Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OS 3 Midterm > OAT Surgical Pt > Flashcards

OAT Surgical Pt Flashcards

1
Q

Good techniques for a surgical patient include?

A
  1. MFR/FPR
  2. Direct inhibition
  3. Still
  4. Indirect
  5. ST
  6. Lymphatic pumps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When do we stop OMT in a surgical pt?

A
  1. Tissue relax
  2. Vasodilation
  3. Increase HR/RR
  4. Discomfort
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CI for surgical pt

A
  1. Avoid direct manipulation over surgical site for 2 wks
    2.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CI: ____________ if midline abdominal incision or aortic aneurysm

A

Plexus inhibition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

CI: Sigmoid release if __________

A

recent left hemicolectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

CI: anterior abdominal incisions

A

Mesenteric release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

CI: fracture of rib/spine or recent spinal surgery

A

rib raising

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CI: DVT, LE fractures, or recent abdominal surgery

A

Pedal pump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CI: lymphatic treatments

A
  • osseous fx,
  • bacterial infections with fever >102,
  • abscess/local infection,
  • certain stages of carcinoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CI: TI release if

A
  • upper rib fx
  • clavicle fx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CI: Liver/spleen pumps if

A
  • thoracotomy
  • chest tube
  • trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In early postop patient, what procedures should be done in inflammatory stage (1-3)

A
  • Facilitate lymph flow, improve mobility, restore biodynamic vitality
  • Ex.
    • Diaphragm release
    • Rib raising
    • Lymphatic pump
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In late postop patient (1-3 weeks), what procedures should be done?

A
  • Treat:
    • fascia/ tissues,
    • SD
    • viscerosomatic reflex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does postop OMT help patient?

A
  1. enhance analgesia
  2. reduce complications
  3. recovery
  4. decrease hospital LOS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

With atelectasis, we want to keep alveoli expanded. How?

A
  1. Thoracic inlet MFR
  2. Abdominal diaphragm release (direct w resp force)
  3. Rib raising & paraspinal inhibition
  4. C3-5 SD (phrenic n. via Stills)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Post-op ileus = increases hospital stay = d/t ANS dysfunction (SANS>PANS). How do we treat?

A
  • Supportive care: diet (NPO => liquids=> ..), stop opiods/anticho, correct electrolytes
  • OMT:
  1. Mesenteric and colon release
  2. Pelvic diaphragm release
  3. Paraspinal ST
  4. SI gapping/sacral rocking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are goals of OMT in hospitalized patient?

A
    1. Promote homeostasis and ability to cope with disease
    1. Sleep, ambulation, eating, pooping pain relief
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What do we use OMT to treat in hospitalized patient?

A
  1. Dysfunctions that impede homeostasis, NOT long-standing/unrelated problems bc we dont want to use their NRG.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are specific objectives of OMT in hospitalized patient?

A
  1. Improve MSK fx
  2. Decrease reflex activity
  3. Relieve congestion and improve immune release
  4. stabilze ANS
  5. Enhance removal/waste from tissue.
  6. Enhance pulmonary ventilation/o2/cell nutrition
  7. restore peristalsis and bowel fx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the 3 most important systems to focus on in hospitalized pt?

A

1. ANS

2. Respiratory

3. CV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do we diagnose hospitalized patients?

A
  1. Supine
  2. LR
  3. Seated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When diagnosing spine and pelvis in a hospitalized patient, what does it mean if [too stiff/ too squishy]?

A
  • Too stiff: flexed type 2
  • Too squishy: extended type 2
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do we want to treat hospitalized patients?

A

Combined treatments (Indirect; BLT, indirect MFR; craniosacral => direct; ME, direct MFR, NM inhibition, PINS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the goal of omt in a post-surgical patient?

A

Improve physiological function to help recover from illness or stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Goal of OMT is to remove added somatic input and reduce the overall firing rate of segmental interneurons and the devistating, self-perp effects, also called ______

A

segmental facilitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

how do we reduce segmental facilitation

A

any procedure that normalized the somatic tissue and reduce nociceptive input

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What area in OMT should we treat first?

A

Facilitated segments, (gently) because they have a decreased AP and fire off easy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How often should we treat facilitated segments?

A

Frequtly (even more than 1x/day). As process improves, freq decreases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Using the 5 factor model, how do we perform a pre-op structural exam?

