principles of physiotherapy in general surgery

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.