Post surgical patient Flashcards
What is atelectasis?
Atelectasis is an area of airless pulmonary parenchyma d/t collapse or incomplete expansion. It
can occur d/t:
● complete obstruction of an airway
● Fluid, tumor, or air accumulation w/in pleural space
● pulmonary/pleural fibrosis
You will see decreased breath sounds, dull percussion, & decreased fremitus. Decreased tidal
volume, increased inspiratory/expiratory pressures, dec functional residual capacity, &
decreased alveolar ventilation all cause incomplete expansion of lungs, causing ___
Atelectasis
Spinal levels for sympathetic nerve supply to sigmoid colon.
Postganglionic fibers from inferior mesenteric ganglion= T12-L2 → goes to distal half of transverse colon, sigmoid, & rectum
Spinal levels for parasympathetic nerve supply to sigmoid colon.
S2-4 to the pelvic splanchnic nerves
Considering a neuro, biomechanical and fluid model treatment approach, describe 6 body regions you would evaluate for somatic dysfunction in this patient.
Neuro - viscerosomatics
Biomechanical and fluid (lymphatics) - Thoracolumbar diaphragm, Ribs (thoracic cage), Sacrum, Lumbar spine, Thoracic spine, OA/AA
Treatment of supine dysfunction of the thoracic spine
Suboccipital inhibiton:
1. Patient supine. Doc seated opposite the side of the PTP.
- Contact the spinous process on side of PTP.
- Induce a force by pulling the spinous process toward you (or anterior pressure), causing rotation into freedom of motion (indirect tx).
- Maintain force, until sense of increasing rotation to freedom of motion is felt.
OSCE
11/23/2015 - post ssurgical patient
stages of post surgical partient
see osce
Stage 1
no bowel sounds, shallow breathing (atelectasis), unbalanced E-Lytes, unbalanced hemodynamics, NPO
A 25 year old female presents with worsening right arm pain and paresthesias after being in a motor vehicle accident. The pain is made worse when the patient tries to style her hair. On exam the cervical spine muscles are tender and the right 1st rib is elevated and tender. Neurological testing and Spurling’s test are negative. Adson’s test, EAST test and Wrights test
are all positive on the right. Shoulder and cervical spine radiographs are reported as negative.
What is the dx?
What 3 possible anatomical areas may be compressing the involved neurovascular bundle?
The patient has thoracic outlet syndrome. The 3 possible anatomic areas where the neurovascular bundle is being compressed include the scalene triangle, costoclavicular space, retropectoralis minor (Anatomical: 1st rib, T1, manubrium).
Adson test Perform and what does it mean?
In Adson’s test, the neurovascular bundle is being compressed by tight scalene muscles or the 1st rib. In order to perform the test, locate the radial pulse on the right arm and have the pt breathe deeply.
Then abduct, extend and externally rotate the shoulder while palpating the radial pulse. The head is extended and rotated towards the affected side (looking TOWARD the right side or the affected side is testing for 1st RIB ETIOLOGY and extending the head and rotating AWAY from the affected side towards the left tests for TIGHT SCALENE MUSCLES).
A positive test is a loss or change in pulse and indicates compression of the subclavian artery between the scalenes, cervical rib or 1st rib.
Wright’s hyperabduction test. Perform and what does it mean?
see
for tight Pec minor
spurling test
see 09-14-2015 osce
Pec minor (wright’s hyperabduction) MFR
Patient supine, pt sits at head of tiable. Affected side’s arm etensed at elbow and flewed at shoulder
right rib 1 or 2 inhalation dysfunction - post isometric relaxation to releax scalene muscles, seated
se osce 09-14-2015 osce
