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PHTY3250 > L12: Physiotherapy Management of Patients Undergoing Cardiac Surgery > Flashcards

L12: Physiotherapy Management of Patients Undergoing Cardiac Surgery Flashcards

1
Q

What is the cardiac disease progression?

A
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2
Q

What are the 6 charateristics of Cyanotic Heart Disease as congenital cardiac disease?

A
  1. Tetralogy of Fallot
  2. Transposition of great arteries
  3. Tricuspid atresia
  4. Truncus arteriosus
  5. Total anomalous pulmonary venous drainage
  6. Eisenmenger’s syndrome
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3
Q

What are the 2 charateristics of Acyanotic Heart Disease as congenital cardiac disease?

A
  1. Left-to-right shunt (ASD, VSD, PDA)
  2. Coarctation of aorta
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4
Q

What are 2 congenital cardiac disease?

A
  1. Cyanotic Heart Disease
    1. Tetralogy of Fallot
    2. Transposition of great arteries
    3. Tricuspid atresia
    4. Truncus arteriosus
    5. Total anomalous pulmonary venous drainage
    6. Eisenmenger’s syndrome
  2. Acyanotic Heart Disease
    1. Left-to-right shunt (ASD, VSD, PDA)
    2. Coarctation of aorta
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5
Q

What are 4 acquired cardiac diseases?

A
  1. Ischaemic heart disease
    • Coronary artery disease
  2. Valvular heart disease
    • Aortic, mitral, pulmonary or tricuspid valves
  3. Diseases affecting great vessels
    • Aorta (dissection, aneurysm, transection)
    • Pulmonary artery (embolism – acute & chronic)
  4. Pericardial disease
    • Constriction
    • Effusion
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6
Q

What are 4 characteristics of Coronary Artery Bypass Grafting (CABG)?

A
  1. For critical stenosis due to coronary artery disease
  2. Overall 2-3% operative mortality, though risk is stratified to individual (1%-31% mortality)
  3. Indicated in those refractory to medical therapy and/or likely to have better prognosis with surgical intervention
  4. Arteries or veins harvested and grafted to aorta and coronary arteries
    • Does not remove blockage – bypasses it
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7
Q

What are 4 characteristics of Valve repair / replacement?

A
  1. Indicated for severe stenosis or regurgitation
  2. Aortic and mitral valve most common
  3. Prosthetic valves are either mechanical or tissue
    1. Mechanical valves:
      1. Titanium, carbon or metal
      2. Longer lasting
      3. Anti - coagulation for life
    2. Biological valves:
      1. Human (allograft/ autograft) or animal (xenograft) tissue
      2. Bioprosthesis deteriorate after 8-15 years, but only require anticoagulation for 3 months
      3. Mainly used in elderly patients
  4. Transcatheter valve replacement
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8
Q

What are 3 mechanical valves in valve repair / replacement?

A
  1. Titanium, carbon or metal
  2. Longer lasting
  3. Anti - coagulation for life
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9
Q

What are 2 biological valves in valve repair / replacement?

A
  1. Human (allograft/ autograft) or animal (xenograft) tissue
  2. Bioprosthesis deteriorate after 8-15 years, but only require anticoagulation for 3 months
    • Mainly used in elderly patients
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10
Q

What are 5 features of all surgical procedures?

A
  1. Anaesthesia
  2. Surgical incision
  3. Organ support
  4. Surgical procedure
  5. Closure
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11
Q

What are 6 features of CABG as a surgical procedure?

A
  1. Anaesthesia
  2. Harvest grafts
  3. Median sternotomy
  4. Cardiopulmonary bypass +/-
  5. Hypothermia
  6. Cardioplegia
  7. Arrests electrical and mechanical activity
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12
Q

What are 5 features of open heart surgery as a surgical procedure?

