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