Principles of physiotherapy in

abdominal surgery

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