Atelectasis — Postoperatively in an Older Patient—Hypotensive and.pdf

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1. ATELECTASIS —POSTOPERATIVELY
IN AN OLDER PATIENT—
HYPOTENSIVE AND ATRIAL
FIBRILLATION
PRESENTED BY NISHA AND TAHIR

2. CASE STUDY
HPI:Mrs.Hisa78-year-oldfemalewho
hadarighthemicolectomycomplicatedby
intraoperativebleeding.Shespent2.5hours
ontheORtableinthesupineposition;2
hoursofthiswasundergeneralanaesthetic.
PMH:Hysterectomy,aMI2yearsago,and
atrialfibrillation.
SocialHx:Shelivesinasenior'sapartment
withherhusbandandhasoneflightofstairs
togetontoherfloor.

3. EXAMINATION ON 1
ST
POD
1. LEVEL OF CONSCIOUSNESS:
Alert, Oriented and
awake
2. Breathing Pattern:
Shallow and Rapid
3. NG tube, central line, epidural infusion,
and urinary catheter in situ ✓
4. Auscultation:
Decreased Breath sounds
at the base of lungs

4. VITAL SIGNS
BP
148/92
mmHg
RR
24 bpm
BPM in
normal
sinus
rhythm
HR
90bpm
Temp
38.4

5. An activity as tolerated
order has been written
but she has notyet been
out of bed.

6. What are the common clinical findings of
patients in atrial fibrillation?
1.Palpitations
2.Arrhythmia
3.Dyspnea
4.chest discomfort
5.dizziness
6.Feelings of weakness caused by
decreased cardiac output
7.Anxiety from the awareness of a rapid
and/or irregular heart beat

7. Symptomatic AF is indicative of poor overall
cardiac function, whereas AF can be well tolerated by
some patients. However, some patients with impaired
ventricular function need coordinated atrial pumping.
Otherwise they develop a drop in both stroke
volume and in cardiac output. These types of
patients tend to suffer the effects of AF.

8. Identify the acute EKG changes
◦The upper panelis an example of a normal EKG tracing.
◦The lower panel is an example of an atrial fibrillation EKG
tracing.
◦In the lower tracing, there are multiple P waves preceding the
QRS complex.
◦They are irregular in shape (looks like an irregular baseline) and
in frequency.
◦This differs from atrial flutter when the multiple P waves are
similar in shape and regular in frequency

10. PHYSICAL THERAPY MANAGEMENT
By day 2 postoperative, patient was able to mobilize with an IV
pole and your assistance for 80 feet.
On day 3 after surgery, however, your patient complains of feeling
tiredand dizzy while in bed and has had palpitations.

11. What cardiopulmonary assessment
procedures will you perform?

12. Check for regularity of the pulse, blood
pressure, oximetry, and auscultate the patient.
Ask if the patient felt any irregular heartbeats or
palpitations.