I want to say Courtney has summed it up well.
We also have a "prehab" component where patients get some education and
training during the pre-op visit in the out patient setting.
POD 0, they are seen by PT/ OT if they are moved to floors earlier in the day.
They have their PCA and pain control is pretty good. Goals are similar to what
Courtney mentioned.
Only difference is we do not encourage RW use unless a patient used one at
baseline or truly needs
it for balance. A large percentage of these patients get "hooked" onto it
unnecessarily and holding onto the RW also promotes poor posture and poor
breathing patterns, on top of the Post op
pain and related causes of shallow breathing patterns.
Log roll for bed mobility, monitoring orthostais, walking 3-4 times daily (
First one with PT and rest with nursing/tech team once we have cleared them
from PT standpoint, transferring to chair QID, etc. We discharge them from our
services once they are on their discharge pain regimen and achieved their
goals. Very rarely, they may need HHPT.
There is good support from nursing team with daily mobility on the post op
floor and we constantly communicate with them on a day to day basis.
Thank you!
Chitra Srinivasan PT, DPT, CLT-LANA
Board Certified Oncology Clinical Specialist
Dallas, TX
________________________________
From: aptaoncology-bounce@xxxxxxxxxxxxx <aptaoncology-bounce@xxxxxxxxxxxxx> on
behalf of Courtney Bush <dmarc-noreply@xxxxxxxxxxxxx>
Sent: Sunday, October 31, 2021 1:43 PM
To: aptaoncology@xxxxxxxxxxxxx <aptaoncology@xxxxxxxxxxxxx>
Subject: [aptaoncology] Re: PT p/o protocol for Whipple procedure
Hi Alane,
I don’t have a protocol to reference but in immediate post-op management in
acute care, I treat this similarly to any other abdominal surgery: I prioritize
early post-op mobility (see progression below), teaching bed mobility with
abdominal precautions (~6 weeks no lifting >10 lbs, log rolling in/out of bed
with flat bed skills/independence/caregiver training prior to discharge),
monitor post-operative vitals (BP, HR, SpO2) with potential for orthostatic
hypotension, and monitoring post-op pain with potential for needing to time
session around pain management. As a practical consideration, the patient may
have a JP drain or two - secure to gown prior to mobilizing.
Typical progression may look like: Day 0- dangle, monitor vitals (may already
be done by nursing, but can repeat with therapy for monitoring activity
tolerance); Day1 - out of bed to chair TID with assist / Ambulate as tolerated
(continue monitoring for orthostatic with each progression/as clinically
indicated), likely with FWW for stability following abdominal incision. Day 2:
cont OOB to chair TID and ambulate hallways TID with staff assist as needed.
May benefit from FWW for discharge.
There is definitely room for variation, encouraging mobility, teaching
abdominal precautions, establishing mobility goals in the framework of DC
readiness & identifying necessary equipment is the overall objective.
Hope this helps!
Courtney
————
Courtney Bush, PT, DPT
ABPTRFE Accredited Residency Graduate,
Acute Care Physical Therapy
Certified Yoga Instructor
Phone: 720-984-7885<tel:720-984-7885>
email: courtney.bush@xxxxxx<mailto:courtney.bush@xxxxxx>
“Love fully, be peace, drink in beauty, offer your heart, seek truth, shine
out, savor bliss, step into your presence, nourish your light.” ~Danny Arguetty
On Oct 31, 2021, at 11:23 AM, alane curry ("acurryil")
<dmarc-noreply@xxxxxxxxxxxxx<mailto:dmarc-noreply@xxxxxxxxxxxxx>> wrote:
I was wondering if anyone has experience or has a protocol to share for P/O
Whipple procedure.
Thanks so much for any insight.
Alane Curry
Sent from my iPhone
