Laparotomy

[emme786]

Hi
I was hoping to get some Rx suggestions from any physios out there. Pt underwent a laparotomy and is now retaining secretions. She has since developed renal failure and is on CVVH. Her O2 levels are also slightly low.
Thanks

[roycar]

your assessment here will guide your treatment.

why is she retaining secretions?
-is she in too much pain to take deep breaths/cough? is analgesia inadequate, have you shown the patient supported cough technique?

-is she shallow breathing? educate regarding the nb of deep breaths. use feedback like an incentive spirometer to ensure deep breathing. positioning can help deep breathing.

-is she very immobile post surgery and because of the hemofiltration? use positioning, frequent changes in position, controlled mobilisation as tolerated, even sit to stands, marching on the spot.

-tenacious secretions? is she having heated humidified oxygen?

-other things like dehydration can lead to difficulty expectorating but im sure this is being monitored if she's under the renal team.

O2 levels can be low for any amount of reasons but id imagine its secondary to the retention of secretions leading to decreased space for gas exchange etc. this could be helped by following some of the above.

breathing control will help if she is anxious/has an increased resp rate/shallow breathing too.