A
  1. Anaesthesia
  2. Median sternotomy +/- graft harvest
  3. Cardiopulmonary bypass, hypothermia
  4. Cardioplegia
  5. Sternal stabilisation
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13
Q

What are 5 features of valve repair/replacement as a surgical procedure?

A
  1. Anaesthesia
  2. Median sternotomy
  3. Cardiopulmonary bypass +/-
  4. Hypothermia
  5. Cardioplegia
    • Arrests electrical and mechanical activity
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14
Q

What are 7 surgical approaches?

A
  1. Median sternotomy
    1. Majority of cardiac surgery
  2. Hemi- sternotomy
  3. Posterolateral thoracotomy
    • Repair of descending aorta and some trauma
  4. Minimally invasive surgery
  5. Transcatheter
    • Transapical
    • Transfemoral
    • Transaortic / ministernotomy
  6. Thoracoscopic
  7. Robotic-assisted
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15
Q

What are the 4 characteristics of bypass cardiopulmonary circuit?

A
  1. First successfully employed 1953
  2. Allows bypass of heart & lungs
  3. Greatly expanded field of cardiac surgery
    1. Motionless heart
    2. Bloodless field
  4. Most cardiac surgery employs bypass
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16
Q

What are the 4 steps of Coronary Artery Bypass Grafting?

A
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17
Q

What are the 4 steps of a Mitral Valve Repair?

A
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18
Q

What are the goals of CABG grafts?

A

provide patients with grafts which have the best long-term patency

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19
Q

What are the 3 donar sites of CABG grafts? What is the gold standard?

A
  1. LITA / LIMA (left internal thoracic (mammary) artery)
  2. Greater saphenous vein (60-70% patency after 10 years)
  3. Radial artery (Uncommon (can get P&Ns)

gold standard is the internal thoracic artery (90% patency at 15 years)

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20
Q

What are 7 short term effects of (Left) Internal Thoracic (Mammary) Graft (LIMA) as a CABG? What is the long term effect?

A
  1. Higher pulmonary complication rates
  2. Reduction in lung function
  3. Increased risk of pleural effusion
  4. Increased risk of phrenic nerve injury affecting diaphragmatic function
  5. Bilateral: potential for poorer sternal healing
  6. Affect circulation breast
  7. No special precautions
  • Keep origin and use distal part

Long term:

  • Lasts long
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21
Q

What are 3 effects of Saphenous vein as a CABG?

A
  1. Few restrictions to activity
  2. Decreased venous return, some problems with venous pooling
  3. No special precautions
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22
Q

What are 4 effects of radial artery grafts as a CABG?

A
  1. Risk of gapping of incision site
  2. Paraesthesia
  3. Decreased circulation
  4. Consider exercises to facilitate circulation, return of ROM and muscle power
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23
Q

What are 5 characteristics of Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)?

A
  1. No CPB
  2. Keyhole surgery (minithoracotomy)
  3. Faster recovery, less pain, lower infection rate
  4. Fewer complications
  5. Needs stabilisation system
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24
Q

What are the 6 characteristics of Off-Pump coronary artery bypass (OPCAB)?

A
  1. Uses a mechanical stabiliser to stabilise apex of heart and coronary arteries
  2. Heart is beating during procedure
  3. Similar outcomes to bypass but technically more difficult
  4. Does not reduce pulmonary complication rates (associated with sternotomy)
  5. Reduced risk of stroke or memory problems (pumphead)
  6. Faster recovery and shorter hospital stay, fewer blood transfusions, and fewer unwanted inflammatory/immune response issues
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25
Q

What are the 3 characteristics of a TAVI? What are the 3 types?

A
  1. Transcatheter Aortic Valve Implantation (TAVI)
    1. Percutaneous (PAVR)
  2. Access methods
    1. Transfemoral (Femoral artery)
    2. Hemi-sternotomy/ transaortic
    3. Transapical (Apex of heart)
  3. Types
    1. Corevalve
    2. Edwards- Sapien
    3. Lotus
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26
Q

When is a TAVI indicated?

