8976 Lecture Notes - Lecture 7: Sputum Culture, Sputum, Respiratory Sounds
2 Jul 2018
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For diagnosis of Post-op Pulmonary Complication
Need 4 of:
- Fever +38 degrees for more than 1 consecutive day
- CXR report of collapse or consolidation
- SpO2 less than 90 on greater than 1 consecutive day
- Changes in sputum (colour/amount)
- Changes in breath sounds
- Increase in white cell count
- Infection found in sputum culture
- Dr says so
Predisposing factors to PPC (post-pulmonary complications)
- Respiratory complications
- Ex-smoker
- Site of surgery (worst – Upper GIT)
- Decreased VO2 Max (poor aerobic capacity-self reported)
- Anaesthetic time greater than 180min
- High risk patients (those with the above) are 8.4 times more likely to develop PPC’s (Scholes,
2009)
Patients are 3 times more likely to develop PPC for every day they do not mobilise away from the
bed post operatively (Haines, 2013).
Sternal Precautions:
- Encourage bilateral upper limb activity to decrease sheering force
- Minimise pushing up/pectoral use to decrease sheering force
- Minimise lifting (less than 5 kilos for 6 weeks)
- Caution with ADL’s (such as opening windows and doors)
- Wound support with coughing
Sternal stability assessment
Palpate sternal incision and;
- Deep inspiration
- Cough
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