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Principles of Physiotherapy in Post-operative cases General Surgery PowerPoint Presentation

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Description : Check out this medical presentation on Physiotherapy and Physical Rehabilitation, which is titled "Principles of Physiotherapy in Post-operative cases (General Surgery)", to know about physiotherapy in post-operative cases.

Tags : Physiotherapy, Physical Rehabilitation, Principles, Post-operative cases, General Surgery

Published on : Aug 02, 2021 | Views : 4436 | Downloads : 34

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Slide 1-

Principles of Physiotherapy in Post-operative cases (General Surgery) Dr.Rajal Sukhiyaji (M.PT. in Sports Science)
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Contents What is surgery? Types of Surgery Postoperative interventions Physiotherapy goals Postoperative complications Postoperative preventions Other complications Summary References
Slide 3-

What is Surgery ??? 3 Phases :- Preoperative Phase Intraoperative Phase Postoperative Phase
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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.
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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.
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Position of patient, drainage tubes Respiratory movement and general posture. IV sites for patency Provide information to patient and family.
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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
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Postoperative Complication Postoperative Atelectasis Pneumonia or bronchopneumonia Deep vein thrombosis Pulmonary embolism General muscle weakness and loss of mobility Pressure sore
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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
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Prevention of chest complication Respiratory complications may be reduced by: Using adequate analgesia Administering oxygen using face masks or nasal prongs Regular physiotherapy
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Preventive measure Chest physical therapy Coughing Breathing exercises Incentive spirometer Early ambulation Bad mobility
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Chest physiotherapy Percussion
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Vibration
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Postural drainage
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Coughing
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Breathing exercise
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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
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Incentive spirometer
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Encourage the patient to take a deep breath in hypoventilation when after there is thoracic or abdominal surgery.
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Prevention of DVT
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Elevation of bed end Compression stockings General breathing exercise Active movement of limb Early ambulation Anticoagulant Calf pumps Minimize use of tourniquets
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Compression stocking
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Prevention of pressure sore
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Positioning
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Prevention of muscle wasting and joint immobility General mobilizing and strengthening exercises
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Encouraging activity 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. Position the patient completely upright (sitting) and turned so that both legs are hanging over the edge of the bed. Assist the patient to stand beside the bed.
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Arm and trunk exercises
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Maintain circulation by encouraging ankle ROM.
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Bed exercises Gluteals Quads
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Knee flexion
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Inner range Quads
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Straight Leg Raise
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Additional Exercise
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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
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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.
Slide 42-

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
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Zimmer frame Elbow crutches Sticks
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Progression Take an aid until patient regained balance skills. In the beginning, walk 10 minutes 3 times a day. As strength improves, walk for 20, 3 times a day. Once the patient fully recovered, regular walks, 20 or 30 minutes 3 or 4 times a week, will help maintain strength.
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Other complication Hypertension Hypotension Septic shock
Slide 46-

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.
Slide 47-

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.
Slide 48-

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
Slide 49-

Promoting bowel function Constipation is common after surgery Early ambulation - improved dietary intake Stool softener (if prescribed) - promotes bowel elimination.
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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.
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Maintaining a safe environment After discharge patient should continue with general exercises Walk further Going up and down stairs with breathing control
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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.
Slide 53-

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.
Slide 54-

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
Slide 55-

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.
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Thank You