prehabilitation – Inspiratory Muscle Training
* Strength training targeting the skeletal muscles responsible for inspiration * A load on the inspiratory muscles is generated through a mouth-held device
36
Common Post-Surgical Attachments
* Intravenous (IV) access * Wound drains * Nasogastric tube (NGT) * In dwelling catheter (IDC) (urinary) * Oxygen Therapy * Stoma bag
37
IV Access
* Provide fluids, electrolytes and medications (eg analgesia) * Access via peripheral (eg cephalic vein) or central veins (internal jugular or subclavian)
38
Wound drains purpose
to let blood, pus, or other fluids escape in order to prevent fluid build-up in a closed space
39
Nasogastric tube (NGT)
* A nasogastric tube (NGT) is a flexible tube that provides access to the stomach through the nose * It allows either delivery of nutritionally complete feed directly into the stomach or removal of stomach contents
40
Stoma bag
A stoma is an opening on the front of your abdomen (tummy) which is made using surgery. It allows faeces or urine to be collected in a pouch (bag) on the outside of your body.
41
Post-operative Physiotherapy Treatment Increase O2 movement
* Deep breathing with inspiratory hold * General positioning * Specific positioning * Mobilisation
42
Post-operative Physiotherapy Treatment Improve secretion movement (Cough effectiveness)
* Huff/cough with wound support
43
Post-operative Discharge Planning Discharge Planning
* Mobility Ax: independent mobility including steps * Independent with HEP/walking program * Submit follow up physiotherapy referrals
44
Post-operative Discharge Planning Education and Advice
* Understanding of education and advice including: - movement restrictions - driving restrictions
45
Abdominal Surgery Postoperative care/precautions:
* Awareness of movement restrictions e.g., lifting * Core stability * Return to work
46
Sternal Complications
Sternal instability- Abnormal motion of the sternum, due to either * bony fracture of the sternum or * disruption of sternal wires inserted to re-attach the surgically divided sternum * Sternal infection, dehiscence and mediastinitis
47
Sternal Complications Risk factors
* Conditions that affect bone healing (diabetes, obesity, COPD) * Gender (female) or BIMA or redo sternotomy
48
Sternal Precautions
* No pushing through hands for 4-6 weeks * Limited weight with elbows by side and pain free * Wound support when coughing (self hug) * No heavy lifting or work for 3 months * No driving for 6 weeks
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