A

For high risk patients (older) with severe symptomatic native aortic valve stenosis necessitating valve replacement

  • Unable to tolerate open heart surgery (high risk patients)
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27
Q

What are 10 characteristics of TAVI?

A
  1. Sterile procedure
  2. Heparin
  3. Retrograde approach: Through femoral artery “aorta “aortic valve (transfemoral)
  4. +/- Balloon aortic valvuloplasty
  5. +/- Rapid pacing 200-220 BPM (no forward CO) for 15-45 seconds
  6. Implantation of bioprosthesis
  7. Recovery in CCU
  8. 2 days CCU, 3 days monitored bed
  9. Antibiotic cover as per AVR
  10. Aspirin
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28
Q

What are 8 possible complications of TAVI?

A
  1. Vascular: Perforation, dissection, bleeding
    • Feed through blood vessel
  2. Inability to cross native valve
  3. Malposition
  4. Leaks (paravalvular) “predictor of mortality
  5. Hemodynamic instability
  6. CVA
    • Stroke 2 X as likely as OHS (atherothrombotic emboli)
  7. Loss of LV guide wire position
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29
Q

What are 3 limitations of TAVI?

A
  1. Significantly increased costs
  2. Inability to remove the calcified aortic valve
  3. High incidence of paravalvular leakage
  4. Incomplete annular sealing
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30
Q

What are 8 characteristics of minimally invasive AVR?

A
  1. Can be done through ministernotomy or minithoracotomy
    • Depends on the anatomical position of the ascending aorta
  2. ↓ mortality & morbidity
  3. Faster recovery
  4. Fewer blood transfusions / less blood loss
  5. ↓ pain
  6. Shorter hospital stay
  7. Better aesthetic results
  8. Longer CPB & cross clamp times
31
Q

What are 3 characteristics of (R) minithoracotomy?

A
  1. 5-7 cm incision at the level of 2nd / 3rd intercostal space
  2. No rib resection
  3. Lower incidence of postop AF & ↓LOSa
32
Q

What are 4 benefits of Robotically assisted cardiac surgery?

A
  1. Smaller incisions
  2. Precise motion control
  3. Improved outcomes
  4. Decreased LOS / bleeding / pain / infection risk
33
Q

What is heart failure (4)?

A
  1. Heart failure is when the heart is unable to supply sufficient cardiac output to support a physiological circulation
  2. May result from any structural or functional abnormality
  3. Ventricular Assist Devices (VAD) provide mechanical support to ventricular function
  4. Used as a bridge to transplantation, rarely as a bridge to recovery
34
Q

What are 4 characteristics of ventricular assist device (VAD)- heartware?

A
  1. Implanted internally in the pericardial space
  2. Continuous flow device
  3. Centrifugal pump with one moving part
  4. Left support only
35
Q

What does a total articular heart look like? Is this realistic?

A
36
Q

What are 2 charcateristics of Intra-Aortic Balloon Pump (IABP)? What are the indications?

A
  1. Provide circulatory support, reducing ventricular workload and oxygen demand of heart
    1. Maintaining coronary and systemic circulation
    2. Allowing heart time to relax and heal
  2. Indications include: Failure to wean from CPBM, depressed myocardial function, low cardiac output, failed coronary angioplasty, cardiogenic shock, septic shock
  3. Increases coronary perfusion and reduces afterload during systole
  4. Balloon placed in descending aorta via femoral artery, deflates rapidly at start of systole and inflates in diastolic phase
  5. Triggered by either pressure changes or ECG (Take care when doing P& Vs)
  6. Hip flexion only to 15° while IABP in-situ
37
Q

When are sternal wires used?

A

Median sternotomy: Incision/ wound and fractured sternum with fixation by wires

38
Q

What are 13 precautions (minor variations between facilities) of sternal wires?

