NHS LOTH IAN - UNIVERSITY HOSPITALS DIVISION

DIRECTORATE OF THERAPY & REHABILITATION

Patient Label Here or write:
Name:
DOB:
Ward: / PHYSIOTHERAPY CTSU GUIDELINE
Consultant Surgeon .
Surgery and Date of Operation .
CNS Sedation / on Propofol Alfentanil / Midazolam
alert & orientated / drowsy / distressed I paralysed
Analgesia / PCA morphine ……….. I / Fentanil… / Pain site………..

CVS Stable Y I No, then .BP…………… M………. CVP………HR/Rhythm……….temp ………
PAP M CO Cl SVR

Pacing wires A V I Dis/connected Off I Fixed / On demand Set at
Inotropes Support Adrenaline………. Norad…………… Dopamine……….
GTN IABP LVAD
If this patient is unstable and requires MHI, please discuss with anesthetist

RESP Self ventilating Fi02 I flow rate Sa02 RR
Via nasal specs / Hudson mask Humidified Y I N
Breathing Pattern Apical / Abdominal I Paradoxical I Distressed I Shallow
Ventilated Mode PS PEEP
FiO2 via EU / trache Humidified Y I N SaO2
Preset RR MV Preset TV Pmax
Measured RR MVe Measured Tve Peak P
ABGs Pre-op on air 02. Auscultation
H+ H+ Right UZ BS Left UZ BS
PCO2 PCO2 AS AS
P02 P02 MZ BS MZ BS
HCO3 HC03 AS AS
SBE SBE LZ BS LZ BS
Hb Hb . AS AS
K+ K+
SUCTION Nil M P B 1 2 3
COUGH Effective / Ineffective Nil M P B 1 2 3
RENAL F/B Colloids
(optional) Urine in Theatre
Blood loss Balance
Other loss

CXR ………………………………………………………………………………………………………………

DRAINS Pericardial / Mediastinal (R) Pleural (L) Pleural Loss ml/6hr Loss last hr…….

Patient Label Here or write:
Name:
Ward:
Date:
DATE / NO. / PROBLEM LIST / DATE INACTIVE / SIGNATURE
Secretion retention
Decrease lung volume
Pain
Agitated / confused / non compliant / sedated
Anxiety
Decreased mobility due to IABP
DATE / NO. / GOALS / GOAL TIME / DATE ACHIEVED / SIGNATURE
Transfer to chair / Day 1 pm
Start mobilising to improve dynamic balance / Day 2
Start increasing exercise tolerance / Day 3
Independent chest clearance / Day 3
Stair assessment / Day 4
Discharge advise booklet explained / Day 5
DATE / NO. / PLAN / SIGNATURE
Manual hyperinflation / suctions I suctions with saline
IPPB with inspiratory hold
Incentive spirometer with inspiratory hold
TEE / inspiratory holds / diaphragmatic breathing / supported cough / cough lock
Transfer to arm chair - with hoist / stand aid / with assistance
Mobilisation- with stand aid / WZF / with assistance of ….... /
with supervision
Stairs assessment

A….Outcome of intervention………………………………………………………………………………………

P…Review later / pm / tomorrow

Name / Designation / Date / Time / Signature