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Acute Care Module 1 > Ortho Part 3 > Flashcards

Ortho Part 3 Flashcards

1
Q

what are the four most common types of spinal surgeries

A

fusion, laminectomy, decompression, and discectomy

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2
Q

describe approach techniques for spinal fusions

A

anterior more common in c spine, posterior more common in L spine

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3
Q

what type of fusion materials can be used in spinal surgeries

A

harrington rods, pedicle screws, cages, and bone

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4
Q

what are harrington rods?

A

distraction-type fixation that immobilizes multisegmental spine in certain planes

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5
Q

what is the purpose of a pedicle screw

A

provides a rigid stable structure to which rods may be attached

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6
Q

how does a cage work?

A

filled with autogenous bone, it is inserted between bodies in order to fuse the segments

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7
Q

how are cages implanted?

A

between vertebral bodies via anterior approach

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8
Q

from where is bone graft material harvested?

A

iliac crest - painful ambulation post op

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9
Q

what is a spinal decompression

A

removal of posterior column (including lamina) and the foramen is widened to relieve pressure on the neural structures

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10
Q

what is a discectomy

A

excision of herniated material, can be combined with other procedures

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11
Q

minimally invasive spinal surgery should be considered for which conditions?

A

disc hernation, scoliosis, fusion

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12
Q

how can you classify cervical orthoses?

A

rigid, semi-rigid, and soft

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13
Q

when is a rigid cervical orthosis indicated? what’s it called?

A

unstable fractures; halo

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14
Q

what is a PT implication for patients with a halo?

A

don’t tug on the vest

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15
Q

when is a semi-rigid cervical orthosis indicated? what are two types?

A

stable fractures post op; philadelphia and miami-j

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16
Q

when is a soft cervical orthosis indicated? what is an example?

A

symptom mgmt and pain control; foam with velcro

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17
Q

how can you classify thoracolumbar and sacral orthoses?

A

rigid, semi-rigid, and soft

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18
Q

when is a rigid TLSO indicated? what are two types

A

stable fractures post op; TLSO and Jewitt

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19
Q

when is a semi-rigid TLSO indicated? what is an example?

A

symptom mgmt and pain control; corset

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20
Q

when is a soft TLSO indicated? what is an example?

A

symptom mgmt and pain control; abdominal binder

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21
Q

what tests and measures would you consider for a patient who has had spinal surgery?

A 
Neuro exam
functional mobility
balance
vitals
cognition
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22
Q

what are spinal precautions

A

no BLT - bending, lifting, and twisting

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23
Q

how long do you expect a spinal patient to be hospitalized?

A

1-2 days unless they have a surgical complication, then usually 3 days

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24
Q

how often should PT services be provided to spinal surgery patients?

A

1-2x/day beginning the day after surgery

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25
Q

what are the four general precautions following a spinal surgery

A
  1. use log rolling for bed mobility
  2. avoid spinal flexion in sitting
  3. wear brace per orders (usu OOB or upright)
  4. limit prolonged sitting
  5. no BLT
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26
Q

what is the lumbar specific post op spinal precaution for lifiting objects?

A

no lifting anything heavier than 10 lbs (gallon of milk)

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27
Q

what are two cervical specific post op spinal precautions

A
  1. no lifting over 5 pounds

2. UE movement <90

28
Q

what are important exercises to prescribe post op for spinal patients

A

activities to reduce CVP risks - ankle pumps and incentive spirometry

29
Q

briefly comment on post op spinal surgery strength and flexibility training

A

inappropriate in acute care

30
Q

if strength and flexibility is contraindicated, and we already mentioned CVP exercises, what else can you work on with spinal surgery patients?

A
  1. spinal precaution education
  2. bracing
  3. aerobic capacity
31
Q

what five factors must be considered for a traumatic fracture

A
  1. skin integrity
  2. site of fracture
  3. type
  4. extent
  5. position of fragments
32
Q

how can you classify a fracture based on skin integrity

A

open v closed

33
Q

how can you classify a fracture based on its site?

