Principles of physiotherapy in general surgery

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Principles of physiotherapy in general surgery

  1. 1. Principles of physiotherapy in abdominal surgery A.THANGAMANI RAMALINGAM PT, MSc (PSY),MIAP
  2. 2. Principles of physiotherapy in abdominal surgery        To To To To To To To prevent chest complication prevent circulatory complication maintain muscle power &joint ROM prevent pressure sores maintain good posture improve &enhance bed mobility gain cooperation &confidence
  3. 3. Pre operative assessment     Read the notes Assess the respiratory function Check for circulatory problems Detailed history of the patient
  4. 4. Clinical notes reading    Co morbid conditions Cause for surgery Any other note by the surgeon/physician
  5. 5. Respiratory assessment        Symmetry Rate Depth Chest expansion Dysnoea Accessory muscle involvement measurement
  6. 6. Circulatory assessment   Homan’s test oedema
  7. 7. History taking   Medical history Subjective history
  8. 8. Pre operative training
  9. 9. Breathing exercises  Diaphragmatic and local expansion exercises
  10. 10. cough  Teach real cough
  11. 11. Arm exercises   Short lever exs Long lever exs
  12. 12. Leg exercises   Ankle& toe movements Static Q’ceps& glutei
  13. 13. Posture correction   Advices Ergonomic advantages
  14. 14. Post operative assessment
  15. 15. Surgery notes reading     Type of incision Type of anesthesia Duration of surgery Immediate complications/unwanted events/management
  16. 16. 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
  17. 17.         Pulse oxymetry PR ECG Heart sounds Systemic arterial blood pressure CVP TPR chart Ventilator support
  18. 18. Understanding the attachments      Iv lines Nasogastric tube Catheter PCA drains
  19. 19. Orientation assessment    Communication ability Alertness Perceptual ability to follow instructions
  20. 20. Objective assessment      respiratory Circulatory ROM/MUSCLE POWER Mobility/functional Etc
  21. 21. Respiratory assessment       Painful breathing Difficulty in coughing Impaired respiration Accumulation of secretions Palpation auscultation
  22. 22. Circulatory assessment   Homan’s sign oedema
  23. 23. Posture& mobility   Kypho scoliosis Bed mobility
  24. 24. Pain assessment   VAS MPQ
  25. 25. Post operative treatment
  26. 26. To prevent chest complication     Breathing exercise Coughing/cough support Inhalation,humidification&PD Breath control exs with arm movts
  27. 27. To prevent circulatory complication       Trendelenberg tilt(15 degree bed end elevation) Leg exs Early ambulation Bed mobility Trunk &abs exs Prevention by medical means
  28. 28. Prevention of bad posture    Firm back support Chair with arms Over correction
  29. 29. 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.
  30. 30. * 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
  31. 31. * 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.

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