preoperative physical therapy for pneumonectomy

Can anyone tell me what all being a physio can do for preoperative physical therapy for pneumonectomy ?

i want to know why the patient advised for this surgery?
-breathing exercises
-huffing
-positioning
-moving from bed to chair -- ( this is useful to the patient to move from bed to chair after surgery)

these exercises are useful before surgery

Hi,

With regards to preoperative physiotherapy for pnumonectomy, there are number of important things that you can do to help the patient. I'm probably reiterating what the previous post said..but I thought some extra detail might make things clearer for you (information from Pryor & Prasad 2006):
Preoperative assessment is the first thing- ask about smoking history; encourage smoking cessation (evidence shows that this can really only decrease PPC incidence once smoking is stopped 8/52 before surgery), PPC risk factor assessment.
Preoperative instructions (eg. for breathing exercises, positioning, movement from bed to chair, huffing, adequate wound support for huffing, postural advice) should be practised before surgery- so that the patient doesn't have to try and learn this exercises once they have post-op pain(due to the surgical trauma of a thoracotomy).
High- risk patients who might require NIV post-op should be be familiarized with the appearance and use of the NIV device & have the correct mask fitting. This aids in its application if required postoperatively.
It is also crucial to tell the patient the importance of not lying on the normal(ie non-operated) side (i.e. NEVER lying with the pneumonectomy side uppermost)..as the bronchial stump may become bathed in fluid which could potentially aspirate into the good/unaffected lung). This is actually a contrainidication(but I'm sure you know this already)

Some doctors even advise patients not to lie on their side at all.
Huffing instead of coughing is also preferred as it generates less intrathoracic pressure & is thus less painful.
Not sure what else might be needed for preop physio(that is cardio specific!). Preop patient education is vital as well- I'm sure the patient would feel more comfortable if they were taught everything before hand (and it is re-emphasized later) eg. early mobilisation, importance of adequate pain relief (so that physiotherapy can be maximised), DVT prevention (do foot & ankle {F&A} exercises).

Well I hoped that helps! COmpliments go to Pryor & Prasad's Physiotherapy for Respiratory and Cardiac Problems:)

Quote:

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Originally Posted by adrenalinejunkie

Hi,

With regards to preoperative physiotherapy for pnumonectomy, there are number of important things that you can do to help the patient. I'm probably reiterating what the previous post said..but I thought some extra detail might make things clearer for you (information from Pryor & Prasad 2006):
Preoperative assessment is the first thing- ask about smoking history; encourage smoking cessation (evidence shows that this can really only decrease PPC incidence once smoking is stopped 8/52 before surgery), PPC risk factor assessment.
Preoperative instructions (eg. for breathing exercises, positioning, movement from bed to chair, huffing, adequate wound support for huffing, postural advice) should be practised before surgery- so that the patient doesn't have to try and learn this exercises once they have post-op pain(due to the surgical trauma of a thoracotomy).
High- risk patients who might require NIV post-op should be be familiarized with the appearance and use of the NIV device & have the correct mask fitting. This aids in its application if required postoperatively.
It is also crucial to tell the patient the importance of not lying on the normal(ie non-operated) side (i.e. NEVER lying with the pneumonectomy side uppermost)..as the bronchial stump may become bathed in fluid which could potentially aspirate into the good/unaffected lung). This is actually a contrainidication(but I'm sure you know this already)

Some doctors even advise patients not to lie on their side at all.
Huffing instead of coughing is also preferred as it generates less intrathoracic pressure & is thus less painful.
Not sure what else might be needed for preop physio(that is cardio specific!). Preop patient education is vital as well- I'm sure the patient would feel more comfortable if they were taught everything before hand (and it is re-emphasized later) eg. early mobilisation, importance of adequate pain relief (so that physiotherapy can be maximised), DVT prevention (do foot & ankle {F&A} exercises).

Well I hoped that helps! COmpliments go to Pryor & Prasad's Physiotherapy for Respiratory and Cardiac Problems:)

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thank you very much for this information
but i want (details)

Briefly the main aims are to:

1-Gain the patient confidence
2-Clear the lungs fields
3-Teach respiratory control and inspiratory holdings
4-Teach postural awareness
5-Teach arm, trunk and leg exercises
6-Teach mobility about the bed.
7-Exercise Tolerance testing


Patient’s confidence : An explanation of the aim of physiotherapy helps the patient’s understanding. Teaching the exercises to be undertaked postoperatively and answering the patient’s questions helps to allay some of the fears of operations.

Clearing lung Fields:

The patient must be discourged from smoking. Shaking, clapping and vibrations with postural drainage if necessary must be used to clear the secretions from the sound lung. Huffing is taught as this is used in preference to coughing postoperatively. The patient is instructed on how to support the wound during coughing and huffing. The arm of unaffected side is placed across the front of the thorax and around the affected side just below the incision side giving firm pressure with the forearm and hand. The upper arm of the affected side reinforces the pressure and the hand fixes the opposite elbow.

Teaching the respiratory control:

Inspiratory exercises are taught for the sound lung together with the inspiratory holding. This means that the patient is asked to take a deep breath in, hold, then breathe in a little further, hold, then breathe out.

Breathing control has to be practiced after secretions have been cleared.

Incentive spirometry may be helpful to improve the patient’s inspiratory capacity.

This a technique used to encourage the patient to take a deep breath in when there is hypoventilation after thoracic or high abdominal surgery due to pain or secretions retention. The breathes in through a tube which is attached to a device that illustrate the volume of the inspired air. For example, at low lung volume, a plastic ball rises to the top of the column, at mid lung volume a second ball rises and at high lung volume a third ball rises. So long as the patient holds a deep breath, the balls remain at the top of the columns. Some devices operate by a light coming on when the volume of breath reaches a pre set level. Some devices work on the expiratory phase rather than the inspiratory phase.

Teaching the postural Awareness:

There is a tendency to protect the scar leads to a scoliosis (concave on the scar side) and forward flexion. This should be prevented.

Teaching Arm Trunk And leg Exercises:

The following exercises shoudl be taught to the patient.

Foot and ankle exercises.

The arm on the affected side must be moved.

1- Into full elevation
2- Hand behind head
3- Hand behind back
4- Hand touch opposite shoulder

Trunk Exercises

1- Sitting on the edge of the bed
(a) Trunk turning
(b) Trunk bending side to side
(c) Trunk stretching backwards

Teach mobility Around the Bed:

A rope ladder should be provided so that patient can pull on it to move around in bed and sit up.

Exercise Tolerance Testing:

An exercise tolerance test should be a part of the preoperative assessment if the lung to be excised is functional and also for the other normal lung.

Thanks for your assessment about pneumonectomy.