This document provides information on preoperative and postoperative physiotherapy assessment for pulmonary surgery patients. The preoperative assessment involves collecting subjective and objective information on the patient's medical history and functional status to create a treatment plan and reduce complications. The postoperative assessment examines the surgery details and any complications while monitoring pain, breathing, circulation, mobility and other factors to aid the patient's recovery. Physiotherapy focuses on regaining strength, mobility and functional independence through techniques like breathing exercises and range of motion.

1. PT ASSESSMENT OF PULMONARY SURGERY
CONDITIONS
JAMIA MILLIA ISLAMIA
CENTRE FOR PHYSIOTHERAPY AND REHABILITATION SCIENCE
SUBMITTED TO : DR. JAMAL ALI MOIZ
SUBMITTED BY : SUALEHA KHANAM
SUBJECT : PT IN CARDIOPULMONARY CONDITION
ROLL NO.: 17BPT037
DATE OF PRESENTATION: 19/02/2021

2. INTRODUCTION :
Physiotherapy Assessment has been used preoperatively and/or
postoperatively to avoid surgical complications and enhance the recovery
of the patients.
It divided into two parts:
1)Pre-operative PT Assessment :
Benefits : To know the functional status ,focus on creating plan to shorten
healing time, To reduce surgical complications ,Mentally prepare patient
for surgery and rehabilitation.
2)Post-operative PT Assessment:
Benefits : To know the postoperative problem of the patient ,
Focus on creating plan to return to daily activities .

3. PREOPERATIVE PT ASSESSMENT :
It includes both subjective and objective Assessment:
Subjective Assessment
• Demographic data : Name ,Age ,Gender ,marital status , Occupation .
• Present history
• Family history of disease
• Drug allergy ,Past anaesthetic history
• Past medical history : Respiratory disorders , other chronic disorders
,Diabetes and hypertension .
• Surgical history : Tracheostomy ,endoscopy etc.
• Personal and social history: history of smoking ,history of alcohol
intake,sleep ,Appetite loss,bowel and bladder , exercise tolerance
,wt.loss etc
• Chest pain : Musculoskeletal chest pain ,Angina pectoris ,Pleuritic chest
pain
• Incontinence :
• Other symptoms : fever ,headache ,peripheral edema, shivering ,wt
.loss , palpitations , vomiting and nausea.

4. OBJECTIVE ASSESSMENT :
• VITAL SIGNS : Temperature ,pulse , Respiratory rate ,blood pressure
and oxygen saturation .
• GENERAL APPEARANCE : Body weight ,height ,Eyes (pallor ,plethora
,jaundice),tounge and mouth ( cyanosis ) ,jugular venous pressure .
• OBSERVATION OF CHEST : chest deformities ( kyphosis ,
kyphoscoliosis ,barrel chest , pectus carinatum) ,symmetry .
• BREATHING PATTERN:Check for bradypnea, tachypnea,
hyperventilation, Prolonged expiration - 1:3 to 1:4
• INTUBATION: Neck movement ,TMJ movement.
• PALPATION :Hoover’s sign - Paradoxical movement of the lower chest
can occur in patients with severe chronic airflow limitation who are
extremely hyperinflated.
• Trachea : tracheal deviation indicates underlying mediasternal shift .
trachea may be pulled towards in collapsed or fibrosed upper lobe or
pushed away from pneumothorax or large pleural effusion.

5. • PHYSICAL EXAMINATION : cough , expectoration , wheezing etc.
• Chest expansion
• CHEST X- RAY :Chest x-rays are often taken early if a respiratory disorder
is suspected.
• Pneumonia ,emphysema ,rib fracture ,tuberculosis, enlarged heart
,pleural effusion ,mass or nodule in the lung .
• ABG analysis
• Oxygen saturation
• Peripheral muscle strength
• Pulmonary function tests : if FEV1/FVC ratio less than 40% of predicted
value and PaCO2 greater than 5 kPa the surgery is definitely
contraindicated.
• Cardiopulmonary exercise test : 6 min.walk test .
• Functional independence measures
• Breathlessness or dyspnea:Association of paraoxysmal nocturnal
dyspnea (PND)
• Grading of breathlessness : MMRC , Modified borg scale .

