Week 7 - Post - Op CABG: Consideratins For The Physical Therapist

Question 1

Benefits of early mobility in acute care

Answer 1

Decreased length of stay and healthcare related costs

Question 2

Benefits of early mobility post CABG

Answer 2

Best recovery post CABG protocols combine active UE and LE exercise w progressive ambulation
Minimizes post op pulmonary complications and helps w secondary complications (pain, impaired mobility, QOL)

Question 3

Median Sternotomy

Answer 3

Midline incision: sternal notch to base of sternum
Bypass grafting
Wire closure (sometimes w a plate/screws)

Question 4

PT Exam post CABG - phase 1 cardiac rehab

Answer 4

Chart review
Check w RN
Pt/family interview
Systems review
Physical exam/tests and measures

Question 5

Impairments in body/structure/function

Answer 5

Decreased functional work capacity
Decreased maximal aerobic capacity
Impaired gas exchange
Dyspnea on exertion
Decreased endurance
Impaired airway clearance
Impaired skin integrity
Pain, edema
Decreased strength and ROM

Question 6

Activity limitations

Answer 6

Decreased upright and standing tolerance
Impaired balance
Impaired functional mobility: walking, stairs, transfers

Question 7

Participation restrictions

Answer 7

ADLs
Work and employment
Family roles and responsibilities
Recreation and leisure activities
Community life
Intimate relationships
QOL and well being

Question 8

PT goals and POC post CABG

Answer 8

Education on sternal precautions
Airway clearance techniques
Cardiopulmonary endurance
Functional mobility for sage discharge
Frequency: daily initially

Question 9

Critical lines, least and tubes

Answer 9

Vent support (CPAP, BiPAP, nasal cannula)
Intracardiac lines
External pacing wires
Arterial lines
Peripheral IVs
Central IVs
Chest tubes
Feeding tubes

Question 10

Post op complications

Answer 10

Incisional pain
Dyspnea
Impaired ventilation
Weakness
Fatigue
Difficulty sleeping and eating
Depression
Neuro cognitive deficits
Thoracic, arm, back, neck pain

Question 11

Sternal complications - rare

Answer 11

Superficial wound infection
Bony nonunion/sternal instability
Sternal dehiscence
Mediastinitis
Lead to increased morbidity and healthcare cost

Question 12

Sternal instability scale

Answer 12

Evident based perspective on movement and activity following median sternotomy

Question 13

Sternal instability scale - 0

Answer 13

Clinically stable sternum - Normal, no detectable motion

Question 14

Sternal stability scale - 1

Answer 14

Minimally separated sternum - upper limb and trunk - slight increase in motion upon special testing

Question 15

Sternal instability scale - 2

Answer 15

Partially separated sternum - regional - mod increase in movement upon special testing

Question 16

Sternal stability scale - 3

Answer 16

Completely separated sternum - entire length (marked increase in motion upon special testing)

Question 17

Special testing of sternal instability scale

Answer 17

Shoulder flexion - uni/bilateral
Trunk lateral flexion or rotation
Coughing
Opposing movements of upper limbs

Question 18

Traditional sternal precautions

Answer 18

No pushing, pulling, lifting > 10 pounds
No B shoulder flexion or abduction > 90 degrees
No B UE extension past neutral
No driving
No prone

Question 19

What puts the most stress on the sternum

Answer 19

Coughing and sneezing

Question 20

Keep your move in the tube

Answer 20

Using a short lever arm decreases risk to sternum
Limiting movement of shoulder girdle and humerus while weighted minimizes pull on the sternum
Allowed unlimited movement of their arms when unloaded
Encourages active patient participation in ADL and functional tasks

Question 21

Scar massage

Answer 21

To begin 6 weeks post op assuming incision is fully healed, no open areas or scabs
Perform daily for 6 months on clean, dry, skin - circles, perpendicular, parallel