General Orthopaedics Flashcards
Subjective examination
patient's feelings present Hx Past orthopaedic Hx Medical Hx Social Hx Medication
Subjective -Patient’s feelings
comfort, pain, situation etc
Subjective - present Hx
Events leadings up to present condition / admission to hospital
subjective - past orthopaedic Hx
’s, joint replacements, soft tissue injuries, orthopaedic surgery
subjective - medical Hx
(relevant only) cardiac, respiratory, neurological, psychiatric, systemic, pathological
Subjective - Social Hx
previous mobility/walking aids, access/steps/stairs, living companion (+ability) D/C destination, occupation, smoker, ETOH
Subjective - Medication
antibiotics, pain relief, PRN angina or asthma medication
Objective Ax
Equipment in situ Respiratory and clinical status circulatory status affected limb unaffected limbs functional abilities radiology
O/E - Equipement in situ
O2, I.V. lines, PCA, drains, IDC, Charnley pillow, pressure dressing, dressings, C.P.M, slings, SCUDs
O/E - respiratory and clinical status
any underlying pathology ( e.g. asthma, COPD, Cancer), spinal or rib trauma / #’s, pneumothorax/haemothorax, infection, general or spinal anaesthetic, medications
Assess: air entry, thoracic expansion, sputum production, cough
Check obs: temp / RR / SpO2 / HR / BP
Check bloods: Hb level?
O/E - circulatory status
any underlying pathology ( e.g. P.V.D., C.H.F., diabetes), colour and temperature of extremities, bruising, swelling, pain etc.
O/E - affected limb
position, incision/s, dressing, ROM ( e.g. active, active/assisted, passive), strength, quads lag, joints above and below, swelling, skin temperature, medically requested restriction of movement, loss of function, neurological deficits (motor/sensory), special tests, palpation, etc.
O/E - unaffected limb
normal function, loss of ROM / strength, prosthesis
O/E - radiology
X-Ray, MRI, CT
General Mgmt - Treatment
- accurately and concisely prescribe & document treatment
- joint mobilisation
- swelling management
- pain management
- weight-bearing (WB) status
- walking aids
- exercises
- fitting of orthoses
General Mgmt - plan/further mgmt
- short term goals (while in- patient)
- ongoing reassessment
- progression of treatment
- frequency/progression of treatments
- discharge criteria
- equipment
- home programs
- referrals – outpatient services
Reasons for elective surgical intervention
Severe unmanageable arthritic joint pain Night pain severely affecting ability to sleep Major functional limitations Quality of life Progressive deformity Trauma or injury Fractures i.e.NOF Avascular necrosis Birth defects and growth disorders Severe joint infection Cancer in or near a joint
Pre operative mgmt
Pre-admission clinic or pre-op joint class MDT approach
Education on joint replacement surgery
Discuss expectations post surgery
Discuss possible limitations post surgery Hip precautions
Driving
Roles of AH intervention Discuss D/C date
-Deep breathing & circulation exercises
Discuss TEDs & SCUDs
Trial walking aids + stairs
Educate & practice WB status
Strengthening exercises – start pre op Falls prevention
Read over outcome measures
1
read over practice notes
1
Normal values BP
120/80 - 145/90 / 90/60
normal values HR
60-100
Normal values SpO2
> 95%
chronic lung conditions 88-92%
ABG normal values
pH - 7.35-7.45 O2- 80-100mmHg CO2- 35-45mmHg PCO3- 22-28 Base Excess -2 - 2