6. POSTOPERATIVE PT ASSESSMENT:
• DATABASE INFORMATION ( from medical records) : Preoperative
investigation , surgical procedure and incision , Concise medical
history
• Surgery notes reading : Type of incision ,type of anesthesia ,duration
of surgery and immediate complications .
• Understanding the attachment : IV lines , catheter , nasogastric tube
,PCA ,drains .
• SUBJECTIVE INFORMATION : Detailed medical history ,smoking
history , cheif complaint ,personal history , present history ,past
history , surgical history ,social history ,family history.
• Pain assessment : A verbal description scale or VAS scale is used to
measure incision or shoulder pain .
• Cough and sputum assessment : the patient ability to cough and
expectorate should be assessed . The color ,volume and consistency
of sputum should be observed .
• Open ended questions : how do you feel .
• Ventilation : Hypoventilation may occur .

7. • ORIENTATION ASSESSMENT : communication ability ,alertness,
perceptual ability to follow instructions .
• OBJECTIVE ASSESSMENT:
• Clinical examination : Inspection , palpation ,auscultation and
percussion
• VITAL SIGNS : Temperature ,blood pressure ,heart rate , pulse.
• Methods of pain control : the PT must be aware the of the various
route of analgesia ( i.e intravenous ,epidural and paravertebral )
• Oxygen delivery systems : level of fractions of inspired oxygen
• Type of chest drain
• Wound Assessment
• Postoperative complications: pulmonary , cardiovascular ,
musculoskeletal ,wound complications.
• ICU PATIENT :Mode of ventilation - supplemental oxygen; intermitent
positive pressure ventilation
• Route of ventilation - face mask, nasal cannula, endotracheal tube,
tracheostomy
• Level of consciousness - measured with Glasgow coma scale
• Central venous pressure (CVP) and pulmonary artery pressure (PAP)
•

8. 1) Respiratory Assessment
• Painful breathing
• Difficulty in coughing
• Accumulation of secretions
• Auscultation :Normal breath sounds bronchial, vesicular
• Abnormal breath sounds - crackles, rhonchi, wheeze, pleural
friction rub
• Hyper resonance - associated with hyperinflation.
• Dullness or flatness
2 )Circulatory Assessment
• Homan's sign
• Oedema
3) Posture and mobility
• Kyphoscoliosis
• Bed mobility
4) General appearance : Pressure sores
5) Palpation : pedal edema , skin temperature , tenderness etc.

9. • Range of motion Assessment of shoulder and trunk on the operated
side .
• Peripheral muscle strength Assessment : shoulder flexion ,Abduction ,
extension and internal rotation .
• Chest movement :Symmetry of chest movements
• ABG analysis : Respiratory acidosis , respiratory alkalosis.
• Acessory muscle movement
• Chest expansion: Both observational and palpational
• Chest X ray :on lateral view :backward displacement of the oblique
fissure and with increasing collapse
• On PA view :there is triangular density behind the heart with loss of
the medial portion of the left hemidiaphragm.
• PFT : FEV ,Airway resistance , inspiratory capacity ,MMV.
• Dyspnea or breathlessness:Exercise tolerance (e.g. number of stairs
client can climb or can walk) ,Shortness of breath at rest ,Associated
swelling of ankles or recent weight gain, Constant breathlessness
(fibrosis, fluid)

10. REFRENCES :
1)K. Athanassiadi, S. Kakaris, N. Theakos, and I. Skottis, “Muscle-sparing
versus posterolateral thoracotomy: a prospective study,” European Journal
of Cardio-Thoracic Surgery, vol. 31, no. 3, pp. 496–500, 2007.
2)T. W. Shields, General Thoracic Surgery, Lea & Febiger, Philadelphia, Pa,
USA, 2nd edition, 1983.