ortho part 1 Flashcards
what are the primary goals for PT for acute ortho patients
- early restorative mobility for max function
2. reduce risk of secondary complications
what kind of image is an xray?
negative image: the more dense, the more absorption
what method is used to read images?
ABCS - alignment, bone, cartilage, soft tissue
how does a bone scan work?
greatest concentration of radiation absorption is the site of greatest metabolic activity
what does a T1 weighted MRI tell you?
anatomic detail (think neuro pics)
what does a T2 weighted MRI tell you?
underlying pathology
what are signs of severe anemia?
fainting, chest pain, angina, and heart attack
how does anemia present in the eyes
yellowing
how does anemia present in the skin
pale, yellow, cold
how does anemia present in respiratory system
SOB
how does anemia present in the MSK system
weakness
how does anemia present in the GI system
change in stool color
how does anemia present in the CNS
fatigue, dizziness, and fainting (severe)
how does anemia present in the blood vessels
low blood pressure
how does anemia present in the heart
palpitations, increased HR, chest pain (severe), angina (severe), heart attack (severe)
how does anemia affect the spleen
enlarges it
what does general anesthesia do
produces a progressive and reversible CNS depression
how might a general anesthesia patient present after surgery
drowsy, impaired cognition, weak, increased bronchial secretions, ventilation may be necessary
where does anesthesia go?
needle into the subarachnoid to CSF
how does an epidural work?
intermittant delivery of pain meds via PCA pump
how does a peripheral nerve block work?
anesthetic bolus or catheterized into a specific nerve
what type of anesthetic is given for TKA?
local femoral nerve block - effects quad activation/strength
what is the most common anesthetic for and why should i care
exparel (bupivicane) - non opiod lasts up to 72 hours but side effects are dizziness, drowsiness, nausea, and constipation
what anticoagulant is given post op to prevent DVT
low molecular weight heparin (warfarin) can be given up to 6 weeks post op
name some types of opioids
oxycodone, hydrocodone, morphine, codeine, buprenorphine, fentanyl, tramadol
how are opioids delivered in the acute setting
patient controlled analgesia (PCA) pumps
when do you wanna schedule tx for a patient on opioids?
at max dose effect
what is your primary informant in a CVP review of systems?
vitals
what do you review in an MSK ROS?
observe for abnormalities and general strength screen
upon primary observation of a patient, what should you consider
lines/tubes/equipment as well as how the room is set up
what are the three scales for pain?
NPRS, VAS, and Wong-Baker
what four things should you consider for integumentary integrity?
- scars
- bruising/cuts
- surgical site/incision
- limb color
what do you screen for in sensory integrity
- compartment syndrome
- peripheral nerve injury
- peripheral neuropathy
what do you do in the involved extremity for ROM?
goni (for knees mostly), functional ROM, note what is limiting full range
what do you do in the involved extremity for muscle strength
MMT, functional strength, what they can do before getting OOB
approximately how much more effort is required to use a standard walker versus unassisted ambulation? versus a wheeled walker?
200%
100%
what are four performance measures
10 meter walk test
TUG
6MWT
activity measure for post acute care (AMPAC) 6-clicks
where do most in patient ortho patients end up
return to home
exhaustive list of post op complications
Adhesions Constipation Contracture Delayed Wound Healing DVT/PE Infection Mal-union Muscle Guarding/Spasm Orthostatic hypotension Prosthetic Failure
how do you decrease post op pain muscle guarding or spasm?
gentle rom, cold/heat depending on location of pain/spasm, and TENS
how do you decrease post op edema?
elevation and active muscle pumping
how do you prevent CVP complications post op
active LE exercise, deep breathing/coughing exercises, aerobic activities
how do you prevent unneccessary joint stiffness/contractures post op
ROM exercises
how do you decrease muscle atrophy across immobilized joints
isometrics
how do you minimize loss of motion and strength in areas prox/distal to involved structures?
AROM and resistive exercises
how do you improve functional mobility while protecting involved structures
AD, education, mobility training
what do you education a patient and family on post op?
positioning
post op precautions or contraindications
exercise programs
