Week 5 Rehabilitation for Patients after Cardiothoracic

Question 1

chest tubes

Answer 1

Important for chest tubes to stay upright
If knocked over, blood can drain back into pleural space
Know location of tubes and where they are attached to patient
Be aware of output pre- and post-mobility
Check with medical/nursing staff or in orders if chest tube can come off suction
Monitor for air leak or bubbling
Keep below the level of the patient when moving the chest tube
Avoid clamping unless ordered by physician
Be aware of use of portable suction for patients who have undergone VATS or have pneumothorax

Question 2

Line

Answer 2

Set up your space in advance
Consider – what can be unplugged/moved? Which side of the bed is easiest to perform mobility on? How far do tubes/wires reach around bed?
Consider safe patient handling with lines/tubes

Question 3

Arterial lines

Answer 3

Allow for taking arterial BP and blood samples
Generally leveled at R atrium to get accurate reading
Keep site visible
Use wrist guard if radial access
If pulled out accidentally or bleeding, apply firm pressure and notify RN
Literature has shown mobility with femoral lines is safe/feasible

Question 4

Pulmonary artery /Swan Ganz catheter

Answer 4

Inserted through R IJ, L subclavian or femoral vein into pulmonary artery to allow for hemodynamic monitoring
Monitors R side heart pressures, pulmonary artery pressure, and cardiac index (cardiac output in L divided by body surface area in meters squared)

Question 5

Pulmonary artery/swan ganz catheter indicates risk for

Answer 5

arrhythmia, pneumothorax, pulmonary artery infarction or rupture, infection, catheter breaking off internally, or movement into R ventricle

Question 6

Post op day 0 CABG

Answer 6

may sit EOB if medically indicated (extubated, awake, able to actively participate)

Question 7

POD1 GABG

Answer 7

OOB to chair, ambulating short distances

Question 8

POD2-3 CABG

Answer 8

transfer to cardiac step down from ICU

Question 9

CABG pt dependent on

Answer 9

respiratory status, cognition/mentation, medical complications, device/mechanical circulatory support needs, medication needs (ie: vasopressors), need for renal therapy such as CRRT

Question 10

Sternal precautions

Answer 10

Avoidance of pushing/pulling
No lifting >5-10 lbs
Avoidance of placing arms behind back
Avoidance of UE elevation beyond 90 degrees
Limited use of UE with bed mobility and transfers

Question 11

Move in the tube

Answer 11

Decreasing length of arm (as a lever) allows patients to perform previously contraindicated movements within a small frame of motion

Question 12

outcome/functional measures for CABG

Answer 12

2MWT
6MWT
2min step test
AM-PAC 6 clicks

Question 13

PPM precautions

Answer 13

No driving
No lifting >5-10 lbs, pushing, or pulling
No reaching above 90 degrees
Variable length of time – 2 weeks to

Question 14

PPM rehab considerations

Answer 14

Patient may be in sling for 1-2 days – surgeon dependent
Use unaffected arm to reach overhead for ADLs and one-handed dressing technique for upper body dressing
Caution with grab bars, DME, other surfaces patients may attempt to push/pull on during mobility tasks
Degree of exercise/physical activity may be more than what PPM is capable of responding to

Question 15

Rehab considerations after AAA repair

Answer 15

Trial abdominal binder with mobility
Utilize bed mobility strategies that decrease pain
Be aware of presence of PCA pump and how this may contribute to hypotension
Monitor incision, pain, and any drains patient may have
Educate patients to avoid strenuous activities and heavy lifting

Question 16

General patient education principles

Answer 16

Splint with coughing, sneezing
Use of incentive spirometer
Creation of a daily mobility schedule
Encouraging OOB to chair for meals and ambulation
DVT prevention strategies
DME and discharge/post-acute needs
Pain and edema management – positioning, gentle ROM
Encouraging eventual cardiac rehab participation

Question 17

Peripheral vascular surgeries

Answer 17

Patients may experience pain with dependent positioning of LE
May be unable to fully bear weight on surgical extremity
May exhibit decreased ROM/strength to surgical extremity, especially if incision crosses multiple joints
Encourage ROM, isometrics  strengthening via HEP
Work on bilateral symmetrical weightbearing if indicated, especially with use of RW
Standing quad sets, hip extension, ankle DF stretching
Monitor drains, tubes, wounds
Generally WBAT without precautions, unless wounds exist to distal extremities or plantar surface of feet from PVD