Atelectasis: Definition, Symptoms - Assignment Example

Student names Instructor Unit Code Date Question 1 After Mr. Gregory underwent a cardio-oesphagetomy surgery to get rid of cancer through the removal of the gullet (esophagus), he developed right lower lobe atelectasis just four days after his surgery. To determine why he developed atelectasis, the risk factors after post-operative pulmonary complications (PPC) and the pathophysiology of the atelectasis are considered and discussed below to determine if they attributed to atelectasis. There are several factors that lead to post-operative pulmonary complications. These are the patient’s prior health as well as the effects that anesthesia has on the patient and the surgical trauma a person experiences. These three main factors determine the risk of a patient to developing PPC. Some of the factors associated with these three risk factors include age, obesity, cigarette smoking, thoracic and abdominal surgery, general anesthesia (Smetana 60) and recent use of anesthesia. Before the operation, Mr. Gregory had been a smoker for over four decades, smoking around 30 cigarettes within a day. However, he recently stopped smoking upon his cancer diagnosis. After his diagnosis, Mr. Gregory started on chemotherapy but his treatment was discontinued. He was then slated for surgery, in particular a cardio-oesphagetomy surgery to remove the cancerous parts. Prior to the surgery, the anesthetist gave the green light for Mr. Gregory to be given general anesthetic in the theatre. One of the most serious post-operative pulmonary complications that occurs after surgery is postoperative pneumonia. In a study by Kanat, the postoperative pneumonia occurred in 85.2% of the surgical patient sample under study (135). The high numbers of patients contracting pneumonia after surgery has placed postoperative pneumonia as the third most common PPC infection that follows wound and urinary tract infections in healthcare centers (Brooks-Brunn 564). In day four after the surgery, Mr. Gregory’s sputum culture was collected. It revealed that he had streptococcus pneumoniae bacteria, which causes pneumococcal disease, including pneumonia. His temperature was at 38.5 degrees in addition to pulmonary infiltration. According to Raad (179), a majority of pneumonia cases occur within the first four to five days after a surgery. Combining the results of the sputum culture, the high temperatures and the bacteria, it is likely that Mr. Gregory developed pneumonia. Apart from pneumonia, mucus accumulation during and after a surgery in the airwaves lead to the inability for the patient to cough, which increased the chances of lung atelectasis. When a patient is undergoing surgery, they receive drugs that can cause partial inflation of the lungs so that normal secretions can accumulate in the lung airways and are cleared when suction is done after the surgery. However, sometimes this does not work, leading to a buildup of mucus. A CT scan of Mr. Gregory on day 3 revealed that he had large quantities of free peritoneal fluid that resulted in a return to the theater for additional surgery. He also produced green sputum when coughing. Atelectasis occurs when a lung or one of its lobes either fully or partly collapses because the alveoli shrink inside the lung. Some of the risk factors that can result in atelectasis are advanced age, conditions that block coughing, lack of movement, recent abdominal or chest surgery, and being under general anesthesia recently. In the case of Mr. Gregory, atelectasis was as a result of several factors that increased the probability of it to occur. For the surgery to take place, he was placed under general anesthesia, which increased his changes of PPC. The cardio-oesphagetomy surgery involved incision in the mid abdomen that also played a part because abdominal surgeries have a greater risk of PPC occurrences. After the surgery, Mr. Gregory had reduced mobility because he was kept in bed to monitor his vitals. He also suffered from pneumonia. Due to the free peritoneal fluid, Mr. Gregory was subject to an additional bout of anesthesia and surgery that increased his changes of PPC and the development of atelectasis. Question 2 Mr. Aston is set for a left trans-tibial amputation and requires an exercise program that will be useful for him as he recovers post operatively. Some of the problems that he faces, both current and post-operative include mobility, washing, toileting, meals preparation, washing, transport, and pain difficulties (See Appendix A). The initial treatment plan consists of intervention measures to be carried out and physiotherapy goals that can be measured (See Appendix B). The treatment includes an exercise program for Mr. Aston that includes hips, the knees and upper limbs. Mr. Aston has to learn how to use his upper body’s strength to his advantage because his left leg will be a residual limp. Therefore, he must exercise in order to become independent once again. Stump massage and de-sensitisation help in reducing pain. The realistic goals to achieve the optimum treatments are set in such a manner that they are achievable, measurable, and timely assist in maximising the treatment. Stump Management One of the problems that Mr. Aston faces is the manner in which he should manage his left leg stump. An ideal stump is well-healed, has minimal pain, mobile and soft scars, has good blood supply, has minimal oedema, is of sufficient length that allows for biomechanical leverage but is not long to