A
  1. Minimise pressure through upper limbs when possible/practical
  2. Bilateral rather than unilateral upper limb activity
  3. Avoid reaching backwards when possible
  4. No weights for 1 month / limited weight with elbows by side and pain free
  5. Pain used as a guide – appropriate level pain relief
  6. No heavy lifting or work for 3 months
  7. No driving for 6 weeks
  8. Sternal support when coughing
    1. Hug folded towel across sternum
    2. Self hugging
    3. Prevent rib springing
  9. Education on moving in bed, transfers, posture, ADL, healing of sternum
    1. Exercises to facilitate, not inhibit, sternal healing
  10. Ladies wear bra esp. if bigger cup
39
Q

What are 5 characteristics of generally normal healing of sternal healing?

A
  1. Improvement in sternal pain over time
  2. No reported clicking/popping
  3. No crepitus on palpation
  4. Cutaneous healing
  5. No signs/symptoms of local or systemic infection

Weak callus formation 4 – 6 weeks and stability at 12 weeks

40
Q

What are the 3 complications for physiotherapy of cardiac surgery?

A
  1. Knowledge of post-operative complications is essential
  2. Physiotherapy intervention is often targeted towards preventing or minimising impact of specific complications
  3. Some complications have serious implications for physiotherapy management, and treatment needs to be modified accordingly
41
Q

What are 6 problems that arise as a result of respiratory complications?

A

Up to 15% of patients suffer from respiratory complications associated with general anaesthesia & major operations

Problems arise from:

  1. Decreased lung tidal volume
  2. Decreased lung expansion
  3. Increased ventilation rate
  4. Diminished ventilation and pulmonary perfusion ratio
  5. Compromised airway defences
  6. Secondary to compromise of cardiac function
42
Q

What are 5 respiratory complications of cardiac surgery?

A
  1. Atelectasis
    1. CPB causes surfactant washout & alveolar collapse
    2. Resorption type from bronchial secretions
    3. Compressive type from pleural effusion
    4. Left lower lobe
  2. Pneumonia
    1. Usually bronchopneumonia secondary to chronic lung disease, smoking or following atelectasis
  3. Pulmonary oedema
    1. Secondary to fluid overload or cardiac failure
  4. Hemidiaphragm (left) paralysis from phrenic nerve damage
    1. Phrenic nerve is close to heart. In surgery when ice is used on the heart –> can cause some temporary damage of nerve (which innervates diaphragm)
  5. Acute respiratory distress syndrome
    • Uncommon, associated with sepsis
43
Q

What are circulatory complications of cardiac surgery?

A

Venous thromboembolism can be a major complication after surgery and may give rise to pulmonary embolism

  • Always treated prophylactically
44
Q

What are 7 predisposing factors of circulatory complications in cardiac surgery?

A
  1. Major surgery
  2. Increasing age
  3. Venous stasis from immobility
  4. Cardiac failure
  5. Obesity
  6. Blood disorders
  7. Prolonged hospital stay
45
Q

What are 4 characteristics of cardiovascular complications in cardiac surgery?

A
  1. Rhythm disturbances are common
    1. Atrial fibrillation
    2. Supra-ventricular tachycardia
    3. Ventricular tachycardia
    4. Bigeminy
    5. Complete heart block
    6. Temporary pacing (external)
  2. Hypertension and hypotension
    1. Orthostatic hypotension common, secondary to immobility and some medications (e.g. GTN)
  3. Fluid Overload
    1. Pulmonary oedema
    2. Pleural effusions
  4. Cardiac failure
    1. Poor haemodynamic function may require IABP support
    2. Tamponade
46
Q

What are 4 cardiovascular complications of atrial fibrillation in cardiac surgery?

A
  1. Atrial fibrillation occurs in one-third after CABG and one-half after valve surgery
  2. Irregularly, irregular pulse
  3. When uncontrolled results in deterioration of exercise capacity
  4. Management depends on ventricular rate:
    1. < 90, treat as per normal
    2. 90-120, care with mobility, will be symptomatic
    3. >120, circulation & breathing exercises only, or as per medical advice
47
Q

What are the 3 dependents of ventricular rate in cardiovascular management for cardiac surgery (atrial fibrillation)?

