Mgr. Alena Sedláková



}Involves a surgical operation on organs inside the abdomen (stomach, gallbladder, small intestine,
large intestine, liver, pancreas, spleen, oesophagus, appendix, abdominal aorta)
}Main reasons include infection, obstruction, tumors, infflamatory bowel disease

}Mini-invasive operations – laparoscopy
}Open abdominal surgery


•Prevention of post-operative pulmonary complications such as pneumonia
•Prevention of decubitus
•Prevention of cardiovascular complications such as tromboembolism
•Prevention of ileus
•Prevention of muscle contractions, weakness and joint stiffness
•Prevention of hernia - training safety coughing, getting out of bed
}

•Preconditioning is important and involves increasing endurance fitness and minimizing functional
deficits of the movement system prior to surgery
•Having already increased the patinnet‘s fitness during the pre-operative phase is an important
benefit during the post-operative rocovery  period
•Any strenghtening prior to surgery increases and accelerates the period of post-surgical recovery
}

}The practice of pulmonary physical therapy practical skills prior to surgery gives patients the
needed peace and certainty during the post-surgical stay in Intensive Care Unit


}Includes the explanation of physical therapy before and after surgery
}Training of pulmonary physical therapy practical skills
}Breathing techniques emphasizing respiratory thoracic and abdominal excursion
}Expectoration with holding an abdominal incision
}Corrective work of the postural system
}Lower extermity movements and movements of the arms
}Training of getting out of and in bed
}
}
}

}We continue with the pre-surgical physical therapy
}As soon as possible and following a consultation with the doctor, we initiate the intensive
exercises that should be repeated 2-4 times per day

}Cardiovascular exercises – ankle pumping exercices to prevent deep vein thrombosis
}Respiratory physical therapy
}Lower and upper extermities movements
}Splinting abdominal incisions during coughing or sneezing
}Bed mobility – movement toward either side of the bed or up and down in the bed
}Rolling to the side – toward the operated or healthy side
}

}Training of verticalization procces (sitting, standing, walking) – strict log-rolling for getting
in and out of bed
}Scare care (incision mobilization) after stiches extraction

}Bed mobility – movement toward either side of the bed or up and down in the bed
}Rolling to the side – toward the operated or healthy side
}Sitting at the edge of the bed, legs in contact with the floor
}Balance training in sitting
}Training of getting out of bed over the operated side
}Training walking and stair training

}Orthostatic disorders
}Such as pale in face, sweat, bad balance, nauzea, feeling dizzy
}Hart rate, blood presure when the patients  are monitoring in the Intensive care unit
}Post-operative patients may have inserted multiple lines, tubes and drains (such as peripheral
line, central line, chest tube, wound drains, urinary catheter etc.). Before mobilization, ask the
nurses about discconnection of lines

}1st.day – respiratory physical therapy, cardiovascular gymnastics, conditioning training in laying
position, bed mobility, training verticalization – sitting?, standing?, walking around the bed?
}2nd.day - respiratory physical therapy, cardiovascular gymnastics, conditioning training in laying
position, in sitting position, walking around the bed, walking in the room…

}3rd.day - respiratory physical therapy, cardiovascular gymnastics, conditioning training in laying
position, in sitting position, walking around the bed, walking in the room, in the corridor, with
our assistance or without
}Approximately after 2 or 3 days the patients are moved from Intensive care unit to standard wards
in hospital and we continue with higher level of physical therapy

}Of course the patients continue with rehabilitation at home following physiotherapist instructions



}Avoid lifting more than 15-20 pounds for 6 weeks
}Avoid strong abdominal work (sit-ups, resisted hip flexion)
}Strict log-rolling for getting in and out of bed
}Avoid activities that encourage Valsava manoeuvre (heavy lifting, forceful coughing, straining on
the toilet)