A 57-year-old female presented to her primary physician's office with complaints of generalized fatigue and a persistent dry cough for the past month. Further diagnostic work-up revealed a localized mass in her left upper lung field that was identified as stage I non–small cell lung cancer (NSCLC). The patient was admitted to the hospital 2 weeks later for a planned flexible bronchoscopy and left posterolateral thoracotomy with left upper lobe lobectomy. Her past medical history is significant for paroxysmal atrial fibrillation, hyperlipidemia, and a 30 pack-year smoking history. The patient is referred for a physical therapy evaluation on postoperative day 1 (POD 1) for left lower lobe atelectasis and poor cough effect. The patient is a newly retired electrician who is actively involved in her community bowling league. She lives with her husband and teenage grandson in a two-story home. She is expected to be discharged home on POD 5.
Based on her health condition, what do you anticipate may be the contributors to activity limitations?
What are possible complications interfering with physical therapy?
What are the most appropriate physical therapy interventions?
What is her rehabilitation prognosis?
Identify referrals to other medical team members.
- ATELECTASIS: Collapse and airlessness of lung tissue
- BRONCHOSCOPY: Internal inspection of the tracheobronchial tree with the use of a bronchoscope (flexible or rigid viewing instrument)
- HEMOPTYSIS: Expectoration of blood from the lungs due to pulmonary or bronchial hemorrhage
- PNEUMOTHORAX: Presence of air within the pleural space
- SUBCUTANEOUS EMPHYSEMA: Presence of free air in the subcutaneous tissues (typically in skin over the chest, neck, or face), resulting from an air-leak in the lungs
Understand the incidence, prevalence, and risk factors for NSCLC.
Describe two standard surgical procedures for the excision of early stage lung cancer.
Identify possible complications of thoracic surgery that may extend hospital stay and/or interfere with physical therapy interventions.
Describe the key elements of physical therapy examination, evaluation, and diagnosis in a patient status/post lung surgery.
Design an appropriate physical therapy plan of care for a patient status/post lung surgery based upon the goals, interventions, and considerations discussed in this case.
PT considerations during management of the individual status/post lobectomy due to lung cancer:
- General physical therapy plan of care/goals: Prevent or minimize loss of range of motion (ROM), strength, aerobic functional capacity, and risk of postoperative complications; optimize lung volumes, oxygen transport, ventilation–perfusion matching, and airway clearance; maximize quality of life through restoring physical endurance and functional independence
- Physical therapy interventions: Patient and family/caregiver education regarding benefits of early and frequent mobility after lung surgery; decrease risk of postoperative pneumonia and atelectasis through deep breathing activities and effective airway clearance techniques (ACTs), upper extremity and chest wall ROM exercises, gait and stair training, prescription of ...