2 - Post-Op Respiratory Care

Info from 'Respiratory Care: Principles and Practice' 4th edition

post-op pulmonary care (PPC)

• unexpected post-op pulmonary abnormalities

• occur more often than cardiac

• results in longer ICU stay

• leading cause of post-op morbidity and mortality

• decreased lung volumes (atelectasis)

• V/Q mismatch

assessment and management of surgical patient

• age

• smoking history

  • stop 4-6 weeks before significant decrease

• lung disease

  • COPD increases risk 26%-78%

• heart disease

  • 50% risk of post-op death

• obesity

  • reduced lung volumes (atelectasis, V/Q mismatch, persistant hypoxemia)

pre-op tests

• PFTs

• ABG

• chest x-ray

• exercise testing

• ECG

• labs

risk factors for post-op pulmonary care

• thoracic and upper abdominal surgery

• PEEP

causes and risk factors for atelectasis

• anesthesia

• pain and immobilization

• obesity

clinical manifestations of atelectasis

• dyspnea

• hypoxemia

• diminished breath sounds

prevention and management of atelectasis

• lung expansion

• early mobilization

• pain control

clinical manifestations for mild to moderate pulmonary emboli

• dyspnea

• pleuritic chest pain

• tachypnea

• tachycardia

clinical manifestations for severe pulmonary emboli

• cyanosis

• hypotension/shock

• syncope (fainting)

• cardiac arrest

diagnostic evaluation for pulmonary emboli

• d-dimer

• computed tomography pulmonary angiography (CTPA)

• V/Q scan

• ECG

treatment of pulmonary emboli

• anticoagulation

• thrombolytic therapy

• surgical/catheter-directed embolectomy

• O₂ therapy and hemodynamic support

risk factors for pneumonia

• aspiration

• prolonged mechanical ventilation

• pre-existing conditions

clinical presentation of pneumonia

• fever

• leukocytosis

• productive cough

• dyspnea

• hypoxemia

diagnosis of pneumonia

• chest radiography

• sputum sample

prevention of pneumonia

• incentive spirometry

• early mobilization

• aspiration precautions

management of pneumonia

• antibiotics

• support