Download to read offline
More Related Content
Similar to abdominal surgery.pptx
abdominal surgery.pptx
- 1. Physiotherapy in Pre and Postabdominal operative stage BY DR/ KHALED ALSAYANI
- 2. Principles /Aims ofphysiotherapy To prevent chest complications To prevent circulatory complications To maintain muscle power and joint ROM To prevent pressure sore To maintain good posture To improve & enhance bed mobility To gain cooperation & confidence To educate the patient
- 3. Steps of physiotherapyin abdominal surgery Postoperative physiotherapy Preoperative physiotherapy Preoperative assessment Preoperative training Postoperative assessment Postoperative training
- 4. Preoperative physiotherapy Ideally patientshould be admitted to the hospital 24 hours or more before the operation This allowed the patient to settle in and to meet those who are responsible for the surgery
- 5. Preoperative assessment a) Readthe notes b) Assess the respiratory functions c) Check for circulatory problems d) Detailed history of the patient It include both subjective and objective assessment Benefits • To gain good rapport • To know the functional status • To understand patients goals
- 6. a) Clinical notesreading • Causes for surgery • Comorbid conditions – like asthma, obesity, diabetes etc. • Any other notes by the surgeon/ physician b) Respiratory assessment • Chest deformities – Kyphosis, Kyphoscoliosis, • Breathing pattern – Normal rate Inspiration and Expiration ratio • Abnormal breathing pattern – Pursed lip breathing Apnoea, Hypopnea Cheyne stokes respiration Ataxic breathing Apneustic breathing
- 7. • Chest movements– Symmetry of chest movements Depth of respiration Accessory muscle involvement • Chest expansion – Both observational and palpation • Dyspnoea/ Breathlessness – “The New York HeartAssociation Scale Of Dyspnoea” • Orthopnoea – Breathless when lying flat “The New Y ork HeartAssociation Scale Of Dyspnoea” I - No symptoms with ordinary activity /Breathlessness with exertion II – Symptoms with ordinary activity III – Symptoms with mild exertion IV- Symptoms at rest
- 8. d) Circulatory assessment •Homan’s test • oedema- qualitative and quantitative both e) History taking • Medical history • Subjective history
- 9. Preoperative training Teach thepatient any exercise that will be started during the very early postoperative period These often include.. • Breathing exercise • Cough reflex • Arm and leg exercise • Posture correction Benefits • To educate and train the patient about the post operative exercise program and physiotherapy importance
- 10. a) Patient education •Explain the general plan of care • Pre operative instructions b) Breathing exercises • Diaphragmatic and local expansion exercises c) Cough • Teach huffing and coughing technique
- 11. d) Arm exercises •Short lever exercises • Long lever exercises e) Leg exercises • Ankle& toe movements • Static Q’ceps & glutei f) Posture correction • Advices • Ergonomic advantages
- 12. Post-operative physiotherapy Aim • Toavoid respiratory and circulatory complication • To prevent pressure sore • To prevent muscle wasting and joint stiffness • To prevent wound infection • Scar management • Postural awareness • Complete rehabilitation inADL
- 13. Post operative assessment •Surgery notes reading • Vital signs checking • Understating the attachments • Objective assessment • Inspection of the surgical incision Benefit – • To know the post operative problems of the patient
- 14. a) Surgery notesreading • Type of incision • Type of anaesthesia • Duration of surgery • Immediate complications/unwanted events/management b) Vital signs checking • Pulse oximetry • PR • ECG • Heart sounds • Systemic arterial blood pressure • CVP • TPR chart • Ventilator support • Lungs volume • ABG analysis
- 15. c) Understanding theattachments • IV lines • Nasogastric tube • Catheter • PCA- patient control anaesthesia • Drains d) Orientation assessment • Communication ability • Alertness • Perceptual ability to follow instructions
- 16. e) Objective assessment i.Respiratory ii. Circulatory iii. ROM/MUSCLE POWER iv. Mobility/functional
- 17. i) Respiratory assessment •Painful Breathing • Difficulty In Coughing • Impaired Respiration • Accumulation Of Secretions • Palpation • Auscultation
- 18. ii) Circulatory assessment •Homan’s sign • Oedema iii) Posture & mobility • Kypho scoliosis • Bed mobility iv) Pain assessment • VAS • NPRS
- 19. Types of Anesthesia GeneralAnesthesia Regional Anesthesia
- 20. Classification of incisions Verticalincision Midline incisions Paramedian incisions Transverse and oblique incisions Kocher's subcostal Incision Mc Burney’s grid iron or muscle splitting incision. Pfannenstiel incision Maylard Transverse Muscle cutting Incision Oblique Muscle cutting incision Thoracoabdominal incisions.
- 21. Midline incision Upper MidlineIncision
- 22. Lower Midline Incision FullMidline Incision
- 23.
- 24.
- 25. Chevron (Roof Top)Modification .
- 26. The Mercedes BenzModification .
- 27. McBurney Grid -IronIncision .
- 28.
- 29. Vascular Complications • Thrombosisor embolism • Can occur at any time between the 3rd to the 21st post-operative day • Thrombosis are mainly of toe types Thrombo-phlebitis Phlebothrombosis • Phlebothrombosis is by far the most serious complication of operations on the pelvis
- 30. Chest Complications • ReducedVentilation • Poor Lung Expansion • Reduced Vital Capacity • Accumulation of secretions • Poor ability to clear secreations • Lung Collapse
- 31. Haemorrhage • It canbe Internal or External • What to look out for? Soakage of dressing Low blood Pressure Feeble Pulse Incresed RR Restlessness Fainting
- 32. Muscle Atrophy andImbalance • Muscles are retracted,cut,split during surgery. • Incision of the muscle reduces it bulk as well as power • Damage to the nerve supply of the muscle can occur during surgery • Reflex inhibition due to pain • Protective inactivity of a muscle lead to atrophy • Addhesion formation can restrict range of motion
- 33.
- 34. Delayed Healing • Infection Surgical site Away from the site • Sepsis • Systemic Illness • Poor post-surgical care
- 35. Post operative training Benefits •Early recovery and less hospital stay a) To prevent chest complication • Breathing exercise (emphasis on lower segments) • Coughing/cough support • Inhalation, humidification • Breath control exercises with arm movements
- 36. b) To preventcirculatory complication • Trendelenburg tilt (15 degree bed end elevation) • Leg exercises • Early ambulation • Bed mobility • Trunk &abs exercises • Prevention by medical means e) Prevention of bad posture • Firm back support • Chair with arms • Over correction
- 37. f) To preventmuscle wasting and joint stiffness • Strengthening exe to weak muscle • Endurance training • Encourage walking and increase distance gradually • Stair climbing • Ask the Patient to be as independent as possible. • Immediately after surgery, encourage patient to move his limbs freely in full ROM. • Relaxed passive movements. • Active assisted exe. in full ROM then active movments.
- 38. g) Scar management •Friction massage • Modality like us. h) Complete rehabilitation in ADL