Pt assessment

Pt assessment

1. P T ASSESSMENT O F PULMONARY SURGERY C O N D ITION S JAMIA MILLIA ISLAMIA CENTRE FOR PHYSIOTHERAPY AND REHABILITATION SCIENCE SUBMITTED T O : DR. JAMAL ALI MOIZ SUBMITTED B Y : SUALEHA KHANAM SUBJECT : P T IN CARDIOPULMONARY CONDITION ROLL NO.: 1 7 B P T 3 7 DATE OF PRESENTATION : 1 9 / 2 / 2 2 1

2. INTRODUCTION : Physiotherapy A s s e s s ment has been used preoperatively and/or postoperatively to avoid surgical complications and enhance the recovery of the patients. I t d i v i d e d into two parts : 1 ) Pre-operative P T Assessment : B e n e f i t s : T o k n o w t h e functional s t a t u s , f o c u s o n creating p l a n t o s h o r t e n h e a l i n g t i m e , T o r e d u c e s u r g i c a l c o m p l i c a t i o n s , M e n t a l l y p r e p a r e p a t i e n t f o r s u r g e r y a n d r e h a b ilitation . 2 ) Post-operative P T A s s e ssment : B e n e f i t s : T o k n o w t h e p o s t o p erative p r o b l e m o f t h e p a t i e n t , F o c u s o n creating p l a n t o r e t u r n t o d a i l y a c t i vities .

3. PREOPERATIVE P T ASSESSMENT : I t i n c l u d e s b o t h s u b j e c t i ve a n d o b j e ctive A s s e ssment : Subjective A s s e s s ment D e m o g r aphic d a t a : N a m e , A g e , G e n d e r , m a r i t a l status , Occupation . P r e s e nt h i s t o r y F a m i l y h i s t o r y o f d i s e a s e D r u g a l l e r g y , P a s t a n a e s t hetic h i s t o r y P a s t m e d i c a l h i s t o r y : Respiratory d i s o r ders , o t h e r c h r o n i c d i s o r d e r s , D i a b e t e s a n d h y p e r tension . S u r g i c a l h i s t o r y : T r a c h e o s t omy , e n d o s c o p y e t c . P e r s o n a l a n d s o c i a l h i s t o r y : history o f s m o k i n g , h i s t o r y o f a l c o h o l intake , s l e e p , A p p e t i t e l o s s , b o w e l and b l a d d e r , exercise t o l e rance , w t . l o s s e t c C h e s t p a i n : M u s c u l o s k e letal c h e s t p a i n , A n g i n a p e c t o r i s , P l e u r i t i c c h e s t p a i n I n c o n t i n e n c e : O t h e r s y m p t o m s : f e v e r , h e a d a c h e , p e r i p h e r a l e d e m a , s h i v e r i ng , w t . l o s s , palpitations , vomiting a n d n a u s e a .

4. OBJECTIVE ASSESSMENT : VITAL SIGNS : Temperature , p u l s e , Respiratory r a t e , b l o o d p r e ssure a n d o x y g e n s a t u ration . GENERAL APPEARANCE : B o d y w e i ght , h e i g h t , E y e s ( p a l l o r , plethora , j a u n d i c e ) , t o u n g e a n d m o u t h ( c y a n o s i s ) , j u g u l a r v e n o u s p r e s s u r e . OBSERVATION OF CHEST : c h e s t d e f o r mities ( k y p h o s i s , kyphoscoliosis , b a r r e l c h e s t , p e c t u s c a r i n a t u m ) , s y m m e t r y . BREATHING PATTERN :Check for bradypnea, tachypnea, hyperventilation , Prolonged expiration - 1:3 to 1:4 INTUBATION : N e c k m o v e m ent , T M J m o v e m ent . PALPATION :Hoover’s sign - Paradoxical movement of the lower chest can occur in patients with severe chronic airflow limitation who are extremely hyperinflated. T r a c h e a : tracheal deviation indicates underlying mediasternal shift . trachea may be pulled towards in collapsed or fibrosed upper lobe or pushed away from pneumothorax or large pleural effusion.

5. PHYSICAL EXAMINATION : c o u g h , e x p e c t o r a t i o n , w h e e z i n g e t c . C h e s t e x p a n s i o n CHEST X - RAY : Chest x-rays are often taken early if a respiratory disorder is suspected . Pneumonia , e m p h y s e m a , r i b f r a c t u r e , tuberculosis, e n l a r g e d h e a r t , p l e u r a l e f f u s i o n , m a s s o r n o d u l e i n t h e l u n g . A B G analysis O x y g e n s a t u r a tion P e r i p h e r a l m u s c l e s t r e n g t h P u l m o n a r y f u n c t ion t e s t s : i f F E V 1 / F V C r a t i o l e s s t h a n 4 % o f p r e d i c t e d v a l u e a n d P a C O 2 g r e a t e r t h a n 5 k P a t h e s u r g e ry i s d e f i nitely c o n t r a i ndicated . C a r d i o p u l m o n a r y e x e r c i s e t e s t : 6 m i n . w a l k t e s t . F u n c t i onal i n d e p endence m e a s u r e s B r e a t h l essness o r d y s p n e a : Association of paraoxysmal nocturnal dyspnea (PND) G r a d i n g o f b r e a t h l essness : M M R C , Modified b o r g s c a l e .

