principles of pt in post operative cases (general
TRANSCRIPT
Principles of Physiotherapy in Post-operative cases (General Surgery)
Dr.Rajal Sukhiyaji (M.PT. in Sports Science)
Contents What is surgery? Types of Surgery Postoperative interventions Physiotherapy goals Postoperative complications Postoperative preventions Other complications Summary References
What is Surgery ??? 3 Phases :-
1. Preoperative Phase
2. Intraoperative Phase
3. Postoperative Phase
Types of Surgeries A surgical Procedure may be, Diagnostic Curative or reparative Reconstructive or cosmetic Palliative
According to the degree of urgency involved: emergent, urgent, required, elective, and optional.
Postoperative Interventions Take careful note of surgery. Discuss condition of patient with medical
staff. Vital signs and note skin warmth, moisture,
and color. Surgical site and wound drainage systems. Level of consciousness, orientation, and
ability to move extremities. Pain level, pain characteristics (location,
quality) and timing, type, and route of administration of last pain medication.
Position of patient, drainage tubes Respiratory movement and general
posture. IV sites for patency Provide information to patient and
family.
Goals
• Gain the patient’s confidence• Prevention of chest complication• Prevention of DVT• Prevention of pressure sore• Prevention of muscle wasting and joint immobility
• Prevention of other complication• Maintaining normal body temperature• Managing gastrointestinal function and resuming nutrition• Promoting bowel function• Managing voiding
Postoperative Complication
Postoperative Atelectasis Pneumonia or
bronchopneumonia Deep vein thrombosis Pulmonary embolism General muscle weakness and
loss of mobility Pressure sore
Hypoxemia Myocardial infarction and heart failure Exacerbation of asthma or chronic
obstructive airway disease Postoperative fever Infection Haemorrhage Urinary problem Post-operative delirium Bowel function issues
Prevention of chest complication
Respiratory complications may be reduced by:
Using adequate analgesia Administering oxygen using face
masks or nasal prongs Regular physiotherapy
Preventive measure Chest physical therapy Coughing Breathing exercises Incentive spirometer Early ambulation Bad mobility
Chest physiotherapy
Percussion
Vibration
Postural drainage
Coughing
Breathing exercise
Breathing Exercise :- Relax shoulder and
upper chest Take a deep breath in
(through nose) to fill the bottom of lung
Hold breath for 3 seconds
Breath out slowly through mouth
Incentive spirometer
Encourage the patient to take a deep breath in when there is hypoventilation after thoracic or abdominal surgery.
Prevention of DVT
Elevation of bed end Compression stockings General breathing exercise Active movement of limb Early ambulation Anticoagulant Calf pumps Minimize use of tourniquets
Compression stocking
Prevention of pressure sore
Positioning
Prevention of muscle wasting and joint
immobility General mobilizing and
strengthening exercises
Encouraging activity
1. Help the patient to move gradually from the lying position to the sitting position until dizziness passes. This can be achieved by raising the head of the bed.
2. Position the patient completely upright (sitting) and turned so that both legs are hanging over the edge of the bed.
3. Assist the patient to stand beside the bed.
Arm and trunk
exercises
Maintain circulation by encouraging ankle ROM.
Bed exercises
Gluteals
Quads
Knee flexion
Inner range Quads
Straight Leg Raise
Additional Exercise
Stair Climbing and Descending
Always lead up the stairs with good leg and down the stairs with operated leg.
Ascending-crutches stay down
Descending –crutches down 1st
Early Ambulation
It is safe to get out of bed on day one unless there is a medical reason not to do.
Nursing staff or physiotherapist can take all the lines and drains.
May need help patients to mobilise due to pain, anxiety, BP drop, fatigue.
Initially will use a zimmer frame to aid balance and weight bearing.
Days 2-3
Dressings and drains have been removed, mobilise with support ,from a zimmerframe and nursing staff.
As the limb gets stronger, progression from Zimmer frame, Elbow Crutches, stick,
Aim=independent.
Exercises 2-3 x daily. Emphasis is on patient doing exercises independent
Zimmer frame Elbow crutches Sticks
Progression
Take an aid until patient regained balance skills.
Once the patient fully recovered, regular walks, 20 or 30 minutes 3 or 4 times a week, will help maintain
strength.
In the beginning, walk 10 minutes 3 times a day. As strength improves, walk for 20, 3 times a day.
Other complication
Hypertension Hypotension Septic shock
Assessing the patency of the IV lines and ensuring that the appropriate fluids are administered at the prescribed rate
Increase in the fluid input with administration of high-flow oxygen. The patient should also be tilted head-down to maintain cerebral perfusion.
Most causes of hypertension relate to inadequate pain relief or anxiety and usually settle with appropriate analgesia.
Maintaining normal body temperature
The room is maintained at a comfortable temperature, and blankets are provided to prevent chilling.
Treatment includes oxygen administration,
adequate hydration, and proper nutrition.
The patient is also monitored for cardiac dysrhythmias.
Managing gastrointestinal function and resuming nutrition Having the patient turn frequently, exercise, and
ambulate as early as possible. This alleviates distention produced by swallowing air, which is common in anxious patients.
When postoperative distention is anticipated, a nasogastric tube may be inserted .
Paralytic ileus and intestinal obstruction are potential postoperative complications
Promoting bowel function Constipation is common after surgery
Early ambulation - improved dietary intake
Stool softener (if prescribed) - promotes bowel elimination.
Managing voiding If the patient cannot void in the specified
time frame, the patient is catheterized and the catheter removed after the bladder has emptied.
Maintaining a safe environment After discharge patient should
continue with general exercises Walk further Going up and down stairs with
breathing control
Advice to Patients…Continue with normal activities as much as possible within limits of pain
Set a new goal each day.
The patient is likely to recover more quickly , if they keep active, rather then resting.
Summary Physiotherapy -aims to
improve muscle function and range of movement, thus
enhancing function
Empower the patient to take responsibility for there
rehabilitation-remind them to complete their exercises at least
three times a day!
Teach ankle circulation exercises, deep
breathing exercises and bed exercises
Help patients to get out of bed on 1st day post
operation
Patients can only go home when they have safe
mobility and sufficient movement and strength.
References Ann Thomson, Alison Skinner, Joan Piercy, Tidy’s
Physiotherapy, 12th edition
Brunner & Suddarth’s textbook of Medical Surgical Nursing, Suzanne C. Smeltzer, Brenda Bare, 10th edition
Bailey & Love’s, Short practice of surgery, Norman S.Williams, 25th edition
Therapeutic Exercise, Carolyn Kisner, Lynn Allen Cobly,
5th edition
Cash’s Textbook of General Medical and Surgical conditions for physiotherapists, Patricia A. Downie,2nd edition
Physiotherapy exercise programme after sugery, Academic health science partnership
Physiotherapy advice after abdominal surgery, Oxford Radcliffe Hospitals
Chest physiotherapy (CPT) , September 15,2013.
Thank You