A

articular, epiphyseal, midbone, etc

34
Q

how can you classify a fracture based on type

A

linear, transverse, oblique, spiral, comminuted, segmental

35
Q

how can you classify a fracture based on extent

A

complete v incomplete

36
Q

how can you classify a fracture based on relative position of fragments

A

nondisplaced v displaced

37
Q

what are the four strata of spinal fracture classification

A
  1. location (transverse/spinous/body)
  2. compression (wedge or burst)
  3. dislocation present or not
  4. stable or unstable
38
Q

what are the three phases of fracture healing and what are their relative times

A
  1. inflammatory (days)
  2. reparative (up to 6-12 weeks post inflammation)
  3. remodeling (6 mo to years)
39
Q

what happens in the inflammatory phase

A

hematoma formation and inflammatory mediators

40
Q

what happens in the reparative phase

A

granulation tissue and fibrocartilage form a soft callus to be replaced by a fibroosseus, bony callus

41
Q

what happens in the remodeling phase

A

complete restoration of the medullary canal

42
Q

how long does it take fractures to heal in peds? adolescents? adults?

A

4-6 wks
6-8 wks
10-18 wks

43
Q

what do you do if you suspect compartment syndrome?

A

contact the doc right away - medical emergency

44
Q

how does a fat embolism occur?

A

large bones may release fat globules from the marrow that can clot causing a PE or stroke

45
Q

what are some types of immobilization strategies?

A

external fixation (spints, braces, casts) or internal fixation (grafts and hardware)

46
Q

when is an external fixator typically indicated?

A

comminuted and open fxs with massive soft tissue injury (eg. pelvic fxs)

47
Q

when is an external cast typically indicated?

A

stable, closed fracture

48
Q

what are the four PT considerations for patients with hip fracture external fixators

A
  1. maintain ROM above/below site
  2. no pulling on the cage
  3. minimized contact with the cage
  4. discuss WB status with medical staff
49
Q

what is an ilizarov frame?

A

pediatric external fixator to extend bone length

50
Q

how long do you expect a patient to be hospitalized following a fracture?

A

1-3 days depending on the fracture site (hips usually warrant longer stays)

51
Q

how often should PT see fx patients?

A

1x per day

52
Q

what are some PT considerations for mobilizing a patient with an immobilized limb fracture?

A

mobilize the patient, although the effected limb will be NWB for 6-8 weeks

53
Q

what are elevation considerations for fracture patients?

A

4-5 in above the hear to assist venous return

54
Q

comment on strength and flexiblity training for fracture patients

A

strengthen around the fx and wb extremitity, core should be trained, AAROM/ROM within the context of the order

55
Q

how do you transfer a patient with a fractured lower extremity

A

towards strong limb, away from weak

56
Q

where is the incision made for a TSA?

A

between pec major and anterior deltoid

57
Q

what are post TSA precautions? (5)

A
  1. ROM restricted per orders
  2. no lifting/pushing/pulling with involved for 6 weeks
  3. no behind the back/IR
  4. no excessive stretching into ER
  5. NWB
  6. hand to mouth feeding with elbow at side
58
Q

what is considered proper bed positioning for a patient post TSA

A
  1. towel roll under the elbow in supine

2. avoid lying on involved extremity

59
Q

what are three therex implications in acute care for post op TSA

A
  1. supine passive fwd flx w elbow flexed
  2. supine passive ER with arm at side/elbow flexed
  3. pendulums
60
Q

what is the weight limit for a straight cane? bariatric cane?

61
Q

what is the weight limit for axillary crutches? bariatric crutches?

62
Q

what is the weight limit for an adult wheeled walker? bariatric wheeled walker?

63
Q

what is the weight limit for a standard adult wheelchair? bariatric extra wide?

64
Q

what is the weight limit for a sliding board

65
Q

what is the weight limit for a tilt table

Acute Care Module 1 (6 decks)

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