OAT Post Surgical Pt. Flashcards
OMT is directed towards improving what?
physiologic function
Five models in context of: Health, Disease, Patient care
probably don’t need to memorize, but might be helpful background
What should you assess in a post surgical pt?
viscerosomatic reflexes
somatosomatic reflexes
Jones tender points
trigger points
chapman reflexes
What are good techniques for post surgical pts? what must you do?
MFR, FPR, stills, indirect, soft tissue, lympathics
adapt to supine treatment
What are the contraindications for a post surgical patient?
- Avoid direct manipulation on surgical sites for 2 wks
- Ab. Plexus inhibition if midline abdominal incision or aortic aneurysm
- Sigmoid release if recent left hemicolectomy
- Mesenteric release if anterior abdominal incisions
- Rib raising if fracture of rib/spine or recent spinal surgery
- Pedal pump absolutely if DVT, lower extremity fractures, or recent abdominal surgery
- Lymphatic treatment relatively if osseous fx, bacterial infections with fever >102, abscess/local infection, or certain stages of carcinoma
- TI release if upper rib fx/clavicle fx
- Liver/spleen pumps if thoracotomy, chest tube, or trauma
In early postop days 1-3, a pt is in the ____ stage. How do we treat?
inflammatory
focus on circulatory and pulmonary (prevent atelectasis)
facilitate lymph flow, improve mobility, restore biodynamic vitality
What is the second stage of early post op?
Diuresis stage - days 4-6
Retained fluids are lost from intra and extracellular spaces
focus on lymphatic, GI, renal, ANS
ensure mobility of thoracic cage and outlet
What do we call weeks 1-3?
late postop
tx fascia, tissues, SD, viscerosomatic reflex
In a hospitalized pt, what are the goals of OMT?
- promote homeostasis and ability to cope with disease
- sleep, ambulation, eating, defecation, pain relief
If you notice has a SD that is relevant to their hospitilization AND they have a SD that is unrelated, but still present. Should you treat one, both, or neither?
probaby treat only the relevant one
“treat dysfunctions that impede homeostatic processes instead of long-standing and unrelated problems since it takes patient energy to incorporate changes”
What are common issues with OMT in hospitalized pts?
modesty
privacy
turn off TV
objects in way (tubes, trays…)
surgical incisions/dressings
decubitus ulcers
What spine SD go along with the following:
a. too stiff
b. too squishy
a. flexed type 2
b. extended type 2
Viscerosomatic and somatovisceral reflexes are initiated through _______.
pain-carrying fibers
What do you treat first?
facilitated areas
neurons in facilitated segments have decreased APs and fire easily
The muscle has a high/low? concentration of nociceptors
low
joint capsules have a high concentration
What are the biomechanical benefits of OMT?
removal of SD
restoration of posture and balance
pain free ROM
Why perform postop OMT?
Shorten hospital stay
Decrease morbidity and mortality
Decrease post-op pain
Facilitate lymphatic flow & improve diaphragmatic mobility
Increase patient satisfaction
What may be included in the neurological model?
Somatic facilitated segment
ANS (SNS and PNS)
Nociception
Sympathetic Innervation
What is included in the respiratory - circulatory model?
delivery of O2 and nutrients
drainage of waste products
CSF flow/PRM
What is included in a lymphatic evaluation?
What are contributing factors to biomechanical SDs?
duration of surgery
position during surgery
inactivity/prolonged bedrest
What is a problem with prolonged bed rest?
SD can develop
What is postop fever?
What are the rule of Ws in postop fever and management?
Restricted motion in one phase can suggest different pathologies. What examples were given in lecture?
- Pneumonia will reduce the excursion of the thorax toward inhalation
- Asthma and other obstructive diseases will reduce the excursion of the thorax toward exhalation
What are both medical and OMT managements of resp-circulatory for atelectasis?
B
What contributes to pretibial edema?
- Immobility due to bedrest
- Systemic inflammation secondary to surgery
- Insufficient circulation & lymphatic drainage
What is both the medical and OMT management of pretibial edema?
E
What are both medical and OMT managements of resp-circulatory for post op ileus?
D (cecum)
Why is pain tolerance lowered after surgery?
hyperactivity of SNS (fight or flight mode after surgery)
What are both medical and OMT neurological managements of post op pain?
C
What are both medical and OMT managements of behavioral for anxiety/delirium?
D
What is the most common manipulative method to modify sympathetic acitivty in the upper GI tract and SI?
rib raising T5-11