A

Supine

Biomechanical: cervical/thoracic/lumbar/sacrum assess

Resp/circulatory:

  • Lymphatic assess
  • cranial assess
  • Rib motion

Neurologic:

  • somatovisceral and viscerosomatic
  • TP counterstrain exam
  • Chapmans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is an OMT pre-op procedure we can do to decrease post-op pulmonary problems?

A
  • OMT to reduce mid-cervical SD (C3-5)
    • ​somatosomatic reflex that dmgs thoracoabdominal diaphragm (phrenic N)
      *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Pre-op, if we are concerned about airway w anesthesia, what do we do?

A

optimize C-spine for intubation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is a complicating factor before surgey

A

prescence of SD (faciltation= one cause of increased chronic pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

TART findings from the viscerosomatic reflexes are from _______ pathologies and not primarily ________ dysfunctions

A

visceral, NOT somatic

34
Q

Pre-op, how can we use OMT to manage a patient with cardiac risk factors?

A

dec allostatic load => improve risk profile

35
Q

Pre-op, how can we use OMT to manage a patient with pulmonary risk factors?

Pre-op, how can we use OMT to manage a patient with hepatic risk factors?

Pre-op, how can we use OMT to manage a patient with nutritional risk factors?

Pre-op, how can we use OMT to manage a patient with metabolix risk factors?

behavioral?

A
  • tx rib SD
  • liver pump => help with hepatic congestion
  • nutritional support for 7-10 days; WL
  • IV fluids/insulin, correct metbaolic acidosis and glucose
  • OMT = control pain in those using pain meds
36
Q

Where do we evaluate lymphatics?

A
  1. Cranio-cervical junction
  2. Cervical-T junction
  3. T-L junction
  4. Lumbopelvic junction
37
Q

What are post-op complication?

A
  1. Treat patients complaints (back, neck, extremitypain)
38
Q

In post-othopedic surgery, what do we treat?

A
  • SD above and below to increase mobility
39
Q

In post-general surgery, what do we treat?

A
  • ANY patients complaints based on needs: most will get SD from laying in bed too long.
40
Q

What is the FIRST priority in a post-surgical patient?

A
  • healing from surgery; prioritize treatment based on what is needed for discharge
41
Q

What is indicated in ALL respiratory disease?

A

Focused evaluation and treatment of thorax

42
Q

When we have restiction motion in inhalation vs exhlation, it may help to suggest pathology. Descibe

A
  • Exhalation SD (reduce excursion of thorax toward inhalation) => pneumonia
  • Inhalation SD (thorax doesnt want to move toward exhalation) => asthma/COPD
43
Q

CHF: ________ excursion; _________ compliance

A

poor excursion

poor compliance

44
Q

COPD in a patient in good health: _______ exursion; _______compliance

A
  • limited excursion
  • spine and ribs ARE compliant
45
Q

How do we treat atlectasis with OMT?

A
  1. Rib raising
  2. Dome diaphragm (Thoracoabdominal/diaphragmatic release)
  3. Pectoral traction
  4. ST and MFR to C3-5 for phrenic N stimulation
  5. Tapotment (chest percussion)
  6. Lymphatic pumps
  7. Visceroscomatic: T1-6/T2-7 and CNX
46
Q

Pre-tibia edema OMT Tx

A
  1. Lymphatics *
    1. Open thoracic inlet
    2. Petrissage and eff
    3. Rib raising
    4. Lymphatic pump
  2. Viscerosomatic: T10-L2 and S2-4
47
Q

What occurs in post-op ileus?

A

Peristalsis decreases:

  • Returns in SI in 24 hours
  • Right colon => 48 hours
  • Left colon => 72 hours
48
Q

OMT for post-op ileus

A
  1. Rib raising (T5-L2) will decrease post-op ileus by 99.7%
  2. Mesenteric release
  3. Paraspinal inhibition to NL sympathetic (lower GI/T10-L2)
  4. OA/AA and sacral rocking to promote parasympathetics
49
Q

What can decrease post-op ileus by 99.7%?

A

RIB RAISING AT T5-L2

50
Q

52 year old female is POD #2 from open laparotomy for ruptured sigmoid diverticulum with abscess formation with c/o constipation, abdominal bloating and discomfort. Patient is afebrile, NPO, surgical drain from abdominal midline, and no bowel sounds in all four quadrants. Abdominal X-ray shows dilated loops of bowel. What is the sympathetic innervation of the colon that will regain its peristaltic activity first?

a) T1-4
b) T2-7
c) T5-9
d) T10-T11
e) T12-L2

A
51
Q

What is the mainstay therapy for post-op pain?

