Pt assessment

Pt assessment

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  PT ASSESSMENT OFPULMONARY SURGERY CONDITIONS JAMIA MILLIA ISLAMIA CENTRE FOR PHYSIOTHERAPY AND REHABILITATION SCIENCE SUBMITTED TO : DR. JAMAL ALI MOIZ SUBMITTED BY : SUALEHA KHANAM SUBJECT : PT IN CARDIOPULMONARY CONDITION ROLL NO.: 17BPT037 DATE OF PRESENTATION: 19/02/2021
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  INTRODUCTION : Physiotherapy Assessmenthas been used preoperatively and/or postoperatively to avoid surgical complications and enhance the recovery of the patients. It divided into two parts: 1)Pre-operative PT Assessment : Benefits : To know the functional status ,focus on creating plan to shorten healing time, To reduce surgical complications ,Mentally prepare patient for surgery and rehabilitation. 2)Post-operative PT Assessment: Benefits : To know the postoperative problem of the patient , Focus on creating plan to return to daily activities .
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  PREOPERATIVE PT ASSESSMENT: It includes both subjective and objective Assessment: Subjective Assessment • Demographic data : Name ,Age ,Gender ,marital status , Occupation . • Present history • Family history of disease • Drug allergy ,Past anaesthetic history • Past medical history : Respiratory disorders , other chronic disorders ,Diabetes and hypertension . • Surgical history : Tracheostomy ,endoscopy etc. • Personal and social history: history of smoking ,history of alcohol intake,sleep ,Appetite loss,bowel and bladder , exercise tolerance ,wt.loss etc • Chest pain : Musculoskeletal chest pain ,Angina pectoris ,Pleuritic chest pain • Incontinence : • Other symptoms : fever ,headache ,peripheral edema, shivering ,wt .loss , palpitations , vomiting and nausea.
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  OBJECTIVE ASSESSMENT : •VITAL SIGNS : Temperature ,pulse , Respiratory rate ,blood pressure and oxygen saturation . • GENERAL APPEARANCE : Body weight ,height ,Eyes (pallor ,plethora ,jaundice),tounge and mouth ( cyanosis ) ,jugular venous pressure . • OBSERVATION OF CHEST : chest deformities ( kyphosis , kyphoscoliosis ,barrel chest , pectus carinatum) ,symmetry . • BREATHING PATTERN:Check for bradypnea, tachypnea, hyperventilation, Prolonged expiration - 1:3 to 1:4 • INTUBATION: Neck movement ,TMJ movement. • PALPATION :Hoover’s sign - Paradoxical movement of the lower chest can occur in patients with severe chronic airflow limitation who are extremely hyperinflated. • Trachea : 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.
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  • PHYSICAL EXAMINATION: cough , expectoration , wheezing etc. • Chest expansion • CHEST X- RAY :Chest x-rays are often taken early if a respiratory disorder is suspected. • Pneumonia ,emphysema ,rib fracture ,tuberculosis, enlarged heart ,pleural effusion ,mass or nodule in the lung . • ABG analysis • Oxygen saturation • Peripheral muscle strength • Pulmonary function tests : if FEV1/FVC ratio less than 40% of predicted value and PaCO2 greater than 5 kPa the surgery is definitely contraindicated. • Cardiopulmonary exercise test : 6 min.walk test . • Functional independence measures • Breathlessness or dyspnea:Association of paraoxysmal nocturnal dyspnea (PND) • Grading of breathlessness : MMRC , Modified borg scale .
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  POSTOPERATIVE PT ASSESSMENT: •DATABASE INFORMATION ( from medical records) : Preoperative investigation , surgical procedure and incision , Concise medical history • Surgery notes reading : Type of incision ,type of anesthesia ,duration of surgery and immediate complications . • Understanding the attachment : IV lines , catheter , nasogastric tube ,PCA ,drains . • SUBJECTIVE INFORMATION : Detailed medical history ,smoking history , cheif complaint ,personal history , present history ,past history , surgical history ,social history ,family history. • Pain assessment : A verbal description scale or VAS scale is used to measure incision or shoulder pain . • Cough and sputum assessment : the patient ability to cough and expectorate should be assessed . The color ,volume and consistency of sputum should be observed . • Open ended questions : how do you feel . • Ventilation : Hypoventilation may occur .
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  • ORIENTATION ASSESSMENT: communication ability ,alertness, perceptual ability to follow instructions . • OBJECTIVE ASSESSMENT: • Clinical examination : Inspection , palpation ,auscultation and percussion • VITAL SIGNS : Temperature ,blood pressure ,heart rate , pulse. • Methods of pain control : the PT must be aware the of the various route of analgesia ( i.e intravenous ,epidural and paravertebral ) • Oxygen delivery systems : level of fractions of inspired oxygen • Type of chest drain • Wound Assessment • Postoperative complications: pulmonary , cardiovascular , musculoskeletal ,wound complications. • 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) •
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  1) Respiratory Assessment •Painful breathing • Difficulty in coughing • Accumulation of secretions • Auscultation :Normal breath sounds bronchial, vesicular • Abnormal breath sounds - crackles, rhonchi, wheeze, pleural friction rub • Hyper resonance - associated with hyperinflation. • Dullness or flatness 2 )Circulatory Assessment • Homan's sign • Oedema 3) Posture and mobility • Kyphoscoliosis • Bed mobility 4) General appearance : Pressure sores 5) Palpation : pedal edema , skin temperature , tenderness etc.
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  • Range ofmotion Assessment of shoulder and trunk on the operated side . • Peripheral muscle strength Assessment : shoulder flexion ,Abduction , extension and internal rotation . • Chest movement :Symmetry of chest movements • ABG analysis : Respiratory acidosis , respiratory alkalosis. • Acessory muscle movement • Chest expansion: Both observational and palpational • Chest X ray :on lateral view :backward displacement of the oblique fissure and with increasing collapse • On PA view :there is triangular density behind the heart with loss of the medial portion of the left hemidiaphragm. • PFT : FEV ,Airway resistance , inspiratory capacity ,MMV. • Dyspnea or breathlessness: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 gain, Constant breathlessness (fibrosis, fluid)
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  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.