B3 L33: Introduction to Orthopaedic Inpatients Flashcards
What is orthopaedic physiotherapy?
Orthopaedic Physiotherapy is that branch of physiotherapy related to the preparation for, or rehabilitation from orthopaedic surgery or related to an orthopaedic hospital admission.
What are 8 reasons why people have orthopaedic surgery?
- Degenerative disease (OA)
- Trauma (fractures, dislocations)
- Pain
- Reconstruction (knee, shoulder- eg. varus or valgus deformity)
- Pathological processes (Ca, RA)
- Prophylaxis/Function (spinal scoliosis)
- Arthroplasty (replacement of joint- eg. hip, knee, shoulders)
- Internal fixation (not conservative- look at bony healing)
When should surgery be considered and when should it not?
How debilitating is the pain VS functional problem
What are the 7 components of the orthopaedic team?
- Patient, family and carers
- Doctors (Consultant (orthopaedic surgeon), Registrar, Resident)
- Pain team (Anaesthetist) (operatively and post-op acute management)
- Nursing (Pre-admission, Theatre, Ward)
- Support staff (Ward receptionist, transport, food services, cleaners)
- Community liaison (CHIP nurse)
- Allied Health (post-surgical management)
- Physiotherapist, assistants and students
- Occupational therapist
- Social worker
- Pharmacist
- Community referral organisations (Mobile rehab, DART, Blue Care etc)
What are the 6 steps in the assessment of an orthopaedic inpatient?
- Preparation
- Interpretation and planning (medical chart)
- Subjective Examination (inteview- talk to the patient, carer, family to get a good overview)
- Assessment, interpretation and planning
- Objective Examination
- (Goal: identify implications which help to guide treatment)
- Assessment, interpretation and planning
- Treatment
- Re-assessment (to see if intervention is effective)
- Assessment, interpretation and planning
- Documentation
How is preparation a step for an orthopaedic inpatient?
Medical chart / Clinical pathway
- Obtaining RELEVANT information
- HPC
- Operation report, post op orders, protocols
- Demographic info
- Investigations − Hb, imaging, blood tests etc
- PMHx
- Respiratory Hx, Cardiac Hx, Osteoporosis etc
- PSHx
- Previous orthopaedic surgery, other major surgery
- Social Hx
- Home support, home access
- Functional Hx
- Previous level of function (aids, distance, assistance required)
Bed chart
- Medications (what, when, route), observations (HR, BP, Temp, RR, SaO2).
How is subjective examination a step for an orthopaedic inpatient?
- Confirm what you know from the chart and attempt to fill the gaps
- Maintain rapport but keep control of the situation
- open v closed questions
- paraphrasing
- Elements of subjective examination
- HPC
- PMHx
- PSHx
- Social Hx
- Functional Hx
- Current Condition
- Pain (where, x /10 at rest, with movement, taking pain relief)
- Dizziness, nausea, drowsiness
- Respiratorystatus (Cough, SOB, Smoker) and
- Neurological status P&N or N – esp if epidural or nerve block
How is objective examination a step for an orthopaedic inpatient?
General observation • Environment • Systems assessment • Respiratory • Circulatory • Neurological • Musculoskeletal • Examination of the specific body region • Functional assessment General observation • This begins as soon as you lay eyes on the patient • Posture/position….gait • Environment • Walking aids, chairs to sit out in…(planning) • Apparatus (IV poles, O2, drains, catheter, compression stockings, pumps, pillows, slings, splints)
What is required in an objective examination system Ax for respiratory assessment?
Respiratory assessment - screening
Cough – Effective? Productive? • Observe RR – Work of breathing • Normal bi-basal expansion • Auscultation - Normal breath sounds? • When necessary, a full respiratory assessment should be performed Selectively choose tests- If not = move on If yes = do more comprehensive test (check history)
What is required in an objective examination system Ax for circulatory assessment?
Circulatory assessment
- For patients at risk of deep vein thromboses
- Commonly seen in the calf and assessed by looking for:
- Swelling of the calf
- Redness of the calf
- Localised pain/tenderness
- Increased temperature on palpation
- Positive Homan’s sign (calf pain on passive ankle dorsiflexion)
What is required in an objective examination system Ax for neurological assessment?
Neurological Assessment
- Modified neurological (eg. pins and needles-if yes = do test, if not = move on) assessment is required in the presence of spinal or epidural anaesthetic. It will help assess patient’s ability to mobilise and should include:
- Hip, knee, ankle strength & sensation
- Full neurological assessment (reflexes, power, sensation) if indicated by the subjective examination - especially in the presence of spinal injury
What is required in an objective examination system Ax for musculosketal assessment?
Musculoskeletal Assessment
- Major joints in unaffected limbs as required
- normal ROM, no tenderness or swelling
What is required in an objective examination system Ax for specific body part assessment? List 5 things
- Observation (wound ooze- signs of infection (for early detection, infection can be catastrophic), swelling…)
- Active movement (as indicated)
- Passive movement (as indicated)
- Muscle strength (as indicated- functional)
- Sensation (Already checked in systems assessment - neurological)
What is required in an objective examination system Ax for functional assessment? List 4 things
- Bed mobility
- Transfers
- Supine ↔ sit
- Sit ↔ stand
- Mobility
- Stairs
In regards to mobility, what does need “assistance” mean?
- Therapist manual/hands on assistance
- 1 x assist, 2 x assist
