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Advanced Clinical Nursing Theory > Ortho Rehab > Flashcards

Ortho Rehab Flashcards

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1
Q

why is it important to know the stages of tissue healing?

A

avoid excessive stress and strain
ensures tissues are challenged during recovery to encourage optimal return to function

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2
Q

why must tissues be challenged during recovery?

A

encourages optimal return to tissue function

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3
Q

what are the stages of healing?

A

post-operative
regeneration
remodelling

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4
Q

when does the post operative healing phase occur?

A

24-48 hours post op

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5
Q

when does the regeneration healing phase occur?

A

day 5 - week 3

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6
Q

when does the remodelling phase of healing occur?

A

6 weeks to 1 year

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7
Q

are the stages of healing the same for bone and soft tissue?

A

yes

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8
Q

what is experienced by the patient during the post op healing period?

A

pain
oedema
beginning of tissue healing

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9
Q

what is involved in the treatment of patients during the post operative healing phase?

A

reduction of pain through multimodal analgesia
cryotherapy
rest
easy movement only

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10
Q

what is the purpose of cryotherapy in wound healing?

A

vasoconstriction and reduction of oedema

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11
Q

what is treatment is critical during the post operative healing phase?

A

rest
analgesia

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12
Q

what movement should the patient be doing in the post op period?

A

easy movement only (non-weight bearing or supported weight bearing)

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13
Q

what is happening to the patient surgical site during the regeneration phase of healing?

A

still fragile
new collagen fibres beginning to form
callus forming around bone

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14
Q

why is relative rest still needed in the regeneration healing phase?

A

area is still fragile

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15
Q

what is involved in patient treatment during the regeneration phase of healing?

A

controlled lead exercise
passive/active ROM exercises

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16
Q

why can movement start to be gently introduced during the regeneration phase of healing?

A

new collagen fibres forming around site

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17
Q

what are the 2 stages in the remodeling phase of soft tissue healing?

A

consolidation
maturation

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18
Q

what is involved in the consolidation phase of remodelling in healing?

A

tissue moves from cellular to fibrous and becomes stronger
increase in strength and alignment

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19
Q

what is involved in the maturation phase of remodelling in healing?

A

vascularity increases
metabolic rate returns to normal

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20
Q

when does the maturation phase of remodelling in healing occur?

A

10 weeks to 1 year

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21
Q

what happens during the regeneration phase of bone healing?

A

bridging callus forms

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22
Q

what happens during the remodelling phase of bone healing?

A

clinical union of bone - crucial for bone healing

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23
Q

what sort of exercises may be involved in the remodelling phase of healing?

A

active e.g. hydro

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24
Q

what is a common factor in cruciate disease?

A

obesity

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25
Q

what may need to be started prior to cruciate surgery?

A

weight loss programme

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26
Q

what may be used to aid pre-op weight loss for cruciate patients?

A

hydrotherapy

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27
Q

why must hydrotherapy be stopped for a time post operatively for cruciate patients?

A

to aid wound healing

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28
Q

when could hydrotherapy restart following cruciate surgery?

A

once wound is sealed and sutures removed

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29
Q

what are the main cruciate repair options?

A

TPLO
TTA
lateral suture

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30
Q

what is involved in the rehabilitation of cruciate disease patients?

A

active exercise
may retrun to toe touching the day after surgery

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31
Q

what is the most common cruciate repair procedure?

A

TPLO

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32
Q

what dogs may TTA and lateral suture be less suitable for?

A

working dogs

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33
Q

what does the rehabilitation of fracture patients depend on?

A

degree of fractures and site
presence of pre-exisiting disease
degree of soft tissue damage
presence of open wounds

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34
Q

what preexisting disease may affect wound healing?

A

diabetes

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35
Q

what are the main components of a fracture rehabilitation plan?

A

adequate analgesia
restricted exercise
cold compress
encourage limb use
supportive dressing if applicable

36
Q

what fracture patients is restricted exercise essential for?

A

THR
those who have had epidurals

37
Q

how can usage of a limb following fracture repair be encouraged?

A

PROM exercises can be used carefully

38
Q

what is the purpose of a supportive dressing for fracture patients?

A

pain relief
joint stability

39
Q

what is the main difficulty if external fixators have been used for fracture repair?

A

can be difficult to apply treatments to the whole limb

40
Q

what type of external fixators make massage and PROM more possible?

A

linear or ring

41
Q

what physio therapy techniques are vital for external fixator patients?

A

active exercise
extension of the distal limb

42
Q

why is extension of the distal limb in external fixator patients crucial?

A

natural flexion of the distal limb often seen with external fixation

43
Q

what are the main issues seen post-op from joint surgery?

