Precautions/Contraindications

Question 1

AICD Pacemaker

Answer 1

For 6 weeks:

• LUE flex/abd <90
• no shoulder IR or EXT
• <5lbs for entire UE
• no cell phone in chest pocket or use on L side

Question 2

Angiogram

Answer 2

if assessed through femoral artery:

flat bedrest x 6hrs following procedure

Question 3

A-Fib

Answer 3

Rate should be controlled <120 bpm prior to tx

Question 4

Autonomic Dysreflexia

Answer 4

• profuse sweating
• increased BP
• restlessness & chills
• notify RN immediately
• check foley
• monitor BP
• raise HOB

Question 5

Breast Reconstruction

Answer 5

• no lifting >10 lbs
• NO REPETITIVE SHOULDER ROM >90 WHILE DRAIN IS IN PLACE
• MAY GO >90 FUNCTIONAL ACTIVITIES/ADLS
• DIEP
  
  • amb w/ trunk flex first 7-10 days
• S-GAP
  
  • no trunk restrictions

Question 6

General Cardiac Precautions

Answer 6

• avoid valsalva
• stop activity if symptoms occur
• avoid exercise in extreme temperatures
• MMT okay, but avoid repeated isometric exercises especially w/ UE

Question 7

ENT Flaps

Answer 7

RFFF & Pec Flaps

• no cervical ROM
• only funx head movements
• typically order POE w/ cervical restrictions

FFF

• typically WBAT w/ post op shoe that should already be in room upon consult

Question 8

DVT

Answer 8

check with team for activity restrictions and type of anticoagulation** check medication packet

Question 9

Femoral Aterial Line

Answer 9

CAN mobilize

coagulation must be adequate

wait 6 hours after removal for mobilization

Question 10

Femoral arterial Sheath

Answer 10

CANNOT mobilize - Strict bedrest

Wait 6 hours after removal before mobilizing monitor

Monitor for bleeding or hematoma at the groin site

Question 11

Flaps/Grafts

Answer 11

• no ROM if crosses the joint
• no procedures BP/IV performed to the flap/graft area
• avoid shearing forces
• splint or cast for protection until healed
• if conflicting WB status, go with most conservative & call MD

Question 12

Intracranial Pressure

Answer 12

Normal Adult = 5-15 mmHg

Normal Child = <10 mmHg

Normal Infant = <6 mmHg

• Notify MD if >15 mmHg
• Head down position increases ICP
• HOB must be elevated approx 30 deg

Question 13

Transphenoidal Hypophysectomy (TSH)

Answer 13

• no nose blowing
• no bending over
• no straws (check POE)
• cough w/ mouth open
• avoid sneezing

Question 14

Hemicraniectomy (skull bone flap removal)

Answer 14

• Helmet MUST BE ON of OOB activity;
• No helmet when lying in bed
• Helmet off with drain
• NO LYING on flap free area
• see helmet fitting competency

Question 15

Lumbar Drain

Answer 15

drain must be clamped by RN prior to any change in position

Question 16

Lumbar Puncture

Answer 16

bedrest x 2hrs following procedure

Question 17

Lymphedema

Answer 17

avoid procedures (BP, IV) on affected limb

Question 18

Neck Dissection

Answer 18

No Cervical ROM if patient had flap in conjunction w/ neck dissection

Question 19

NG/PEG tubes

Answer 19

• HOB >30 deg when feeding
• shut feeding off or on hold when getting pt OOB or HOB flat
• differs w/ peds

Question 20

Orthostatic Hypotension

Answer 20

monitor BP & HR w/ change in position

Drop in SBP > 20 mmHg

Adjust pt position and notify RN

Question 21

Pacing Wires

Answer 21

Bedrest x 1hr following lines being pulled

Question 22

Sinal Surgery

Answer 22

Ortho or spinal Surgery

• restrictions usually 6-8 wks
• no bending/lifting >10 lbs/ twisting
• check if brace required for OOB

Question 23

Sternotomy Surgery

Answer 23

• no pulling or pushing for 4-6 weeks
• no lifting >10 lbs for 10 weeks
• no bending forward at the waist
• Pt may use RW for balance w. ambulation
• no driving for 6 weeks
• palpate for sternal stability w. UE movements
• if s/p I&D of sternal wound and/or flap
• No UE ROM/exercise until cleared by MD

Question 24

Total Hip Surgery

Answer 24

• check for WB status
• Posterior
  
  • no hip flex >90, IR, ADD
• Anterior
  
  • no hip ext, IR, ADD

Question 25

Vasopressors

Answer 25

hold therapy until pt. weaned off/stable on low dose.

ask if any changes made over 2 hrs

Agents: dobutamine, dopamine, epinephrine, norepinephrine (Levophed), phenylephrine, metraminol, ephedrine, & vasopressin