A
  1. < 90, treat as per normal
  2. 90-120, care with mobility, will be symptomatic
  3. >120, circulation & breathing exercises only, or as per medical advice

Unable to sit up and walk

48
Q

What are 2 neurological complications of cardiac surgery?

A
  1. Major stroke in up to 3%
    1. Associated with cardiopulmonary bypass
    2. May be due to either thromboembolism or an air embolus
    3. 30-40% may suffer from microemboli without residual deficit
  2. Post-operative delirium/ anxiety/ PTSD/ memory loss/ depression
    1. Very common in post-surgical patients although they may not tell you
    2. Related to general anaesthesia, opiates, medications, sleep deprivation, physiological stress, infection, hypoxia and pre-cognitive function
49
Q

What are 2 musculoskeletal complications of cardiac surgery?

A
  1. Minor musculoskeletal pain after open heart surgery is common
  2. May arise directly from procedure
    1. Costovertebral or costotransverse joints
    2. Costochondral and sternocostal joints
    3. Entrapment of intercostal nerves
    4. Post-thoracotomy neuralgia
  3. May be secondary to immobilisation or an exacerbation of pre-existing injury
    1. Thoracic spine
    2. Lumbar spine
    3. Shoulder
50
Q

What are 3 sternal complications of cardiac surgery?

A
  1. Superficial Sternal Wound Infection (SSWI)
    1. Skin, subcutaneous tissues no further pectoralis fascia
  2. Sternal Dehiscence / Non-union “Instability”
    1. Abnormal motion of the sternum due to disruption of wires or bone fracture of the surgically divided sternum
    2. Dehiscence 1-2/52, non-union>6/52
  3. Deep Sternal Wound Infection DSWI / Mediastinitis
    1. Deep sternal incisional infection, involving skin and subcutaneous tissue and often the bone

Can have open wound for couple days

51
Q

What are 5 main risk factors of sternal complications of cardiac surgery?

A
  1. Obesity
  2. Diabetes
  3. COPD
  4. IMA (esp BIMA)
  5. Re-sternotomy
52
Q

What are 11 other risk factors of sternal complications of cardiac surgery?

A
  1. Macromastia
  2. Osteoporosis
  3. Severe coughing
  4. Prolonged duration surgery
  5. Prolonged post-op ventilation
  6. Blood loss/transfusions
  7. Higher NYHA
  8. PVD
  9. Emergency surgery
  10. Delerium
  11. Paramedian incision
53
Q

What are 2 characteristics of deep sternal wound infection as medical management?

A

Two staged pectoralis major flap repair (pec flap)

  1. Debridement, irrigation, open sternum – 48-72 hours
  2. Bone and soft tissues sutured closed with flap overlying sternum
54
Q

What are 3 characteristics of sternal instability (no infection) as medical management?

A
  1. Pectoral major flap repair – single stage (Pecs cross the midline)
  2. Sternal rewiring/re-stabilisation
  3. Conservative management

Unable to use arms (keep them together)

55
Q

What are 6 short term aims of physiotherapy for cardiac surgery?

A
  1. Respiratory
    1. Prevent chest complications e.g. pneumonia, respiratory failure
    2. Improve respiratory function - facilitate O2 wean, improve exercise tolerance
  2. Mobility (Get patient up as soon as possible (mobility))
    1. Assess, direct and progress mobility – aim for independent walking ASAP
    2. Muscle strength and range of motion
    3. Falls prevention
  3. Wound care
  4. Musculoskeletal (where indicated)
  5. Neurological (where indicated)
  6. Education
    1. Home exercise program – walking and exercises. Cardiac rehab.
    2. Sternal precautions
    3. Return to activity and work
56
Q

What are long- term aims of physiotherapy for cardiac surgery?

