Running head: POST ABDOMINAL SURGERY

The Importance of Mobility Post Abdominal Surgery Jennifer Mynhier Ferris State University

POST ABDOMINAL SURGERY The Importance of Mobility Post Abdominal Surgery Immobility and bed rest have many adverse effects on the human body. This is true in both healthy and sick patients. There is research that has been done, based on the benefits of mobility in patients that have undergone abdominal surgery. The activity discussed in the referenced research article is not typically common in the practice setting, but there is plenty of evidence to support the importance of ambulation and activity starting the day of the surgery versus a patient mostly on bed rest after having abdominal surgery. As said by Harvey, Herriman, & Obrien (2013), Evidence-based interventions have the potential to prevent pulmonary complications, wound instability, drain displacement, and orthostatic hypotension. Promoting early mobility is one example of an evidence-based strategy to improve patient outcomes (p. 63). Content

According to Winkelman (2009), adverse effects of immobility are displayed in basically all of the body systems. Muscle atrophy, decreased cardiovascular function, orthostatic instability, decreased pulmonary ventilation and perfusion, increased urine output causing fluid and electrolyte imbalance, skin breakdown and hindered wound healing. There is also some evidence that bed rest can affect the nervous system including cognition, awareness, pain-related sensation, and sleep pattern. The immune system, gastrointestinal system, and bone structure function may also be lessened. Some of these body functions can be reduced in as little as three days but more commonly it takes eight to thirty days for some of these effects to occur (p. 254264). If these signs and symptoms are shown even in healthy patients, it seems that it would not be beneficial to have a patient remain primarily immobile while trying to recover from an abdominal procedure.

POST ABDOMINAL SURGERY Research The article by Harvey, Herriman & Obrien (2013) in summary, refers to information based off of a study done on sixty-six abdominal surgery patients. These patients were observed before and after surgery for grip strength, muscle endurance, fatigue, and pain. Half of these

patients received traditional care, and the other half were given multimodal rehab. There were no major differences in pain noticed, but there was improvement in pulmonary function, oxygenation, and cardiovascular response in the patients that received the multimodal care. This group also had earlier bowel movements, less fatigue, decreased inflammation, and felt ready to be discharged quicker. On average, these patients were discharged from the hospital about one day sooner. Techniques for the multimodal patients included ambulating two to four times on the day of the surgery, spending at least eight hours of the recovery days out of bed, participating in respiratory physiotherapy, and range of motion exercises. The use of a bedside ergometer was implemented in the patients that were admitted to the intensive care unit (p. 64-66). With the rising healthcare costs in our country, patients being discharged even one day sooner would be extremely advantageous not only to the patient, but the hospital and the insurance companies as well. The healthcare system is constantly looking for ways to save money and discharge patients in a timelier manner. The most likely reason that these methods are not already common practice is that people believe that the risks outweigh the benefits, but this is not necessarily the case. There are several special factors that need to be taken into consideration when caring for post abdominal surgery patients. As outlined by Harvey, Herriman & Obrien (2013), using lifts and slings can help to promote mobility as well as helping to prevent injury of involved staff. It is exceptionally crucial to assess for orthostatic hypotension and making sure the patient is not experiencing dizziness,

POST ABDOMINAL SURGERY blurred vision, or lightheadedness in order to aid in the prevention of falls. It is vital to be sure not to do anything that will affect the healing of the surgical site wound. This can include taking into account the patients pre-operative status, i.e. diabetic, smoker, NSAID user. The wound must be inspected and palpated, supported with any movement, and drainage devices must be well secured. Pain management is key, this can be done not only by medications, but also by splinting, ice, heat, and even massage. It may be favorable to include respiratory, occupational, or physical therapy in the patients care (p. 66-70). Patient safety is always an imperative role of any healthcare provider, so it is important to take precautions to prevent any harm to each and every patient. Correlation Per Harvey, Herriman, & Obrien (2013), the use of abdominal binders to support the abdomen during recovery are not commonly used as it is believed that these may impede pulmonary function, but there is lack of evidence that there is any negative changes in forced vital capacity, forced expiratory volume, or peak expiratory flow. It was verbalized by the noncontrol patients that the use of abdominal binders increased comfort during ambulation and

improved security and support, which made these patients more successful with activity. The use of the binders should help make a patient more comfortable during ambulation and activity which may encourage them to be out of bed more often than someone not given the binders. Based off of the research, this can help shorten recovery times and increase body system functions. Although there is ample evidence supporting the importance of mobility after abdominal surgery, there is not much information out there about specifics. Harvey, Herriman, & Obrien (2013), state that guidelines and recommendations suggesting the timing, frequency, duration,

POST ABDOMINAL SURGERY and intensity of mobilization efforts are nonexistent (p. 65). If it is common knowledge that immobility and bed rest cause problems in every body system, why is there such lack of strategies for these post-surgical patients? Conclusion

Patient mobility beginning the day of an abdominal procedure could be prodigious to the patients healing. Some benefits include decreasing inflammation, promoting oxygenation, and increasing cardiovascular function. All these factors encourage a faster healing period, which may decrease hospital stays and help to keep healthcare costs down. There was no correlation shown between a decreased amount of pain in the test patients while recovering, which would be great, but the faster, more efficient healing could mean that the patient would be in pain for a shorter amount of time. Mobility of post-surgical patients is unfortunately one type of evidencebased practice that is not very common in the hospital setting. There is a plethora of evidence out there showing the harmful effects of immobility, and how it can effect each body system from cardiovascular to muscular to integumentary. Therefore it should be common practice to increase patients mobility as soon as possible after abdominal surgery. This can be done with the assistance of abdominal binders, slings and lifts, and careful monitoring of the patient, in order to prevent any undue harm.

POST ABDOMINAL SURGERY References Havey, R., Herriman, E., & Obrien, D. (2013). Guarding the gut: early mobility after abdominal surgery. Critical Care Nursing Quarterly, 36(1), 63-72. doi:10.1097/CNQ.0b013e3182753237. Retrieved from CINAHL Winkelman, C. (2009). Bed rest in health and critical illness: a body systems approach. AACN

Advanced Critical Care, 20(3), 254-266. doi:10.1097/NCI.0b013e3181ac838d. Retrieved from CINAHL.