A

pain and swelling

44
Q

what treatment should be used in the post op period following joint surgery?

A

cryotherapy
pressure dressings
PROM
massage
analgesia

45
Q

when should cryotherapy be utilised post op in joint surgery patients?

A

immediately post op

46
Q

how long should pressure dressings be applied to joints following joint surgery?

A

12-24hours post op

47
Q

what is the purpose of cold therapy in joint surgery patients post op?

A

aids reduction of swelling

48
Q

what is the purpose of PROM following joint surgery?

A

maintains normal ROM
encourages blood flow and lymphatic circulation
stimulates sensory awareness

49
Q

what is the benefit of increasing blood and lymphatic circulation in joint surgery patients?

A

assists reduction of oedema

50
Q

how should joint replacement surgeries be managed?

A

slow and controlled walking
must be settled and calm
clear signage on kennel

51
Q

what can be done if joint replacement patients are stressed?

A

administration of sedation due to the risk of catastrophic damage to the implant

52
Q

how is tendon injury managed?

A

rest
NSAIDs

53
Q

when can PROM be started for tendon injury patients?

A

after 3 weeks rest

54
Q

how long should exercise be limited for in tendon injury patients?

A

3-6 weeks

55
Q

is the tendon at full strength after 6 weeks?

A

now

56
Q

what can be used to assist a patient with a tendon injury?

A

support aids (e.g. boot)

57
Q

what are the primary goals of rehabilitation?

A

weight bearing
active range of movement (ROM)
muscle building

58
Q

what is the purpose of building muscles?

A

support of joints and limbs

59
Q

what does rehabilitation assist with?

A

return to function
minimisation of stress on surgical site

60
Q

what is required to perform rehabilitation well?

A

full understanding of the condition

61
Q

what ways of measuring efficacy of rehab are there?

A

subjective - how you feel they’re doing
objective - actual measurement using scales

62
Q

what is essential throught the rehab period?

A

adequate pain relief

63
Q

what may be involved in rehab as well as post op care?

A

pre-emptive or surgical management

64
Q

what is involved in pre-emptive / surgical management of ortho cases?

A

cryotherapy
support dressing
weight bearing encouraged where possible
pain management
assessment of other conditions / lifestyles

65
Q

what is the role of a support dressing?

A

reduction of oedema and analgesia

66
Q

what is the role of weightbearing in pre-surgical management?

A

reduced muscle atrophy

67
Q

when is cryotherapy most effective?

A

initial 72 hour period post op/injury

68
Q

what is the role of cryotherapy?

A

vasoconstriction
analgesia
reduction of oedema

69
Q

how often should cryotherapy be performed?

A

3 x a day

70
Q

how long should each session of cryotherapy be?

A

15 mins

71
Q

what temperature is advised for heat therapy?

A

46 degrees C is sufficient

72
Q

what is the benefit of heat therapy?

A

increased blood flow to region
increased elasticity of tissues
muscle relaxation

73
Q

what must you be careful about when using hot and cold therapy?

A

test on self to ensure not too hot
wrap cold in a towel to prevent burns

74
Q

what is the purpose of massage in rehabilitation?

A

increases blood flow and so oxygen supply to muscles
aids removal of waste products
helps muscle work more effectively
alleviates pain
settles patient
mobilisation of adhesions

75
Q

when can massage be used?

A

before and after exercise or physiotherapy

76
Q

what must always be performed before a physiotherapy session?

A

massage

77
Q

what are the main types of physio exercises involved in rehabilitation?

A

assisted exercises
active exercises

78
Q

what is the difference between assisted and active exercise?

A

assisted involves external support of the patient by RVN
active is the patient doing it for themselves

79
Q

what are the main assisted rehabilitation exercises?

A

assisted standing
weight shifting
side bending and cervical flexion/extension
balance boards
swiss balls
muscle stim

80
Q

what are the main active rehabilitation exercises?

A

slow walks
stair climbing
sit to stand or down to sit
treadmill walking

81
Q

what is involved in advanced rehabilitation exercises?

A

dancing
wheelbarrowing
hydrotherapy

82
Q

when would advanced rehabilitation exercises be started?

A

6-12 weeks post op

83
Q

what is essential when managing a patient’s long term rehab?

A

communication between nurses, vet and client
having clear primary goal

84
Q

how can we ensure effective communication regarding patient rehab?

A

clear notes on progress
any procedures recorded
videos of patient can help
discussion as a team of plans and any proposed changes

85
Q

what must be communicated to an owner during rehabilitation?

A

progression
exercises
how they can help
management of expectations
get them to invest

Advanced Clinical Nursing Theory (36 decks)

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