CBL: Post-surgical Pt. Flashcards
Location of celiac, superior mesenteirc ganglia, and inferior mesenteric
Celiac = below xiphoid process IM = just above umbilicus SM = halfway between xiphoid and umbilicus
Steps for abdominal ganglia inhibition
- Finger pads (one or both hands) lined up along pt’s midabdominal line, contacting skin along the ganglion that is to be inhibited
- apply gentle downward pressure until resistance of underlying tissue felt and is matched
- pressure held till softening or release is felt
Contraindication for abdominal ganglia inhibition
Postop patient with MIDLINE ABDOMINAL INCISION
What nervous system structures are being targeted in suboccipital decompression?
superior cervical ganglion = trying to dec stimulation of this so to decrease sympathetic tone
Vagus n. = increase parasymp tone
Steps suboccipital decompression
- finger pads in pt’s suboccipital sulcus bilaterally
- Physician carries elbows medially, placing lateral traction on suboccipital tissues
- simultaneously places gentle traction on occiput, force of traction matches resistance of tissues
- hold until release on both sides if felt
Steps cervical ganglia inhibition
- finger pads on ARTICULAR PILLARS of pt’s cervical spine on both sides
- gently life finger contacts in an ANTERIOR AND SUPERIOR direction until ARTICULAR resistance is perceived and matches degree of life
- amount of life is held until release is sensed
Steps Posterior Abdominal Diaphragmatic Releases: Releasing lumbar spine/crura (BLT)
Position: pt SUPINE; physician side of table = basically they’re on their back and your hand is under at the spine kind of like how rib raising looks
- Evaluate T12 - L3 for SD or inc paraspinal tension
- Contact spinous processes on either side of vertebral unit with SD
- Vertebral unit moved in directions that EXAGGERATE ITS FREEDOM OF MOTION - flex/ext, rotation, right or left sidebending
- Directions of freedom may be individually HELD AT THEIR POINT OF LIGAMENTOUS BALANCE, can stack multiple motions of direction. Pt can assist with respiratory effort
- Release occurs as tissues are held at point of ligamentous balance
Indication and steps for abdominal lift
Indication: constipation
Steps:
1. Pt. supine, knee to 90 deg bent
- Doc contact lower LEFT quadrant of abdomen just superior to inguinal lig; gently inserts finger pads into pt’s abdomen
- Tissues held in this position until release felt
- Steps 3 repeated until pt’s maximal release accomplished
- For RIGHT lower quadrant, repeat steps 1 - 4, lifting VERTICALLY toward RIGHT upper quadrant
Indication for rib raising
- improve resp biomechanics and lymphatic drainage
2. Normalize symp tone to LUNGS
Indication for cervical soft tissue
- Normalize PARAsymp tone to LUNGS
2. Remove cervical SD that may affect innervation to abdominal diaphragm = C3 - 5
Indication for thoracic pump with recoil
- Aerate alveoli
- Prevent atelectasis
- Mobilize lymph fluids
Contraindication for sigmoid release
left hemicolectomy
Contraindication for rib raising
fracture of rib/spine or recent spinal surgery
Contraindication pedal pump
ABSOLUTELY = if DVT
also if lower extremity fractures or abd surgery
Stages of post op and what you should focus on treating in each stage
- Inflammatory stage (days 1 -3) early postop
focus on circulatory and pulmonary first = prevent atelectasis and maintain circulation;
lymphatics treatments
- Diuresis stage (days 4 - 6) early postop
retained fluids will be lost form intr and extracell places so focus on lymphatics, GI, renal and ANS system
Ensure mobility of throacic cage and outlet (b/t pt has inc fluid flow)
- Late postop (1-3 weeks)
tx fascia/tissues, SD, and viscerosomatic reflex (residual pain)