A

morphine

52
Q

OMT for post-op pain (3)

A
  1. Rib raising + paraspinal inhibtion to NL hyperactive sympathetic activity
  2. ST and MFR
  3. Visceroscomatic: T1-L2 and CN10/S2-4
53
Q

65 year old male is POD#3 from CABG (coronary artery bypass graft) surgery c/o chest pain and constipation. He admits that he has zero pain tolerance and has been dependent on his pain medication. He has been begging the nurses for more pain medications. The nurse informs you that he hasn’t been able to drink much fluids and that he has yet to pass a bowel movement s/p surgery. Which of the following OMT techniques in addition to medical management (eg. stool softener & laxative) would most directly address the nurse’s primary concern?

a) Sacral inhibition
b) BLT for C3 FRLSL
c) Mesenteric release
d) Lower extremity petrissage
e) MET for T7 ERRSR

A
54
Q

OMT for post-op anxiety and delirium

A
  • Calming techniques:
    • sub-occiptal inhibition
    • CV4
55
Q

Osteopathic manipulative treatment applied after a major

gastrointestinal operation is associated with

A
  1. Decreased time to flatus
  2. Decrease post-op LOS
56
Q

in OMT, what is inhibition?

A

sustained deep pressure over hypertonic muscle; pressure directed to MUSCULOTENDON JUNCTION

57
Q

In a pt with acute herpetic stomatitis (shallow ulcers), wht is the plan?

SD is where?

A

Cervical, thoracic, rib

  1. Antiviral meds
  2. ST on hypertonic cervicothoracic muscles
  3. ART to rib
58
Q

5 factor OMT model to post-op patient

  1. Biomechanical
  2. Resp/circulatory
  3. Neuro
  4. MEtabolic-energic
  5. Behavioral
A
  1. Biomechanical
    1. Postural muscles, spine and extremties
  2. Resp/circulatory
    1. Diaphragms (thoracic inlet, thoracoabdominal, pelvic)
    2. Venous and lymph drainage
  3. Neuro
    1. ANS
    2. Tx: Sympathetic ganglia, Parasympathetic vagus n and parasympathetic pelvic splancnic
  4. MEtabolic-energic
    1. if we treat other models first can treat this if we consider relationships
    2. homeostasis, NRG balance, reg process, inflamm and repair,
  5. Behavioral
    1. Psycholical and social activities (Diet, excersie, metal status)
59
Q

The most common manipulative method to modify sympathetic activity in the upper GI tract and small intestine is…

a) OA release
b) Rib Raising to T5-T11
c) Sacral Rocking
d) Muscle Energy to T1-6
e) Counterstain Tender point

A

b)Rib Raising to T5-T11

  • Upper GI (T5-9)
  • SI and R colon (T10-11)
60
Q

Regarding the osteopathic treatment of this patient, which of the following structures most likely plays a role in the maintenance of ileus in his post-abdominal surgery period?

  • a)Facial nerve
  • b)L5 nerve root
  • c)Phrenic nerve
  • d)Spinal accessory nerve
  • e)Vagusnerve
A
61
Q

Current treatment for post-abdominal surgery patient often indicates the use of SCDs (sequential compression device) for prophylaxis of DVT. What manipulative technique may also be beneficial?

a) Cervical HVLA
b) ME for L on R sacral torsion
c) Gentle effleurage
d) Mid-thoracic paraspinalsoft tissue
e) Paraspinalinhibition

A
62
Q

Your attending has ordered rib raising and paraspinalinhibition for your post surgical patient. What is the rationale for this treatment?

a) It will normalize CSF flow
b) It will increase parasympathetic activity to intestinal tract
c) It will inhibit rib motion to decrease pain
d) It will reduce sympathetic hypertonicity to intestinal tract
e) It should not be ordered because it is contraindicated in a patient with acute abdominal pain.

A
63
Q

Your attending has ordered rib raising and paraspinalinhibition for your post surgical patient. What is the rationale for this treatment?

  • a)It will normalize CSF flow
  • b)It will increase parasympathetic activity to intestinal tract
  • c)It will inhibit rib motion to decrease pain
  • d)It will reduce sympathetic hypertonicity to intestinal tract
  • e)It should not be ordered because it is contraindicated in a patient with acute abdominal pain.
A
64
Q

Suboccipital Decompression adds gentle traction to what ganglion?

