Post-Surgical Management - Week 7 Flashcards
1
Q
Indications for surgical management of MSK conditions
A
- Severe trauma
- Severe degeneration
- Guidelines/standards are constantly shifting
- Techniques come into and then out of fashion
2
Q
Most common MSK surgeries
A
- Knee replacement
- ACL surgery
- Hip replacement
- Shoulder replacement
- Arthroscopy
- Joint fusion
3
Q
Open procedures
A
Involve large incision
4
Q
Arthroscopic
A
- Smaller incisions = lower risk of infection
- Less blood loss and scarring
- Preserve surrounding tissues
5
Q
Common Post Op complications
A
- Infections
- Venous thromboembolism - deep vein thrombosis
- Pulmonary embolus (PE)
- Poor wound healing
- Scarring and adhesions
- Prolonged immobilization
6
Q
Infection risk factors
A
- Coincident infection/colonization
- Steroid use
- Obesity
- Smoking
- Extremes of age
- Poor nutritional status
- Transfusion
7
Q
Signs and symptoms of infection
A
- Redness
- Swelling
- Heat
- Pain
- Cloudy or discolored drainage
8
Q
PT Role in infection
A
- Monitoring of surgical site until healing of wound complete
- Educate patient and practice sound infection control procedures
- Report signs of infection to patient, care-giver and surgeon
9
Q
Deep vein thrombosis - venous thromboembolism
A
Blood clot formed in deep veins - common in lower leg - if breaks free, can lead to pulmonary embolism
10
Q
Risk factors of DVT
A
- Age
- Best rest/immobility/ distance travel
- CHF
- Estrogen, family history, blood cancers, solid cancers
- Major trauma
- Past VTEs and stroke, obesity, pregnancy/post partum, smoking, non infectious inflammatory conditions
11
Q
PT role in DVT
A
- Recognize signs and symptoms and refer out fast for medical testing and intervention
- Prevention of immobility, mobilization, exercise to promote circulation
- Monitoring anti-coagulant status, patient compliance with medications and monitoring lab values
12
Q
Poor wound healing risk factors
A
- Smoking
- Infection
- Diabetes
- Age
- Nutrition
- Immune function
13
Q
PT role in poor wound healing
A
- Encourage proper nutrition
- Behavior modification
- Infection control
14
Q
Scars and adhesions
A
- Infiltration of fatty and fibrous tissue, fibrosis
- Perspective: surgery is controlled trauma:
15
Q
Risk factors of scars and adhesions
A
Prolonged immobilization
16
Q
PT role with scars and adhesions
A
- Early mobilization as safe
- Passive mobility techniques and scar mobilization
17
Q
Detrimental effects of immobilization
A
- MSK tissues require loading to maintain optimal condition
- Prolonged immobilization will degrade tissues and make it more susceptible to injury (cartilage, ligament degeneration, decreased in bone density, weakness and atrophy of muscle and changes in resting length)
18
Q
PT role in detrimental effects of immobilization
A
- Sage early mobilization
- Proper positioning when immobilized
- Progressive strengthening program
19
Q
Post op intervention
A
- Address impairments in typical step-wise progression
- Work within healing time-frames
- Know post-operative precautions and contraindications
- Monitor for complications and incorporate preventative interventions
- Follow protocol
20
Q
Post op protocols
A
- Surgery-specific/ surgeon specific guideline
- Time based and criterion based
- Establish expectations for patient improvement and progression of treatment
- Detail what is permitted and when/how
- Not a cook-book —> not a replacement for reasoning