obstruct the prosthetic component choices and has a large surface area that helps in the distribution of pressure. Though the surgical procedure plays a crucial role in the creation of the perfect stump, physiotherapy is necessary so as to maximise the opportunities to make stump management ideal. One of the problems that arise in relation to stump management is the post-operative factors that influence the period between the prosthetic fitting and the rate of rehabilitation is the manner in which the wound heals, especially in the compromised vascular area (Johanesson 367). Oedema is another problem that occurs after amputation. Oedema occurs when the residual limb swells during the night when a liner is not worn when an amputee is sleeping. Consequently, Mr. Aston has to ensure that he wears a shrinker to control oedema while sleeping so as to control his stump from swelling. By controlling the oedema in the residual limb, Mr. Aston will also be promoting pain control, shaping the stump for prosthetic fitting, wound-healing and will be protecting the incision in the days of rehabilitation (Lusardi 592). Monitoring Tool to measure The Effectiveness of Physiotherapy Treatment To evaluate how effective the physiotherapy treatment is, the Patient-Reported Outcome Measures (PROMS) is used to acquire unique patient-centred information by gathering data from the patient regarding their physiotherapy treatment. Because of the purposes of audit and the increased usage of PROMS for routine patient care, this monitoring tool has become firmly embedded in clinical research. Their use will be helpful in ensuring that Mr. Aston’s voice is heard in all aspects of his care. This is important because physiotherapy treatment should always remain patient-centred. By using PROM monitoring tool to measure how the treatment is effective, the patient’s opinions on the treatment, then the impact of his condition on his life and rehabilitation efforts will be captured using questionnaires that focus on elements of the patient’s well-being. A single PROM can measure a single dimension such as physical activity to determine the mobility rehabilitation efforts and their success. Therefore, PROM offers a flexibility in the range of PROMS that can be used and are designed so as to measure how effective the treatment is based on patient feedback. Question 3 Mr. Bury improved condition after the exacerbation of the Chronic Obstructive Pulmonary Disease (COPD) means that he will be discharged soon. To help improve his situation once discharged, some specific multidisciplinary interventions can be employed. These interventions include, smoking cessation, pulmonary rehabilitation, education and self-management, nutrition, counselling, and end-of-life care. Mr. Bury has been a life-long smoker most of his life. He smokes between 30-40 cigarettes in a day. Since he has already been diagnosed with COPD, smoking cessation is the most single foremost issue that he needs to address. This is because as a COPD patient, Mr. Bury’s continuation of smoking will lead to a decline in the functioning of his lungs. As such, Mr Bury must quit smoking. In fact, the smoking risk factor should be given the top priority in COPD management above all other severities. To ensure that Mr Bury stops smoking, the multidisciplinary intervention is to address this addiction with the patient. The intervention will be used to help the patient stop smoking by utilizing available means such as counselling or drug therapy or a combination of both so as to manage the COPD condition better. In addition, the intervention will refer Mr. Bury to a smoking cessation program should the counselling in an office setting prove unsuccessful. Mr. Bury’s current exercise tolerance is restrictive of his mobility when he is outside of his house. Though he can walk around the house, Mr Bury was not able to leave his flat before the exacerbation of the COPD. In addition, he had swollen ankles prior to his treatment, which limited his mobility further. Therefore, Mr. Bury needs to increase his mobility through increased exercises. Because of his COPD diagnosis, it follows that the best course of action is to put Mr. Bury under pulmonary rehabilitation, which is a structured multidisciplinary intervention suitable for patients who have chronic pulmonary diseases. Pulmonary intervention will assist Mr. Bury improve his exercise tolerance, reduce his difficulties in breathing, which will in turn improve his quality of life (Bernard 900). In addition, this intervention is helpful in relieving fatigue and dyspnea, the two main debilitating symptoms that COPD patients such as Mr. Bury can suffer from, and thus improve his quality of life (Heidelbaugh 176). When managing COPD, self-management and education are vital components if a multidisciplinary approach is to be taken. A self-management program for Mr. Bury, be it one-on-one or in a group setting, that has educational sessions can be utilised to explain to the patient the nature and the course of his disease. The educational sessions will also teach Mr. Bury how to live with the repercussions of COPD and how to integrate it into his social life. The patient will also help in the preparation of an action plan for the exacerbations so as to improve his quality of life and reduce the usage of healthcare resources (Costi 362). The use of an individualised action plan will also ensure an early initiation of therapy. Mr. Bury will have access to psychosocial support, which will help him deal