Patient Post-Operative Therapy Guide - Physiotherapy and Occupational Therapy

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1 James Paget University Hospitals NHS Foundation Trust Patient Post-Operative Therapy Guide - Physiotherapy and Occupational Therapy Patient Information

2 Introduction This guide is to help you take control of your recovery and rehabilitation after your operation. It includes exercises and advice to help you during your hospital stay and after discharge. The information in the guide will also help to reduce the risk of chest infections and deep vein thrombosis. Early mobilisation is key for a speedy recovery. 2

3 Things to expect after your surgery You should expect to get out of bed at the earliest opportunity after your surgery (this could be as soon as four to six hours). This will reduce your risk of chest infection and deep vein thrombosis and make you more independent. Do not worry about pain Pain is normal after surgery. Please take your pain relief as prescribed. It will not only relieve pain but also help you to start moving about. Coughing Coughing will not damage the stitching (even if it feels like it). Hugging a pillow or towel over the wound site will reduce pain and provide extra support. Attachments If you have any drips or drains or a catheter attached after surgery, these can be moved around and you can walk with them. Please do not attempt to pull any attachments. Ward staff are always available to help you with these. 3

4 Walking on the ward Problem Drips Catheter Drains Pain Solution Ask a nurse to attach these to a drip pole Place this on frame or hold like a bag Hold in hand or clip to your clothes or frame Make sure you take pain relief when offered or ask for more No shoes/slippers Ask relatives/family to bring some in for you Anxiety about walking post operation Do not walk with only socks on Walking barefoot is safe if no footwear is available Staff on the ward are happy to walk with you do not be afraid to ask. 4

5 Breathing exercises Deep breaths Take three deep breaths in through your nose and breathe out through your mouth. Practise this deep breathing exercise hourly. These can be done in bed, in a chair and even while you are walking. Active cycle of breathing technique This can be done in any position but ideally practise it when sitting comfortably in an upright position. Spend a few minutes doing normal breathing. Take three big breaths, expanding your rib cage Try a huff which is a short, sharp breath with your mouth open as if misting a mirror You may feel ready to cough up some sputum. If not, go back to the beginning and repeat the cycle until any sputum you have is coughed up. You can use this technique at any time of day, when you have some sputum to remove. It can also be used to help control any coughing. 5

6 Bed and chair circulation exercises Lying on your back or sitting. Bend, straighten and rotate your ankles. Repeat times. Lying on your back with straight leg in bed. Bend your ankles and push your knees down firmly against the bed. Hold for five seconds and relax. Repeat times. Lying on your back with one leg straight and the other leg bent. Exercise your straight leg by pulling your toes up, straightening your knee and lifting your leg. Hold for approximately five seconds and slowly relax. Repeat times with both legs. 6

7 Lying on your back in bed, keeping your knee straight. Take your leg out to the side and then back to mid position. Repeat times. Lying on your back with arm by your side. Straighten your arm towards the ceiling and down slowly. Repeat times. Bend your elbow and then straighten your elbow. Repeat times. Sitting in a chair. Pull your toes up, tighten your thigh muscle and straighten your knee. Hold for approximately five seconds and slowly relax your leg. Repeat times. 7

8 While sitting on a chair, lift your leg up off the seat, keeping the knee bent. Return to starting position. Repeat times. Sit or stand. Lift your arm up, letting the thumb lead the way. Repeat times. Exercise advice These exercises should be carried out little and often (try four times a day). Only move as far as any pain allows. If you experience any pain or difficulty with these exercises, discontinue and consult your physiotherapist or doctor/gp. 8

9 Walking Walking to and from the toilet and up and down the ward is good exercise for you while you are on the ward. After discharge, progress your walking gradually. Start with short distances and build up to longer distances. How far you can manage will depend on your walking ability prior to your operation. Walking aids After your operation you may require a walking aid, such as a frame or stick, to help you get about, depending on your need after the surgery and your pain. A physiotherapist will be able to assist you if you usually use a walking aid but have not brought it into hospital, or if you need to use one short or long term after your operation. If you require ongoing support with your walking after being discharged from hospital, a referral can be made to a physiotherapist in the community. 9

