physiotherapy student education purpose

1. Principles of physiotherapy in
abdominal surgery
A.THANGAMANI RAMALINGAM
PT, MSc (PSY),MIAP

2. Principles of physiotherapy in
abdominal surgery
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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. Pre operative assessment
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Read the notes
Assess the respiratory function
Check for circulatory problems
Detailed history of the patient

4. Clinical notes reading
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Co morbid conditions
Cause for surgery
Any other note by the
surgeon/physician

5. Respiratory assessment
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Symmetry
Rate
Depth
Chest expansion
Dysnoea
Accessory muscle involvement
measurement

6. Circulatory assessment
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Homan’s test
oedema

7. History taking
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Medical history
Subjective history

8. Pre operative training

9. Breathing exercises
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Diaphragmatic and local expansion
exercises

10. cough
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Teach real cough

11. Arm exercises
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Short lever exs
Long lever exs

12. Leg exercises
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Ankle& toe movements
Static Q’ceps& glutei

13. Posture correction
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Advices
Ergonomic advantages

14. Post operative assessment

15. Surgery notes reading
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Type of incision
Type of anesthesia
Duration of surgery
Immediate complications/unwanted
events/management

16. Vital signs checking
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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

18. Understanding the attachments
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Iv lines
Nasogastric tube
Catheter
PCA
drains

19. Orientation assessment
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Communication ability
Alertness
Perceptual ability to follow
instructions

20. Objective assessment
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respiratory
Circulatory
ROM/MUSCLE POWER
Mobility/functional
Etc

21. Respiratory assessment
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Painful breathing
Difficulty in coughing
Impaired respiration
Accumulation of secretions
Palpation
auscultation

22. Circulatory assessment
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Homan’s sign
oedema

23. Posture& mobility
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Kypho scoliosis
Bed mobility

24. Pain assessment
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VAS
MPQ

25. Post operative
treatment

26. To prevent chest complication
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Breathing exercise
Coughing/cough support
Inhalation,humidification&PD
Breath control exs with arm movts

28. To prevent circulatory complication
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Trendelenberg tilt(15 degree bed end
elevation)
Leg exs
Early ambulation
Bed mobility
Trunk &abs exs
Prevention by medical means

29. Prevention of bad posture
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Firm back support
Chair with arms
Over correction

30. LEARNING POINTS
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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.

31. * 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

32. * 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.