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OS3 EX1 > OAT: Surgical Patients > Flashcards

OAT: Surgical Patients Flashcards

1
Q

why the fuck do you do an OSE on a hospitalized patient?

A

literally because it just offers clues for overall asessment

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2
Q

good techniques for surgical patients

A
  • MFR/FPR
  • still technique
  • indirect
  • soft tissue
  • lymphatic pump
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3
Q

CONTRAINDICATIONS FOR SURGICAL PATIENT

A
  • avoid direct manipulation on/over surgical sites for 2wk\
  • abd plexus inhibition if midline abdominal incisions or aortic aneurysm
  • sigmoid release if recent left hemicolectomy
  • mesenteric release if anterior abdomial incisions
  • rib rising if fracture or spinal surgery
  • pedal pump if DVT, lower extremity fracture, or recent abdominal surg
  • lymphatic tx relatively if osseous fracture, bacterial infection with fever over 102, abscess, or certain stages of cx
  • TI release if upper rb fracture/clavicle fracture
  • liver/spleen pumps if thoracotmy, chest tube, or trauma
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4
Q

early post op: inflammatory stage

A

day 1-3

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5
Q

early post op: diuresis stage

A

day 4-6

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6
Q

late post op

A

1-3 weeks

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7
Q

early post op: inflammatory stage–FOCUS?

A

circulatory and pulm first; prevent atelectasis and maintain circultation
facilitate lymph flow
techniques: diaphragm release, rib raising, lymphatic pump

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8
Q

early post op: diuresis stage–FOCOUS?

A
  • lymphatic, GI, renal, and ANS

- ensure mobility of thoracic cage and outlet

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9
Q

late post op–OMT retults?

A

enhances analgesia, reduce complications, aid in recovery, maybe decrease hospital length of stay

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10
Q

why we do OMT them boi in the hospital?

A
  • promote homeostasis and patient abilty to cope
  • sleep, ambulation, eating, poopin, pain reflief
  • treat dysfuntion that impede homeostatic impede homeostatic porcesses
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11
Q

issues with OMT in hospitalized pt

A
  • privacy
  • modesty
  • turn off TV
  • objects in the way
  • surgical incisions and dressings
  • decubitous ulcers
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12
Q

how to diagnose spine if they not prone

A
  • spring along axial spine and pelvis
  • if too stiff–flexed type 2
  • if too squishy–extended type 2
  • tissue texture changes
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13
Q

what happens if rapid movements of vertebral unit?

A

create sympathetic motor outburst from the related an also distant facilitated spinal cord segments

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14
Q

what happen if pain is experienced at a facilitated segment?

A

creates further facilitation

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15
Q

facilitated segments are often the result of what?

A

acute visceral processes

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16
Q

muscle has ___ concentration of nociceptors, whereas joint capsules have ____ concentration of nocieptors

A

low; high

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17
Q

preoperative examination: biomechanical approach

A

-cervical/thoracic/lumbar/sacrum spinal assesment

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18
Q

preoperative examination: respiratory-circulatory

A

-lymphatic assesment, cranial assesment, rib motion

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19
Q

preoperative examination: neurologic

A

-somatovisceral and viscerosomatic considerations, TP conuterstrain exam, chap reflex

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20
Q

OMT pre-op to reduce mid cervical SD has been shot to what?

A

decrease post op pulmonary complications

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21
Q

what is one cause of increased chronic pain?

A

facilitation

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22
Q

Pre-op assement for surgical risk factors: Cardiac

A

ejection fraction <35%, presence of JVD, recet MI w/i 6months

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23
Q

Pre-op assement for surgical risk factors: pulmonary

A

smoking, COPD, sleep apnea, rib SD

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24
Q

Pre-op assement for surgical risk factors: hepatic

A

ascites, bilirubin >2, prothrombin time >16s, albumin <3, encephalopathy

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25
Q

Pre-op assement for surgical risk factors: nutritional

A 
albumin <3, loss of 20% body wieght over 6 months
-BMI>40 (class 3 obese)
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26
Q

Pre-op assement for surgical risk factors: metabolic

A

diabetic ketoacidosis/coma

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27
Q

Pre-op assement for surgical risk factors: behavioral

A

illlicit drug and alcohol use

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28
Q

why do even perform post op OMT?