A

Cardiac rehabilitation

Individually assess and treat as required

  • No recipe treatments!
57
Q

What are 7 post operative assessment?

A
  1. General observation (FiO2, drains, IDC, infusion lines, inotropic support, pacing)
    • Improve cardiac output post op (medications)
  2. Vitals (BP, HR & rhythm, temp, RR, SpO2, ABG)
  3. Patient observation (alertness, respiratory effort, pallor, cyanosis, JVP)
  4. Palpation (chest expansion, percussion, pulses, oedema, DVT check)
  5. Auscultation (anterior & posterior)
  6. Cough (quality, sputum)
  7. Mobility (bed, walking)
58
Q

What are 7 evidences for physiotherapy post cardiac surgery?

A
  1. Pre operative eduction
  2. Cardiac rehabilitation
  3. Early mobility / exercise
  4. Inspiratory muscle training pre surgery
  5. Supportive vest/ garment
  6. Still debating:
    1. Prophylactic deep breathing exercises / incentive spirometry
    2. Pre- operative exercises
    3. NIV
  7. Surgeon / facility protocol
59
Q

What are 5 characteristics of respiratory care for cardiac surgery?

A
  1. Encourage deep breathing
    1. Deep breathing exercises ± tactile facilitation
    2. +/- Incentive spirometry
    3. Probably most useful in very early post-operative stage- immediately after extubation and over next day or so
  2. Sputum clearance is vital
    1. Pain relief
    2. Supported huff/cough
    3. Active techniques (percussion & vibrations) where indicated
  3. Arterial saturation monitoring important, including post-treatment
  4. Need to be vigilant for worsening respiratory status, however be aware that it may also be due to worsening cardiac function
  5. Mobility / exercise
60
Q

What are 2 exercises for cardiac surgery?

A
  1. Circulatory exercises commence early while patient is in bed
    • Calf and hip/knee flexion
  2. Upper limb and thoracic/cervical spine exercises progressively over next 2- 3 days as drains and central venous line are removed
    • Check local protocol
61
Q

What are 2 characteristics of in and out of bed mobility for cardiac surgery?

A
  1. Bed rope both hands/backrest up if deconditioned 1 – 2A.
    • Use mechanical bed
  2. Sidely with counterweighting – minimises abdominal use
62
Q

What are 3 characteristics of repositioning up the bed mobility for cardiac surgery?

A
  1. Bed rope to sit forwards, bottom shuffle back, minimal use arms
  2. Bed flat, bent knee push securing patients feet. Folded slidesheet under patient body if required.
  3. Stand then reposition
63
Q

What are 5 characteristics of early mobilisation for cardiac surgery?

A
  1. Analgesia prior
  2. Require assistance X 2 people, POD1
  3. Mobility improves quickly as drains and infusions are removed
  4. Need to assess heart rate & rhythm (arrhythmias), blood pressure, SpO2 and inotropic support
  5. Observe time precautions after removal of patient attachments – 15-20 minutes for drain, 1 hour for pacing wires, 4-6 hours for IABP
64
Q

What are 9 contradications of mobility post-op?

A
  1. PVC > 5 at rest or Multifocal
  2. PVC (Premature Ventricular Complexes)
  3. Rapid AF (>100 bpm) < 24 hrs if untreated.
  4. Inotropic support to maintain resting BP usually if Dopamine is > 5 mics/kg, if on Adrenaline at all or if on Dobutamine at all.
  5. IABP in situ or < 6hours of removal.
  6. 2nd degree heart block with PVC
  7. 3rd degree heart block
  8. New ST segment changes
  9. Low Hb requiring transfusion
65
Q

What are 9 preacautions of mobility post-op?

A
  1. Rest HR > 100bpm
  2. AF > 100bpm for > 24 hours
  3. Systolic BP> 160 Diastolic > 90
  4. Systolic < 80
  5. Inotropic support usually Dopamine 3-5 mics/kg
  6. PVC < 5 at rest
  7. Pacing with no underlying rhythm
  8. Low Hb not requiring transfusion
66
Q

What are 4 musculoskeletal characteristics of cardiac surgery?