with anxiety and fear. He will also have access to social services support and occupational therapy to improve his independence in various activities. While recovering, Mr. Bury needs nutritional intervention. An improved diet that has adequate protein, calories, fluids, calcium and potassium will health to ease Mr. Bury’s breathing problems and also improve his immunity. By adequately being hydrated, Mr Bury will thin his respiratory mucus, which will help to prevent the mucous membrane from drying. The consumption of protein will help promote the immune functions in the body. As a COPD patient, Mr. Bury needs to maintain a healthy weight and immunity to avoid infection and ease his breathing. Calcium is also important because it will help with the maintenance of healthy bones and muscle contraction. Muscle contraction also benefits from normal serum potassium levels that help in breathing. For an overall multidisciplinary action, it is essential to also discuss with the patient end-of-life care. This is because it helps to address the concerns and fears of the patient. As such, Mr. Bury is able to have all his end-of-life care concerns addressed now instead of leaving the subject until he is moribund. Mr. Bury will have discussions of the advanced care issues such as the use of mechanical ventilations and biPaP well ahead of time and be well prepared. Works cited Bernard, Sarah, et al. “Aerobic and Strength Training in Patients with Chronic Obstructive Pulmonary Disease.” Am J Respir Crit Care Med 159 (1999): 896-901. Print. Brooks-Brunn, Ann. “Predictors of Postoperative Pulmonary Complications Following Abdominal Surgery.” Chest 111.3 (1997): 564-571. Print. Costi, S., Brooks, D., and Goldstein, R.S. “Perspectives that Influence Action Plans for Chronic Obstructive Pulmonary Disease.” Can Respir J 13.7 (2006): 362-368. Print. Heidelbaugh, Joel J. Chronic Obstructive Pulmonary Disease: A Multidisciplinary Approach. Philadelphia, Pennsylvania: Elsevier, 2015. Print. Johannesson, Anton, et al. “Comparison of Vacuum-Formed Removable Rigid Dressing with Conventional Rigid Dressing after Transtibial Amputation.” Acta Orthopeadica 79.3 (2008): 361-369. Print. Kanat, Fikret, et al. “Risk Factors for Postoperative Pulmonary Complications in Upper Abdominal Surgery.” ANZ J Surg 77.3 (2007):135-141. Print. Lusardi, Michelle. “Postoperative and Preprosthetic Care.” In Lusardi, Michelle et al. (editors). Orthotics and Prosthetics in Rehabilitation, Third Edition. Missouri: Elsevier, 2013.p. 532-594. Print. Raad, I., et al.”Treatment of Nosocomial Postoperative Pneumonia in Cancer Patients: A Prospective Randomized Study.” Ann SurgOncol 8: (2001): 179-186. Print. Smetana, Gerald, W. “Postoperative Pulmonary Complications: An Update on Risk Assessment And Reduction.” Cleve Clin J Med 76.4 (2009): S60-65. Print. Appendix A: Problem List Problem Before Surgery After surgery Mobility difficulties Mr. Aston is in too much pain and uses a wheelchair to move to and from the bathroom. Can walk with no aids though slowly due to pain Mr. Aston will have mobility issues due to the amputation and will require the wheelchair. After the amputation, he will require aids to walk independently again. Transfers Can independently transfer although Mr. Aston is in a lot of pain. The left trans-tibial amputation will leave the Mr. Aston unable to independently transfer because of the operation Toileting Can toilet independently with the help of a wheelchair unable to toilet independently Washing Able to wash independently when in a seated position. difficult when showering and requires assistance Meal preparation Difficulties when preparing meals from a standing position after the amputation because of body balance problems Pain Currently, the patient is in pain is intense since the patient is unable to sleep and feels a throbbing and burning sensation. After the amputation, Mr. Aston will experience residual limb pain on his left caused by post-operation swelling. Appendix B: Treatment Plan Intervention Provide Mr. Aston an amputee leaflet with information about post-operative care, the importance of exercises, the correct manner to perform the exercises, what to expect from rehabilitation process, and general advice. Point out to Mr. Aston the importance and role of a multidisciplinary team in their rehabilitation efforts. Draw a joint goal setting with Mr. Aston and the multidisciplinary team to plan the discharge of the amputee from hospital within the first 10 days post operatively, assuming the internal pathway for an amputee is 10 days. Provide a vascular nurse to provide juzo sock so as to help with the stump shaping and swelling. Consultants and nurses to help review medical post-operative care and wound management. Physiotherapy goals Formulate and individual exercise program for Mr. Aston for his knee, hip and upper limbs. Transfer practice since the amputee cannot transfer independently. Stump massage to alleviate pain. Scare mobilisation. De-sensitisation reduction and phantom sensation reduction to reduce the amount of pain felt on the residual limb. Set realistic goals in alignment with the patient’s expectations in regards to personalised goals and prosthetic rehabilitation. Assessment prior to discharge to ensure that the patient can continue doing exercises that improve the range of motion, strengthen his upper body and be able to use crutches properly. Ability to set up and use prosthesis properly. Ability to use and set up the wheelchair properly. Read More