Post thoracotomy

physiotherapy
management
Problem list
Pain
ICD insitu
Decreased air entry
Retained secretions
Decreased movement especially shoulder on the
operated side
Decreased mobility
Poor posture
Treatment plan
Ensure adequate analgesia
Ensure patency of drain tube ( milking them as
necessary)
Deep breathing exercise ( hold, sniff)
Lateral costal shakings below the incision
Elevation of foot end of bed to aid drainage of
secretions as in case of pleural effusion
Coughing and huffing with good support in forward lean
sitting/ edge of the bed
 Full range of active assisted arm exercise
Patient advised to walk around by carrying his own
drainage bottles in holder
Trunk, shoulder girdle exercises and postural correction
 Post operative regime
3 days protocol also used in closed heart surgery

Day of operation
O2 therapy
Breathing exercise and cough with support of incision
but not to compress the drain tube
Continued each time patient wakes up from sedation
Day 1
Comfortable positioning (side lying), sitting with
adequate pillow placement ( 5 pillows)
Breathing, coughing, limb and shoulder girdle exercises
Correct posture
Day 2
Chest treatment 2 to 3 times depending on auscultation
findings
If drains off suction, mobilization is increased and then
stair climbing started
Day 3
Day to day assessment and treatment as necessary
Postural exercises
General activities
Patient will go home probably 8 to 10 days
Follow up Physiotherapy should not be necessary,
unless shoulder has been particular problem.
 Cardiac surgrery
Open heart surgery:
Incision in to one or more of the heart chambers.
Closed heart surgery
Surgery done without opening the heart chambers
Advantages:
Not requires cardiopulmonary byepass
Less invasive
Less traumatic
 Open heart procedure are those for correction of
congenital heart defects, to repair diseased valves, and
in the treatment of severe coronary heart disease.
It requires cardiopulmonary by pass
Circulation and oxygenation outside of the patients
body so that beating of the heart may be temporarily
suspended
CP by pass also enables surgery to repair damage to the
great vessels that transport blood to and from the heart.
Repair of diseased valve
Mitral valve and tricuspid valve open heart surgery
Pulmonary valve closed heart surgery
Aortic valve depends on the severity of the damage
Repair of congenital heart defects
Most congenital malformation can be repaired surgically
and fall into 2 categories
1) CP bypass required for inter cardiac abnormalities Eg:
septal defect
2) CP bypass not required for ligation of patent ductus
arteriosus or removal of an aortic constriction.
Coronary artery bypass graft (CABG)
Aims: to restore adequate blood to myocardium
CP bypass is used
Narrowed or obstructed area bypassed by using Internal
mammary artery or leg vein
The principal uses of CABG may be to relieve angina or
to prolong persons life
 Heart transplantation
Indication
Irreversible heart damage ( no medication/surgery)
Usually replaced with healthy human heart
1967- cape town, south Africa first time
Patient 18 days survival death due to pulmonary
infection
Experimental artificial hearts have also been implanted
but these requires an external power supply long term
survival rates are unknown
No of tests required before transplantation Eg: Histo
compatiablity
Disadvantages:
Risk of rejection
Patient may be weaker than most before the procedure,
because lack of nerve supply of the transplanted heart
will respond slowly to the demands of the physical
activity
85 90% - 1 year survival ( at least)
75% - still alive after 5 years
50 60% - live for a further 5 years
Physiotherapy objectives in cardiac
surgery
Full range of motion exercise arm, leg, trunk
Correct posture midline incision stooping posture
Breathing exercise to improve ventilation
General mobility bed rope
Coughing self assisted and PT assisted
Huffing and coughing to remove secretions
 Post operative regime
OPEN HEART SURGERY
Post operative problem list
Pain
Decreased air entry
Retained secretions
Reduced arm and leg movements
Decreased mobility
Treatment plan:
1. Ensure patient has adequate analgesia
2. Unilateral and bilateral deep breathing exercises with
breath holds and sniffs in half lying or lying
3. Unilateral posterior basal shakings, huffing, coughing
with support
4. Unilateral active/assisted arm and leg exercise, active
ankle exercises
5. Increase mobility and progress to stair climbing and
exercise class
 Post operative regime
7days protocol
Day of operation:
No treatment, will vary from patient to patient and
surgeon to surgeon
Day 1:
Treatment in ITU, analgesia, good Blood pressure, acceptable
ECG, pulse, steady drainage
Arm, leg exercises
Breathing exercises
Coughing and huffing with adequate support
O throughout treatment
2

Side lying position with the help of bed rope

Progressed to sitting
Day 2
Position the patient in sitting out in a chair
O2 therapy discontinued
Breathing exercises
Ankle toe movements
Coughing and huffing
Short walk around the bed
Day 3
Walking increased
Chest treated according to the auscultation findings
Day 4
If the patient walks 100 yards with no shortness of
breath then stair climbing can begin
It is advisable to climb only 1 flight at first to ensure
that there are no adverse effects
Day 5
Stair climbing and walking should be increased
Trunk exercises can be included at this stage

Day 6
Same as day 5
 Day 7
Advice to continue his walking and exercises
Home exercises includes neck, shoulder girdle, arm and
trunk exercises, coughing is useful
Walking 1 2 miles a day ( started after 6 weeks of
discharge from hospital)
Sexual relations avoided for 4 weeks after discharge
Resume light work after 2 months, heavy work after 3
months.