Patient 2

Question 1

Knee arthroscopic debridement

Answer 1

Also known as key hole surgery, involves using a camera and small tools inserted into the joint through small incisions.
Debridement usually involves a wash out of the joint with fluid and the removal of loose bodies and OA changes of the joint.
Indications - OA if previous steroid injections and Physio have been ineffective.
The efficacy of this procedure has been question, a number of studies have shown that there is no difference i pain or improved function compared with that of sham procedure. Showing that there is definite an element of placebo effect with this treatment.
The AAOS incorporated the conclusions into their treatment guidelines, stating that arthroscopic debridement offers no more benefit than what Physiotherapy and NSAIDS can provide.

Question 2

Sustained stretches

Answer 2

Before the arthroscopy the patients ROM was limited by pain, the prolonged lack of mobility can cause the periarticular structures to become shortened. Therefore after the debridement pain should be reduced and our aim is to increase the ROM by lengthening these structures.
To elongate these tissues it would require a force of sufficient magnitude to be applied to cause micro trauma.
Most research has shown the optimal time for joint mobilisation is 3x30 sec which can be sustained or oscillatory, we use sustained and the increase in length is owed to creep.
The frequency is decided by the irritability of the symptoms and stage of recovery.

Question 3

Diabetes

Answer 3

Is where there is an inability of the pancreas to produce sufficient insulin to control blood glucose levels.
An elevated blood sugar level stiffens the arteries and causes narrowing of the blood vessels.
Narrowed vessels lead to restriction of blood flow, the increased blood glucose also decreased red blood cell function so reduced oxygen supply to the site of injury leading to slowed healing process
The high blood glucose level affects white blood cell activity so lowers the efficacy of the immune system, increasing risk of infection
Affect treatment - allow more time for healing when setting goals, more important to do circulation exercises to increase blood flow to site of injury, make sure blood glucose level is monitored. Do not mobilise patient if level is below 100mg/dl or above 250mg/dl

Question 4

Metformin

Answer 4

Is an oral diabetes drug that helps regulate blood glucose levels for people with type 2 diabetes.
It works by helping type 2 diabetics respond better to their own insulin, decrease the amount of glycogen produced by the liver and decreasing the amount of glucose absorbed in the intestine
Side effects - if taken with insulin or when blood glucose is low it increases the risk of a hypoglycaemic attack

Question 5

Femoral nerve block

Answer 5

Anaesthetic injected into the femoral nerve guided by ultrasound.
No real precautions
A study of 1018 participants found that there was an increased falls risk after FNB and an increased chance of developing femoral neuritis.

Question 6

Blood pressure

Answer 6

Normal ranges -
systolic: 90-140mmHg,
diastolic: 60-90mmHg
Hypotension is low pressure in the systemic circulation
Can cause dizziness and fainting
Causes - hypovolaemia which can be caused by blood loss, dehydration, vomiting/diarrhoea, side effects of medication
Affect Rx - do not mobilise if below 90mmHg
Check what’s normal for patient first.

Question 7

Ibuprofen

Answer 7

Is a non steroidal anti-inflammatory drug
It works by reducing the hormones that cause inflammation and pain
Precautions - long term use can increase your risk of heart attack or stroke, can cause damage to the stomach or intestines
Side effects - allergic reaction, signs of stroke/heart attack, nausea/vomiting, dizziness and headache

Question 8

Codeine

Answer 8

Is an opioid pain medication used to treat mild to moderate pain
Contraindications - paralytic ileum, frequent asthma attacks, or bowel obstruction
Side effects - dizzy/drowsiness, nausea/vomiting, constipation. Slowed heart rate, hypo ventilation, confusion/hallucinations

Question 9

Aspirin

Answer 9

Is an anti platelet medicine, which means it reduces the risk of blood clots forming in the blood.
Reduces the ability of platelets to stick together and reduces the risk of clots forming
Side effects - increased risk of bleeding, indigestion, allergic reaction