Ortho- Post OP Flashcards
_ _ is recommended 6 weeks prior to surgery
Smoking cessation
After hip replacement WBC levels will be? Tx is?
Will be above 11K (is a normal inflammatory response)- leukocystosis
Treatment is still indicated
Risk of DVT post op peaks at? (Time frame) Risk remains high?
Peaks at 2-3 weeks
Risk remains high 3 mos post op
Post surgery you should never underestimate the? Always use?
Never underestimate the surgical stress response
Always use gait belt or have a second person on hand
_ affects PT intervention in post-op patients. Should know?
Anesthesia
Should know what type was used
A _ is a one time shot of anesthesia that lasts - hours. It is injected into the? Requires a _ _ hospital stay. Often used in?
Spinal, lasts for 24-48 hours
It is injected into the subarachnoid space/ CSF at L3-4
Requires min 24 hour hospital stay
Often used for LE surgeries
What are the 4 side effects of spinal?
P III
Pruritis
Itchiness
Increased hypotension
Increased urinary retention
3 common types of canal/ nerve blocks?
Femoral Nerve block
Adductor canal block
Inter scalene block
With a femoral nerve block patient will have decreased _ strength, and an increased?
Decreased quad strength
Increased fall risk
With a adductor canal block which nerve is targeted? Primarily a _ block, spares? Reduced? Time frame?
Saphenous nerve block
Primarily a sensory block, spares motor control of the quads
Reduced fall risk
Lasts 12=24 hours
An interscalene block affects the _ _. Is contraindicated for patients with _ _ function because it can affect the _. Lasts?
Affects the brachial plexus
Is contraindicated in patients with decreased respiratory function because it can affect the diaphragm
Lasts 12-24 hours
Which type of injection/ anesthesia is often injected into the posterior capsule, collateral ligaments, quads, pes anserinus, Anteromedial capsule, periosteum, IT band and subcutaneous tissue of the knee? AKA? Consists of?
Local infiltrate anesthesia (LIA)
AKA: peri-articular injection
Consists of a cocktail of drugs
LIA is not used in the _ knee, but can still _ _ _ causing?
Not used in the posterolateral knee, but can still bathe the Peroneal nerve and cause foot drop
Patients with a TKA are typically _ with no _ precautions. Should avoid _ stress and watch for _ _. Position used post surgery? Why?
Typically FWB (day of surgery) with no ROM precautions
Should avoid valgus stress and watch for genu recurvatum
90/90 position is used 18-24 hours post surgery, helps reduce/ prevent swelling and bleeding post surgery
Absent heel strike, hip hike/ hip Abd, foot drop, and shorter stride on uninvolved side are common?
Gait deviations seen post TKA
TKA patients: goal of full AROM within? Kneeling usually after? _ _ for complete recovery. Should avoid?
Full AROM within 3 months
Kneeling usually after 9 months
Full year for complete recovery
Should avoid propping knee up with pillows
What is the primary elevator of the arm in a reverse TSA?
Deltoid becomes primary elevator (instead of RC muscles)
Precautions with TSA?
No lifting
Precautions with reverse TSA (3)?
No ER past 20 degrees
PWB only, do not push up onto elbow (in affected UE)
Keep hands in front of you/ in sight
What is the difference in WB status for a patient who had THA using cemented vs. uncemented procedure?
Cemented- FWB
Uncemented- PWB
Advantages of anterior approach for THA: _ sparing, easier _, reduced chance of _ and more accurate control of _ _.
Muscle sparing
Easier recovery (less blood loss/ pain)
Reduced change for dislocation
More accurate control of leg length
Disadvantages with anterior approach THA: more difficult _ _, over traction can cause _ _ _. Is avoided in patients with _, due to increased risk of _, and patients who already have significant _ _ _.
More difficult for surgeon
Over traction can cause femoral nerve palsy
Is avoided in patients with pannus (large gut) due to increased risk of infection, and patients who already have significant hip flexion contractures
With anterior approach there is no _, because _ _ is not affected. Full _ and _ _ can occur more quickly.
No limping, because gluteus medius is not affected
Full ROM and weight bearing more quickly
2 precautions for anterior approach THA?
No hip hyperextension
Avoid hip ER
With posterior approach to THA surgeon _ _, usually through _ _. Greater risk of _. Preserves _ _, and offers good exposure _ _.
Surgeon splits muscle, usually through gluteus Maximus
Greater risk of dislocation
Preserves abductor function
Offers good exposure to femur and acetabulum for surgeon
3 precautions with posterior approach THA?
No hip flexion past 90 degrees (no soft sofa sitting- must add pillows to chair or couch)
Avoid IR
No adduction past midline
The _ _ to THA is not as common. Incision occurs through _. Greater risk of post op _ and _ _.
Lateral approach not as common
Incision occurs through TFL
Greater risk of post-op limp and trendelenburg gait
What are 3 common impairments seen post op with hip replacement surgery?
Flexion contracture
Abduction contracture
Abductor weakness
Strict indications for spinal surgery: _ pain, _ symptoms, _, and progression of _.
Intractable pain
Neuro symptoms
Claudication
Progression of slippage
What are 3 signs of spinal cord compression?
Positive babinski
Positive Hoffman’s
Clonus
_ _ syndrome is considered a neurological emergency, resulting in _ disturbances, LE _ and loss of _, saddle _, and loss of _ and _ control
Cauda Equina Syndrome
REsulting in gait disturbances, LE weakness and loss of reflexes, saddle anesthesia and loss of bowel and bladder control.
Severe postural headache, photophobia*, nausea and vomitting are all signs of a _ _. Notify _, occurs in approximately -% of lumbar surgeries.
All signs of a dural tear
Notify surgeon, occurs in approximately 5-14% of lumbar surgeries
With a dural tear patient is on strict bed rest for _ - _ _. _ is ok, but no _ for 36 hours.
Strict bed rest 24-48 hours
Rolling is okay, but no sitting for 36 hours
