Ilustrasi Kasus 7
A 53-year-old woman with long-standing chronic obstructive pulmonary disease (COPD) presents for a laparoscopic cholecystectomy. Her past medical history includes hypertension well-controlled with lisinopril, a 40-pack-year history of smoking, and resultant COPD.
The patient states that she can do her own grocery shopping, but that she often has to stop and rest when she gets short of breath. She states that she had the flu 6 to 7 months ago, which aggravated her COPD resulting in hospitalization. She currently uses an Advair inhaler (a long-acting beta agonist) and Spiriva (a long-acting anticholinergic agent). Approximately once a week she also uses a Ventolin inhaler for breakthrough therapy.
The patient was recently referred to a pulmonologist, who added oral steroids to her regimen. Since the adjustment of her medical regimen, she has had more energy to devote to activities. Her vital signs are BP of 140/80 mm Hg, a heart rate of 85 bpm, and her respiratory rate is of 24 breaths per minute. She does not use accessory muscles of respiration, and can speak in complete sentences. Her laboratory blood tests are normal.
➤ What are your concerns during preoperative evaluation for this patient?
➤ What are the ventilator strategies for this patient?
➤ What are the likely postoperative concerns for this patient?
Comprehension Questions
1. A 50-year-old man with stable severe COPD has just undergone a radical prostatectomy. His intraoperative course was uncomplicated. Currently he is in the post-anesthesia care unit (PACU) with a respiratory rate of 28, SpO2 94% on 6 L oxygen by a simple facemask. When breathing, he uses his alae nasi and intercostal muscles. Pain is controlled with a patient controlled analgesic regimen. The nurse calls you to assess this patient, as he doesn’t “look right.” What is your first step?
A. Intubate the trachea
B. Institute BiPAP after getting an arterial blood gas
C. Administer naloxone
D. Administer diuretic
2. What is the role of PEEP?
A. Improves oxygenation
B. Decreases atelectasis
C. Decreases cardiac output
D. Decreases the risk of pneumothorax
3. In the preoperative clinic, a 50-year-old woman presents for a laparoscopic adrenalectomy for a benign adenoma. She has a history of progressive shortness of breath over the past couple of years, and a slight but steady decrease in her functional capacity. She needs oxygen at night to help her breathe. Her past medical history includes well-controlled hypertension (with one drug, onset of disease 3 years ago). She is not obese but does appear to use accessory muscles of respiration. What would your differential diagnosis include?
A. Cardiac failure
B. COPD exacerbation
C. Asthma
D. Being in poor physical shape
The patient states that she can do her own grocery shopping, but that she often has to stop and rest when she gets short of breath. She states that she had the flu 6 to 7 months ago, which aggravated her COPD resulting in hospitalization. She currently uses an Advair inhaler (a long-acting beta agonist) and Spiriva (a long-acting anticholinergic agent). Approximately once a week she also uses a Ventolin inhaler for breakthrough therapy.
The patient was recently referred to a pulmonologist, who added oral steroids to her regimen. Since the adjustment of her medical regimen, she has had more energy to devote to activities. Her vital signs are BP of 140/80 mm Hg, a heart rate of 85 bpm, and her respiratory rate is of 24 breaths per minute. She does not use accessory muscles of respiration, and can speak in complete sentences. Her laboratory blood tests are normal.
➤ What are your concerns during preoperative evaluation for this patient?
➤ What are the ventilator strategies for this patient?
➤ What are the likely postoperative concerns for this patient?
Comprehension Questions
1. A 50-year-old man with stable severe COPD has just undergone a radical prostatectomy. His intraoperative course was uncomplicated. Currently he is in the post-anesthesia care unit (PACU) with a respiratory rate of 28, SpO2 94% on 6 L oxygen by a simple facemask. When breathing, he uses his alae nasi and intercostal muscles. Pain is controlled with a patient controlled analgesic regimen. The nurse calls you to assess this patient, as he doesn’t “look right.” What is your first step?
A. Intubate the trachea
B. Institute BiPAP after getting an arterial blood gas
C. Administer naloxone
D. Administer diuretic
2. What is the role of PEEP?
A. Improves oxygenation
B. Decreases atelectasis
C. Decreases cardiac output
D. Decreases the risk of pneumothorax
3. In the preoperative clinic, a 50-year-old woman presents for a laparoscopic adrenalectomy for a benign adenoma. She has a history of progressive shortness of breath over the past couple of years, and a slight but steady decrease in her functional capacity. She needs oxygen at night to help her breathe. Her past medical history includes well-controlled hypertension (with one drug, onset of disease 3 years ago). She is not obese but does appear to use accessory muscles of respiration. What would your differential diagnosis include?
A. Cardiac failure
B. COPD exacerbation
C. Asthma
D. Being in poor physical shape