A
  • shorten hosptial stay
  • decrease morbidity and mortality
  • decrease post op pain
  • facilitate lymphaticc flow and improve diaphragmatic mobility
  • increase patient satisfaction
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29
Q

CHAP: esophagus

A

A: bilateral 2nd ICS
P: bilateral b/w TP and SP of T2

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30
Q

CHAP: pylorus

A

A: sternal
P: right T10 at costotransverse joint

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31
Q

CHAP: liver

A

A: right 5th ICS
P: right b/w TP and SP b/w T5 and T6; right b/w T6 and T7 b/w TP and SP

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32
Q

CHAP: gallbladder

A

A: right 6th ICS
P: right b/w T6 and T7 b/w TP and SP

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33
Q

CHAP: pancreas

A

A: right 7th ICS
P: right b/w T7 and T8 between SP and TP

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34
Q

CHAP: small intestines

A

A: bilateral 8-10th ICS
P: upper–b/w T8 and T9 b/w TP and SP
mid–b/w T9 and T10 b/w TP and SP
low–b/w T11-T12 b/w TP and SP

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35
Q

CHAP: stomach acidity

A

A: left 5th ICS
P: left b/w T5 and T6 b/w TP and SP

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36
Q

CHAP: stomach peristalsis

A

A: left 6th ICS
P: left b/w T6 and T7 b/w TP and SP

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37
Q

CHAP: spleen

A

A: left 7th ICS
P: left b/w T7 and T8 b/w TP and SP

38
Q

CHAP: appendix

A

A: right 12th rib tip

39
Q

CHAP: cecum

A

A: right proximal IT band

40
Q

CHAP: proximal transverse colon

A

A: right distal IT band

41
Q

CHAP: sigmoid colon

A

A: left proximal IT band

42
Q

CHAP: distal transverse colon

A

A: left distal IT band

43
Q

treatment goals of lymphatic treatment in post op

A

improve oxygenation and nutrients

reduce risk of infection, healing time, fibrosis and scarring

44
Q

biomechanical SD in post op: contributing factors

A

duration of surgery
position in surgery
inactivity
prolong bedrest

45
Q

how often does paitents get post op fever

A

40%

46
Q

Post op fever–rule of W’s

A 
wind; POD 1-2
water; POD 3
walking; POD 5-7
wound; POD 7-10
wonder drug; POD 7+
47
Q

WIND; POD 1-2

A

management:
- atelectasis: CXR, deep breath + cough, incentive spirometry
- pneumonia: sputum cultures, antibiotics

48
Q

WATER; POD 3

A

management: UTI–UA, urine culture, remove foley, antibiotics

49
Q

WALKING; POD 5-7

A

management: DVT/PE–Us w/ venous doppler, CT andiogram, heparin with warfarin, IVC filter

50
Q

WOUND; POD 7-10

A

management: wound infection–US/CT, antibiotics, inscision + drainage, wound care

51
Q

WONDER DRUGS; POD 7+

A

remove unmecessary drugs

52
Q

what is the most likely complication when s/p abdominal surgery?

A

pulmonary

53
Q

what kind of restricted motion will pneumonia patients have?

A

reduced excursion of the thorax toward inhalation locally over the area of consolidation

54
Q

what kind of restricted motion will asthma patients (and other obstructive diseases) have?

A

reduced excursion of the thorax towards exhalation

55
Q

35-60% of thoracic duct lymphatic duct flow is due to

A

the response and effects of respiratory movements

56
Q

contributing factors to atelectasis

A

anesthesia and mechanical ventilation
bed rest (bc limit breathing movements)
pain
obesity, smoking, respiratory distress

57
Q

PFT changes related to atelectasis

A 
decreased tidal volume
increased inspriatory and expiratory pressures
decreased vital capacity
decreased functional residual capacity
decreased alveolar ventilation
58
Q

breathing pattern that leads to atelectasis

A

shallow breaths without maximal inhalation lead to alveolar collapse

59
Q

OMT management of atelectasis

A 
rib raising
thoracoabdominal diaphragm release
pectoral traction
soft tissue and myofascial release to C3-5 for phrenic n stimulation
tapotment
lymphatic pumps
viscerosomatics= T1-6/ T2-7 AND CN10
60
Q

contributing factors for pre tibial edema

A

immobility bc bed rest
systemic inflammation secondary to surgery
insufficient circulation & lymphatic drainage

61
Q

medical management of atelectasis

A

bronchodilators
mucolytic agents via neb
cough, deep breathing exercising, incentive spirometry, early ambulation
(early mobilization has been shown to decrease LOS by 1.1 days

62
Q

medical management of pretibial edema

A

venous stasis reduced with early ambulation and SCD
leg elevation if allowed
instructing patients to “spell the alphabet” with their feet

63
Q

what the fuck is SCD?

