Lab 12 - Ortho Lab 2

Question 1

Answer 1

1. Look at her goals, has a partner, home environment, no railing, stairs, bathroom on second floor
   
   2. Watch video
   3. Exact same exercises as knee replacement just limited with tracker brace
   4. Ensure any transfers the brace is locked into 0 degrees of extension
      Can perform stairs with crutches (up = good foot first while in 0 degrees extension, down = bad foot first followed by good foot)

Question 2

Answer 2

3. He is in cast so watch colors in toe for lack of circulation or loss of sensation, tightness in cast, redness/infection (fever, chills, sweat) -> go to emergency if they cant get into their doctor or surgeon because could lead to amputation
   
   5. Standard walker because he has vertigo, even use a wheel chair to help go farther than he can without a walker (don’t use roller scooter for this because too much pressure with the cast on the tibia and ankle). If stairs you want to use a crutch and rails or two crutches if they have no rails
4. Stairs with walker -> UP: put walker up then hop up with good foot DOWN: Put walker down (make sure they are close to stair), hover with bad leg going first then hop down with good leg

Question 3

Answer 3

1. Adjust treatment or assessment based on his symptoms. You’ll want to know baseline when doing treatment and assessment to see if there are any changes from baseline symptoms and if treatment is working. Want to perform sensory assessment to reduce risk of falling if loss of sensation is present.
   
   2. No heavy lifting (over 5-10lbs), no bending, twisting, forward flexion, no hip flexion passed 90 degrees, no reaching outside base of support, WBAT
   3. UE: Stick to 90 degrees shoulder flexion, perform strength with shoulder flexion, have him touch his shoulder and perform resistance, bring arm to ceiling and apply resistance, wrist extension resistance, wrist flexion resistance, grip, myotomes, perform in supine to start
   4. Do log roll onto side with pillow, have one person on legs and one on upper body to lift into sitting
   5. Can they don/doff their own brace, do they have stairs, cant drive (cannot check blind spot)
   6. IDK
2. Healing with movement for laminectomy (single/double leg stretching, isometric abdominals), healing without movement for lumbar spinal fusion (walking, deep breathing)

Question 4

Answer 4

1. Oxygen saturation level (may have COPD because on oxygen), may have sensitivity at iliac crest due to bone graft, smoking history (affects healing time, integrity of the graft, high risk for flammable surface because felt on Miami J collar), pre-op symptoms, risk of pneumonia (anaesthetic, analgesics, and smoking add to that)
   
   2. There will be a wear schedule, routine care (nurses provide that), positions it can be worn with, eating, patients in collar typically for 6 weeks, collar on at all times, collar pad can be removed when eating, collar can be adjusted in bed or when fully supported
   3. Need to ensure small pillow to ensure neutral neck and able to slide collar on and off (most patients want to help but remind them to stay still), ruffs tie should be a loss knot that is offset from each other and is not on top of the scar site (patient should be able to remove them). Take ruffs off when applying neck brace. Need to ensure its lined up perfectly so patients head is straight and ensure shirt is under collar at bottom to prevent rubbing on felt
   4. Do same exercises as question #3
   5. Put pillow in between legs, put hand on hip and behind shoulder leg to roll (make sure it’s a log roll = NO TWISTING), can still with arm underneath to bring into sitting but cant lift up with arm under neck
   6. Use 2 wheel walker or rollator walker, could use hemi-walker potentially if having upper body issues. No driving (until can perform blind spot), pain control (need it for exercises), don/doff their collar or if there is a family member who can learn and understand.
   7. Breathing exercises, walking, isometrics for UE and LE, can do isometrics on head (but proceed slowly), shoulder rolls and arm ranges (no extreme ranges)
   8. Differences same as above
   9. They should go back to the hospital if they have any redness or sores from collar, incision site (infection), experiencing redness fever, sweat, chills, sensation changes
2. Don/doff, pain control, ability to do ADL’s, social support

Question 5

Refer to lab for exercises and care after spinal surgery