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