PT Implications for Cardiovascular and Thoracic Interventions

Question 1

What are thoracotomies used for?

Answer 1

Posterior and lateral thoracotomy incisions are used for lung resection procedures

Question 2

What are the PT interventions after a lateral thoracotomy?

Answer 2

-segmental breathing to minimize atelectasis
-side bending
-lateral chest wall stretching

Question 3

What is a thoracoabdominal incision used for?

Answer 3

To give access for procedures on the diaphragm, esophagus, biliary tract, spleen, R lobe of liver, adrenal gland and kidney

Question 4

What do patients struggle with after a thoracoabdominal incision?

Answer 4

-coughing
-deep breathing
-thoracic extension

Question 5

PT interventions following a thoracoabdominal incision

Answer 5

-implement breathing exercises early
-implement mobilization early
-avoid forward flexion postures

Question 6

What are the sternal precautions?

Answer 6

1. No shoulder flexion >90
2. No lifting >5 lbs
3. No pushing or pulling w/ UE
4. No sitting in car behind airbag
5. Perform only pain free bilateral arm movements

Question 7

What does it mean to “keep your move in the tube?”

Answer 7

A way to teach patients how to perform load-bearing movements in a way that minimizes sternal stress
-keeping UEs close to body as if they were in an imaginary tube

Question 8

PT interventions following a CABG

Answer 8

-mobilization of LEs
-sit at EOB
-deep breathing exercises
-incentive spirometry
-coughing exercises
-progressive mobility

Question 9

What should you teach your patient if they are unable to cough?

Answer 9

Teach them to huff- deep inspiration following by forced expiration without glottis closure

Question 10

T/F coughing is one of the best ways to clear the airway?

Answer 10

truueeeeee

Question 11

What is an incentive spirometer?

Answer 11

A device used to help you keep your lungs healthy while they are healing
-teaches patients how to take slow, deep breaths following surgery
-should be used every 1-2 hrs, 10 reps each time

Question 12

Physician recommendations following implantation of a pacemaker

Answer 12

-involved UE in sling for 25 hrs
-no exercise to involved shoulder for 4-6 wks
-limit shoulder flex to 90 for 4-6 wks
-minimally WB through assistive device
-no lifting >5 lbs for 4-6 wks
-no driving until cleared
-no diathermy or estim

Question 13

Chest tube considerations

Answer 13

-chest tube must stay upright
-keep in gravity dependent position
-airway clearance techniques
-shoulder ROM exercises to patient’s tolerance (assists in pulmonary ventilation)
-chest x-ray after tube is removed to rule out penumothorax