10 Occupational therapist advice Whilst in hospital you are not able to carry out your normal daily routine. When returning home after surgery you may find some of your normal daily activities too tiring or strenuous at first. It is important to think about these whilst in hospital to help with planning ahead, and making some adjustments to help you to manage your daily activities following your surgery. You may need to return to more strenuous activities gradually. You will need to try and avoid pulling/pushing, and take care not to squash your abdomen or stretch too far whilst you are recovering. You may need to reorganise your environment to avoid over-reaching and bending and do household jobs in small chunks, resting regularly. Whilst in hospital you can help speed up your recovery by: Asking relatives to bring in some clothes that can be easily pulled on, e.g. loose pullover tops or fleeces, elasticated or loose fitting trousers or skirts, Velcro fastening shoes or sturdy slippers etc. Start to try to get yourself dressed each day. This will give you an idea of how you will manage and make you feel better Walk yourself to the bathroom and sit at the sink to get washed rather than at the bedside. Only ask for help if you really need it rather than always expecting to be helped Walk out to the toilet rather than ask for a commode at the bedside. 10

11 After discharge you may need to think about: Shopping Can you get food delivered? If possible, order via the internet, make use of home delivery services (milkman, supermarket delivery etc.) Ask a relative or friend to do it for you If there is no help, do it little and often. Use a small wheeled shopping trolley or bag rather than carrying bags Use a mobility scooter round the shop Get help packing and with reaching high and low Shop at quieter times to avoid waiting around. Cooking You may find it easier if you: Use a microwave at work surface height Use convenience meals as a speedy alternative Plan ahead and stock the freezer Put frequently used items within easy reach Sit down to prepare food Use a wire straining basket when using saucepans to avoid the need to lift the pan of water Use a small jug kettle, tea maker or fill a large kettle with only the amount of water you need using a lightweight plastic jug Use a kitchen trolley or eat in the kitchen. 11

12 Laundry Can someone help with your laundry, particularly with large items, e.g. bedding? Can you use a tumble dryer or indoor airer rather than hanging out on the line? Is there a local laundry pick-up/drop-off service? Can you get your washer/dryer raised up to reduce bending? Ironing Lower the ironing board and sit down Only iron what is essential Is there a local ironing service? Can someone help? Driving You need to: Ask for advice about whether you need to inform the DVLA about your surgery - it may affect your insurance if you do not Ask your consultant/gp about when it is safe to return to driving. Bed making Use fitted sheets and kneel rather than bend. Use a lightweight duvet rather than heavy blankets Use energy saving equipment, e.g. long handled: shoe horn, grabber, sponge, dustpan and brush, to avoid bending and reaching 12

13 Use a lightweight carpet sweeper rather than pulling and pushing a vacuum cleaner. Other domestic activities Some small aids can be purchased from the hospital occupational therapy store. This can be discussed with your occupational therapist or therapy assistant practitioner on the ward. The British Red Cross sell small aids and also have an extensive equipment loan store for all larger items. The Independent Living Centre, based in the same building as the Red Cross, have an extensive variety of equipment you can try out, and gain advice about what is best suited to your needs. Call their number to make an appointment to visit. 13

14 Contact Numbers British Red Cross Short term loan of equipment, commodes, backrests, raised toilet seats, wheelchairs, perching stools, bath boards etc. Telephone: Meals Wiltshire Farm Foods: (frozen ready meals) Oakhouse Foods: (frozen ready meals) Grandma s Kitchen: (delivers hot meals on plates to your door) Mollie s Pantry:

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16 Feedback We want your visit to be as comfortable as possible. Please talk to the person in charge if you have any concerns. If the ward/department staff are unable to resolve your concern, please ask for our Patient Advice and Liaison (PALS) information. Please be assured that raising a concern will not impact on your care. Before you leave the hospital you will be asked to complete a Friends and Family Test feedback card. Providing your feedback is vital in helping to transform NHS services and to support patient choice. Trust Values Courtesy and respect A welcoming and positive attitude Polite, friendly and interested in people Value and respect people as individuals So people feel welcome Attentively kind and helpful Look out for dignity, privacy & humanity Attentive, responsive & take time to help Visible presence of staff to provide care So people feel cared for Responsive communication Listen to people & answer their questions Keep people clearly informed Involve people So people feel in control Effective and professional Safe, knowledgeable and reassuring Effective care / services from joined up teams Organised and timely, looking to improve So people feel safe The hospital can arrange for an interpreter or person to sign to assist you in communicating effectively with staff during your stay. Please let us know. For a large print version of this leaflet, contact PALS Authors: Physiotherapy and Occupational Therapy Department 16 April 2012 Revised December 2013, July 2017 James Paget University Hospitals NHS Foundation Trust Review Date: July 2020 PH 17 version 3