A
  1. Thoracic pain is common after open heart surgery
  2. Other MSK complaints are often the result of a pre-existing problem with an acute exacerbation
  3. May require treatment if it impedes patient’s post-operative recovery
  4. Otherwise refer to outpatients department (only if indicated)
67
Q

What are 3 neurological characteristics of cardiac surgery?

A
  1. Early rehabilitation may be necessary for patients who have suffered a neurological insult peri-operatively
  2. Usually only routine input until patient is transferred to rehabilitation unit
  3. Physiotherapists working in rehab unit still need to observe usual sternotomy precautions
68
Q

What are the 5 characteristics of discharge for cardiac surgery (6)? How long is the discharge plan?

A
  1. +/- Stair test prior to discharge used to elicit potential adverse advents and to build confidence
  2. Progressive walking program (local protocols)
    1. 5 mins twice daily week 1
    2. 10 mins twice daily week 2
    3. 15 mins daily week 3
    4. 20 mins daily week 4
    5. 25 mins daily week 5
    6. 30 mins daily week 6
  3. Adjust program to individual patient
  4. Advise about return to sport or hobbies
  5. Advice to seek PT advice if ongoing musculoskeletal pain – usually via cardiac rehab
69
Q

What are cardiac surgical clinical paths?

A

Clinical paths vary between institutions, mostly due to differences in roles within multidisciplinary and cross-functional teams as well as staffing constraints, for example:

  1. Pre-operative education may be delivered by video
  2. Nurses may be responsible for post-operative mobility and breathing exercises after extubation
  3. Physiotherapy review may be only by individual referral (directive) rather than by open referral (autonomous)

Also depends on complexity of patients, preference of staff and historical context

70
Q

What is CABG POD1 – ICU?

A
  1. Assess patient, note:
    1. Extubated during previous night, stable on 4LO2
      • As long as they are conscious/awake and alert & on nasal prongs
    2. 2-3 x chest drains
    3. Weaning inotropic support
    4. +/- cardiac pacing
    5. PCA for pain relief
    6. Productive cough
  2. Treatment (2 X treatment)
    1. Incentive spirometry / deep breathing exercises
    2. Huff/cough
    3. Upper limb, lower limb exercises
    4. Mobilise x 2 assist approximately 15-30m 1st walk
    5. Sit out of bed
71
Q

What is CABG POD2 - ward?

A
  1. Assess patient, note:
    1. Pacing ceased, sinus rhythm, rate 80-100
    2. 1 x drain in-situ (may be removed during day)
    3. Fluids & PCA through CVL (removed when drains removed)
    4. Stable on 2LO2, productive cough
  2. Treatment (1xtreatment ± 1xreview):
    1. Incentive spirometry
    2. Huff/cough
    3. Upper limb exercises
    4. Mobilise x 1 assist approximately 40-60m (Increase exercise and more independence)
    5. Encourage SOOB
72
Q

What is CABG POD3 - ward?

A
  1. Assess patient, note:
    1. All drains removed
    2. PCA/CVL removed
    3. Stable on room air, dry cough
  2. Treatment (1xsession):
    1. Huff/cough
    2. Progress exercises
    3. Mobilise independently approximately 100-150m
    4. Encourage mobility and exercises 2-3 times daily
73
Q

What is CABG POD4-5 - ward? (sometimes Day 8-9)

A
  1. Assess patient, note:
    1. Dry cough
    2. Off telemetry, pacing wires removed
    3. Mobilising around ward independently
    4. Possibly home tomorrow
  2. Treatment (1xsession):
    1. Home exercise program
    2. Stair test
    3. Referral for cardiac rehabilitation
    4. Discharge from physiotherapy

PHTY3250 (20 decks)

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