A

sequential compression device

it compresses the legs in a proximal direction every 2-3 mins

64
Q

OMT management of pretibial edema

A

lymphatic treatments

viscerosomatic=T10-L2 and S2-4

65
Q

treating atelectasis and pretibial edema falls under which model?

A

respiratory circulatory

66
Q

treating post op ileus falls under which osteopathic model

A

metabolic energetic

67
Q

contributing factors to postop ileus

A 
anesthesia
extensive surgical manipulation
extended bedrest
narcotic use
electrolyte abnomalities
68
Q

when does peristalsis return to the bowels?

A

small intestine–24hr
right colon–48hr
left colon–72hr

69
Q

signs and symptoms of post op ileus

A

slight abdominal distention
absent bowel sounds
dilated loops of bowel on xray

70
Q

medical management of post op ileus

A
  • no specific therapy?
  • just fuckin wait to for them to poop before u try advancing diet
  • reduce opiods for pain management
  • correct any underlying electorlyte abnormalities
71
Q

OMT management of post op ileus

A
  • rib raising at levels T5-L2
  • mesenteric release
  • paraspinal inhibition to normalize sympathetic activity
  • OA/AA treatements and sacral rocking to promote parasympathetic activity
72
Q

what are the benefits of OMT for post op ileus

A

decreased time to first fart and decreased post op hospital stay

73
Q

mainstay therapy for post op pain

A

FUCKIN OPIOIDS

74
Q

side effects of opioids

A 
respiratory depression
nausea
vomiting
clouded sensorium
constipation
75
Q

treating post op pain is considered which model?

A

neurologic

76
Q

contributing factors to post op pain

A

duration of operation
degree of operation trauma
incision type
intraoperative reaction

77
Q

medical management of post op pain

A

gentle handling of tissues
expedient operations
good muscle relaxation
opiods for pain management

78
Q

OMT management of post op pain

A
  • rib raising w/ paraspinal inhibition to normalize hyperactive sympathetic activity
  • soft tissue and myofasical release
  • viscerosomatic=T1-L2 & CN 10/ S2-4
79
Q

____ and _____ are normal in patients undergoing surgery

A

anxiety and fear

80
Q

a history of what may exaggerate patients response to surgery

A

under lying depression or chronic pain

81
Q

contributing factors to anxiety and delirium related to surgery

A

drugs»psychosis: meperdne, cimetidine, corticosteriods
electrolyte abnormalities
delerium tremens (alochol withdrawl seen POD 2-3)
hypoxia, sepsis, ARDS

82
Q

treating anxiety and delirium is part of what model?

A

behavioral

83
Q

define delirium

A

visual hallucinations, delusions, acute orientation difficulties, memory impairment
-sx wax and wane and are temporary, secondary to underlying cause

84
Q

medical management of anxiety and delirium

A
  • treat underlying cause
  • supportive care: frequent reorientation, remove barriers to communication, optimise sleep-wake cycle
  • anxiolytics
  • antipsychotics
85
Q

OMT management of anxiety and delirium

A

calming techniques: subooccipital inhibition and CV4

86
Q

5 model OMT approach to Post Op PT: biomechanical

A
  • postural muscles
  • spine
  • extremites
  • myofascial relationships of the organs
87
Q

5 model OMT approach to Post Op PT: respiratory-circulatory

A
  • diaphragms: thoracic inlet, thoracoabdominal, pelvic

- venous and lymphatic drainage

88
Q

5 model OMT approach to Post Op PT: neurological

A
  • ANS

- treat sympathetic ganglion, parasympathetic vagus N, and parasympathetic pelvic splanchnic

89
Q

5 model OMT approach to Post Op PT: metabolic-energetic

A
  • treating the other models first can therby treat this model taking into consideration the relationship to the interal organs and endocrine glands
  • homeostasis , energy balance, regulatory processes, inflammation and repair, absorption of utrients, and removal of waste are all targeted goals
90
Q

5 model OMT approach to Post Op PT: behavioral

A

psychological and social activities: diet and exercise, and mental status

OS3 EX1 (11 decks)

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