A

superior cervical ganglion and vagus nerve (related to the OA and suboccipital tissue)

65
Q

Suboccipital decompression technicque

A
  1. Doc places finger pads in pts suboccipital sulcus/groove
  2. Carry elbows medially, adding lateral traction to subocc tissue
    1. add traction to occipupt
  3. hold until release is felt
66
Q

Cervical Ganglia Inhibition

A
  1. Doc places fingerpads on articular pillars of patients cervical spine
  2. move fingers in anterior-superior direction
67
Q

Posterior Abdominal Diaphragmatic Releases: (Releasing the Lumbar Spine/Crura) (BLT), what segments of spine are evaliated

A

T12-L3

68
Q

Posterior Abdominal Diaphragmatic Releases: Releasing the Lumbar Spine/Crura (BLT)

A

PT supine; doc at side of table

  1. Doc evals T12-L3
  2. Contacts SP on either side of vertebral unit that has SD
  3. Move it in directions that exag FOM: F/E, rotation, SB
69
Q

Rib Raising

•Position: Patient is seated with arms crossed in front of the chest. Physician stands in front of the patient.

  1. The patient’s arms are supported on the physician’s chest, and the physician’s hands reach around the patient to contact the patient’s ______ on both sides
  2. The physician leans so that ______________ occurs and simultaneously carries the contact with the patient’s ribs, ______ and ________.
  3. The physician’s hand contacts with the patient’s rib angles ____________ and the procedure is repeated until all of the patient’s ribs have been raised. A focused effort may be placed on any region that exhibits the greatest restriction.
A
  1. rib angles
  2. extension of patients thoracic spine
  3. anterior and superior
  4. superior and or/ inferior
70
Q

Thoracic inlet release opens _______

A

terminal lymphatic drainage

71
Q

Thoracic inlet release is a ______ technique

A

BLT

72
Q

Abdominal diaphragm release is a _______ technique and improves what

A
  • direct MFR with resp cooperation
  • improves respiratory biomechanics and lymphatic drainage from lungs
73
Q

Abdominal Diaphragm Release

  1. With the patient supine, the physician grasps the sides of the rib cage.
  2. Observe the respiration to determine _________
  3. Carry the diaphragm to the ___________ barrier in rotation, sidebending, and flexion/extension.
  4. The patient takes some deep breaths as the physician maintains the fascial barrier while resisting __________ on the side with best motion.
  5. Recheck.
A
  1. With the patient supine, the physician grasps the sides of the rib cage.
  2. Observe the respiration to determine the most restricted hemidiaphragm.
  3. Carry the diaphragm to the restrictive barrier in rotation, sidebending, and flexion/extension.
  4. The patient takes some deep breaths as the physician maintains the fascial barrier while resisting inhalation on the side with best motion.
  5. Recheck.
74
Q

job of rib raising

A

improve resp biomechanics

lymphatic drainage

normalize sympathetic tone

75
Q

Rib Raising (prone)

  1. Apply ____________ traction to the _________ rib angles until ________ motion of the chest is observed.
  2. Maintain _________ traction until tissues soften.
  3. May be applied once to each rib group or rhythmically for several cycles.
  4. Treat bilaterally.
A
  1. anterolateral
  2. posterior
  3. anterior
  4. anterolateral
76
Q

Cervical Soft Tissue job

A
    1. Normalize parasympathetic tone to lungs
  • 2. remove cervical SD that may affect the innervation of the abdominal diaphragm arising from C3-5
77
Q

cervical ST treats from _______ => _________

A

cervicothoracic to occipitocervical junctions

78
Q

Thoracic Pump with Recoil

  • A lymphatic pump used to (3)
A
  1. aerate alveoli
  2. prevent atelectasis
  3. mobilize lymphatic fluids
79
Q

Thoracic Pump with Recoil

    1. Turn the patient’s head to one side.
    1. Physician places his palms on the patient’s chest with hands spread over the chest or medial and lateral to breasts for female patients.
    1. Have the patient take a deep breath and let it all out. During ______ the physician follows the thorax (gentle springing may be applied). Maintain the compressive force and instruct the patient to _________. Resist _________ motion, and when sufficient force accumulates, __________
    1. Repeat as needed.
A
  • => compress during exhalation
  • => resist inhalation
  • => suddenly release compression
80
Q

Note: The recoil portion of this [thoracic pump w/ recoil] technique is contraindicated in _________ patients.

A

COPD

81
Q
A

OS 3 Midterm (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions