Principles of physiotherapy in abdominal surgery A.THANGAMANI RAMALINGAM PT, MSc (PSY),MIAP
Dec 01, 2014
Principles of physiotherapy in abdominal surgery
A.THANGAMANI RAMALINGAM PT, MSc (PSY),MIAP
Principles of physiotherapy in abdominal surgery
To prevent chest complication To prevent circulatory complication To maintain muscle power &joint ROM To prevent pressure sores To maintain good posture To improve &enhance bed mobility To gain cooperation &confidence
Pre operative assessment Read the notes Assess the respiratory function Check for circulatory problems Detailed history of the patient
Clinical notes reading Co morbid conditions Cause for surgery Any other note by the
surgeon/physician
Respiratory assessment Symmetry Rate Depth Chest expansion Dysnoea Accessory muscle involvement measurement
Circulatory assessment Homan’s test oedema
History taking Medical history Subjective history
Pre operative training
Breathing exercises Diaphragmatic and local expansion
exercises
cough Teach real cough
Arm exercises Short lever exs Long lever exs
Leg exercises Ankle& toe movements Static Q’ceps& glutei
Posture correction Advices Ergonomic advantages
Post operative assessment
Surgery notes reading Type of incision Type of anesthesia Duration of surgery Immediate complications/unwanted
events/management
Vital signs checking Tidal volume-2ml/kg body weight Minute volume-100ml/kg body weight FVC-70ml/kg FEV1-70-90%of FVC paO2-not less than 70mm/hg Paco2-not more than 50mm/hg RR-12-16/min ABG analysis
Pulse oxymetry PR ECG Heart sounds Systemic arterial blood pressure CVP TPR chart Ventilator support
Understanding the attachments Iv lines Nasogastric tube Catheter PCA drains
Orientation assessment
Communication ability Alertness Perceptual ability to follow
instructions
Objective assessment respiratory Circulatory ROM/MUSCLE POWER Mobility/functional Etc
Respiratory assessment Painful breathing Difficulty in coughing Impaired respiration Accumulation of secretions Palpation auscultation
Circulatory assessment Homan’s sign oedema
Posture& mobility Kypho scoliosis Bed mobility
Pain assessment VAS MPQ
Post operative treatment
To prevent chest complication
Breathing exercise Coughing/cough support Inhalation,humidification&PD Breath control exs with arm movts
To prevent circulatory complication
Trendelenberg tilt(15 degree bed end elevation)
Leg exs Early ambulation Bed mobility Trunk &abs exs Prevention by medical means
Prevention of bad posture Firm back support Chair with arms Over correction
LEARNING POINTS* The incidence of pulmonary complications
is higher after upper abdominal or chest surgery than operations on other parts of the body due to a severe and prolonged alteration in pulmonary mechanics.
• The sitting position increases FRC significantly and early mobilization is to be actively encouraged. Sufficiently effective analgesia must be maintained so that these activities are not impeded by pain.
* It is critically important that the analgesic method chosen is one that can best improve pain and pulmonary function. Effective analgesia will improve the detrimental effects of surgery on pulmonary mechanics and prevent pulmonary complication
* Physical therapy has a valuable role to play in the prevention of respiratory complications as well as their treatment, although the relative values and indications for different therapies have still to be conclusively determined.