6. POSTOPERATIVE P T ASSESSMENT : DATABASE INFORMATION ( f r o m m e d i c a l r e c o rds ) : P r e o p e r a tive i n v e s tigation , s u r g i c a l p r o cedure a n d incision , C o n c i s e m e d i c a l h i s t o ry S u r g e r y n o t e s r e a d i n g : T y p e o f i n c i s i o n , t y p e o f a n e s t h e s i a , d u r a t i o n o f s u r g e r y a n d i m m e d i a te c o m p l i c a t ions . U n d e r standing t h e a t t achment : I V l i n e s , catheter , n a s o g a stric t u b e , P C A , d r a i n s . SUBJECTIVE INFORMATION : D e t a i l e d m e d i c a l h istory , s m o k i n g h i s t o r y , c h e i f c o m p l a i n t , p e r s o n a l h i s t ory , p r e s e n t h i s t o r y , p a s t h i s tory , surgical h i s t o ry , s o c i a l h i s t o r y , f a m i l y h i s t ory . P a i n a s s e s s ment : A v e r b a l d e s c r i p tion s c a l e o r V A S s c a l e i s u s e d t o m e a s u r e i n c i s i o n o r s h o u l d e r p a i n . C o u g h a n d s p u t u m a s s e s s ment : t h e p a t i e nt a b i l i t y t o c o u g h a n d expectorate s h o u l d b e a s s e s s e d . T h e c o l o r , v o l u m e a n d c o n s i s tency o f s p u t u m s h o u l d b e o b s e r v e d . O p e n e n d e d q u e s t ions : h o w d o y o u f e e l . V e n t i lation : H y p o v e n t i l a t i o n m a y o c c u r .

7. ORIENTATION ASSESSMENT : c o m m u nication a b i l i t y , a l e r t n e s s , p e r c e p t u a l a b i l ity t o f o l l o w i n s t r uctions . OBJECTIVE ASSESSMENT: C l i n i c a l e x a m ination : I n s p e ction , palpation , a u s c u l t a t i o n a n d p e r c u s s i o n VITAL SIGNS : T e m p erature , b l o o d p r e s s u r e , h e a r t r a t e , p u l s e . M e t h o d s o f p a i n c o n t r o l : t h e P T m u s t b e a w a r e t h e o f t h e v a r i o u s r o u t e o f a n a l g e s i a ( i.e i n t r a v e nous , e p i d u r a l a n d p a r a v e r t e b r a l ) O x y g e n d e l i v e r y s y s t e m s : l e v e l o f f r a c t i ons o f i n s p i r e d o x y g e n T y p e o f c h e s t d r a i n W o u n d Assessment P o s t o p e r ative c o m p l i c a tions : p u l m o n a r y , cardiovascular , musculoskeletal , w o u n d c o m p l i c a tions . ICU PATIENT :Mode of ventilation - supplemental oxygen; intermitent positive pressure ventilation Route of ventilation - face mask, nasal cannula, endotracheal tube, tracheostomy Level of consciousness - measured with Glasgow coma scale Central venous pressure (CVP) and pulmonary artery pressure (PAP)

8. 1 ) R e s p i r a tory A s s e s sment P a i n f u l b r e a t hing D i f f i culty i n c o u g h i n g A c c u m u l a tion o f s e c r e t i o n s A u s c u l t a t i o n :Normal breath sounds bronchial, vesicular Abnormal breath sounds - crackles, rhonchi, wheeze, pleural friction ru b Hyper resonance - associated with hyperinflation . Dullness or flatness 2 ) Circulatory Assessment H o m a n ' s s i g n O e d e m a 3 ) Posture a n d m o b i l i t y K y p h o s c o l i o s i s B e d m o b i l i t y 4 ) G e n e r a l a p p e a r a n c e : P r e s s ure s o r e s 5 ) Palpation : p e d a l e d e m a , s k i n temperature , tenderness e t c .

9. R a n g e o f m o t i o n Assessment o f s h o u l d e r a n d t r u n k o n t h e o p e r a t e d s i d e . P e r i pheral m u s c l e s t r ength Assessment : s h o u l d e r f l e x i o n , A b d u c t i o n , extension a n d i n t e r n a l r o t a t i o n . C h e s t m o v e m e n t : S y m m e t r y o f c h e s t m o v e m e n t s A B G a n a l ysis : R e s p i r a tory a c i d o s i s , r e s p i r a t o r y a l k a l o s i s . A c e s s o r y m u s c l e m o v e m e n t C h e s t e x p a n s i o n : B o t h o b s e r v a t i o n a l a n d p a l p a t i o n a l C h e s t X r a y : o n l a t e r a l v i e w :backward displacement of the oblique fissure and with increasing collapse O n P A v i e w :there is triangular density behind the heart with loss of the medial portion of the left hemidiaphragm. P F T : F E V , A i r w a y r e s i s t ance , inspiratory c a p a c i t y , M M V . D y s p n e a o r b r e a t h l e s s n e s s :Exercise tolerance (e.g. number of stairs client can climb or can walk) , Shortness of breath at rest , Associated swelling of ankles or recent weight g a i n , Constant breathlessness (fibrosis, fluid)

10. REFRENCES : 1 ) K . Athanassiadi, S. Kakaris, N. Theakos, and I. Skottis, “Muscle-sparing versus posterolateral thoracotomy: a prospective study,” European Journal of Cardio-Thoracic Surgery, vol. 31, no. 3, pp. 496–500, 2007. 2 ) T . W. Shields, General Thoracic Surgery, Lea & Febiger, Philadelphia, Pa, USA, 2nd edition, 1983.