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S4- Acute Care > Week 4- Orthopedic Conditions > Flashcards

Week 4- Orthopedic Conditions Flashcards

1
Q

PART 1: PT EVALUATION

A

PART 1: PT EVALUATION

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2
Q

What are some MSK conditions we may see in acute care?

A
  • Bone fractures, including multitrauma situations
  • Surgical repair of fractures
  • Joint replacements
  • Spinal surgeries
  • Soft-tissue surgeries
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3
Q

What are 5 main parts of a MSK exam?

A
  • Medical chart review
  • Any restrictions?
  • Diagnostic imaging
  • Medication Review
  • Patient Interview
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4
Q

MSK Exam:

  • Includes a medical _____ _______.
  • What are some restrictions we may see?
  • What are the types of imaging used with orthopedic conditions?
A
  • medical chart review
  • Weight-bearing (NWB, PWB, TTWB, WBAT, FWB), ROM, Orthotics, Exercise protocols
  • Radiography, CT, MRI, Bone scan, Myelography
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5
Q

Diagnostic Imaging:

  • ___________ is the standard for detecting injury to ______ as well as evaluating intraoperative and postoperative positioning of a procedure.
  • _________ are better for subtle/complex bone fractures and injuries to soft tissue.
  • ______ are best for diagnosing spinal disc injuries and soft tissue injuries.
  • ___________ assess bone density related to tumors and avascular necrosis as examples.
  • __________ is an x-ray/CT scan with a contrast dye to look for spinal conditions.
A
  • Radiography
  • CT
  • MRI
  • Bone scan
  • Myelography
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6
Q

What are the components of a MSK exam?

A
  • Observation
  • Pain
  • Cardiopulmonary
  • Integumentary
  • Sensation
  • ROM
  • Strength
  • Reflexes
  • Balance
  • Posture
  • Functional mobility
  • Outcome measure tool
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7
Q
  • When should pain levels be taken?

- Is there guaranteed pain with orthopedic conditions?

A
  • before, during, after

- Yes

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8
Q

With integumentary, note if there is drainage and look at the skin condition ________ to the injury/surgery.

A

distal

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9
Q

With sensation, assess ________.

A

distally and around surgical site

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10
Q

Balance assessment is essential, why?

A

Pain and joint dysfunction related to the injury/surgery will impact sensory input and ability to maintain/regain balance.

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11
Q

List some pain scales that are used.

A
  • Numeric 0-10
  • VAS
  • Wong-Baker Faces
  • Nonverbal Pain Scale (NVPS)
  • Brief Pain Inventory
  • McGill Pain Questionnaire (regular and short form)
  • Shoulder Pain and Disability Index (SPADI)
  • Lower Extremity Functional Scale
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12
Q

What (2) pain scales can be used for nonverbal patients?

A
  • Wong-Baker Faces

- Nonverbal Pain Scale (NVPS)

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13
Q

When looking for outcome measures, what drives your decision making?

A

What information do I need in order to assess patient ability, safety, and discharge needs?

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14
Q

MSK Considerations:

  • Decrease _____ and/or ______ guarding
  • Prevent _________/________ complications
  • Prevent _____ and ______ deficits
  • Improve ___________ mobility while protecting the involved structures
  • Post-op _________ effects
  • Effect of pain and pain medication(s)
  • _____ restrictions
  • Patient education on post-op precautions
  • Determining appropriate AD
  • Modifying _________ based on restrictions/precautions
  • Will any of the above increase ____ risk?
A
  • pain and/or muscle guarding
  • circulatory/respiratory
  • ROM and strength
  • functional
  • anasthesia
  • WB
  • mobility
  • fall
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15
Q

What is the best way to have patients learn their restrictions?

A

-Teach them the restrictions and then have them verbalize them back to you.

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16
Q

PART 2: JOINT REPLACEMEMENTS

A

PART 2: JOINT REPLACEMEMENTS

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17
Q

What are the 2 types of Knee Arthroplasties?

A
  • Unicondylar (unicompartmental) Knee Replacement

- Total Knee Replacement

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18
Q

Unicondylar (unicompartmental) Knee Replacement:

  • Only one compartment (medial or lateral) is replaced
  • Indicated when one compartment has degeneration and _______ and ________ ligaments are intact.
  • _______ allow for the preservation of normal knee kinematics.
  • Facilitates _________ recovery
A
  • cruciate and collateral
  • Does
  • quicker
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19
Q

Total Knee Replacement:

  • Replacement of the femoral condyles, the tibial articulating surface, and the dorsal surface of the patella.
  • Post-op WB status usually _____ but ALWAYS confirm, never assume.
A

WBAT

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20
Q

Total Knee Arthroplasty (TKA):

  • What is the usual reason for surgery?
  • Post-op WB status = ______ usually
  • What are some post-op concerns?
  • ____ machines are sometimes used.
  • What are their precautions?
A
  • Severe joint degeneration resulting from OA, RA, or trauma.
  • WBAT
  • DVT, PE, infection, pain, edema, patellar tendon rupture, patellofemoral instability, component failure or loosening, and peroneal nerve injury
  • CPM (continuous passive motion)
  • No specific movement restrictions.
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21
Q

Total Knee Arthroplasty (TKA):

  • What are the (3) evaluation components?
  • What are the requirements for D/C home?
A
  • P/AROM goni
  • Skin inspection at surgical site
  • Immediate D/C planning
  • Independent with HEP
  • Safe with household mobilization
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22
Q

TKAs have become “____ procedures” in which patients return same day as surgery.

A

“day procedures”

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23
Q

With TKAs post-op protocol will vary depending on the surgeon, however AROM and strengthening typically begin ___________.

A

immediately

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24
Q

With a TKA we are typically aiming to achieve __-__ degrees knee ext-flex. There is also a big focus on _________ mobility.

A
  • 0-90 degrees

- functional

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25
Q

What is the usual reason for Total Hip Arthroplasty (THA)?

A

Degenerated joint surface or repair following a fall.

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26
Q

With THAs, post-op WB status usually _____ but ALWAYS confirm, never assume.

A

WBAT

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27
Q

What are the precautions for THAs?

A
  • Posterolateral approach: no hip flex past 90, no adduction past midline, no IR past neutral
  • Anterolateral and 2-incision approaches: limit hip ext especially with ER
  • Avoid sleeping on surgical side
  • Avoid sitting on low surfaces
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28
Q

What are the possible complications of THAs?

A
  • Dislocation
  • Aseptic loosening
  • Hematoma formation, heterotopic ossification
  • Infection
  • Nerve injury, vascular damage
  • DVT → PE
  • MI, CVA
  • Leg-length discrepancy
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29
Q

What are the S/Sx of hip dislocation?

A
  • Excessive pain with motion
  • Abnormal internal or external rotation of the hip with limited active and passive motion
  • Inability to WB through LE
  • Shortened limb (leg length discrepancy)
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30
Q

Total Hip Arthroplasty (THA):

  • What are the (5) evaluation components?
  • What are the requirements for D/C home?
A
  • P/AROM goni
  • Skin inspection at surgical site
  • Measure leg length
  • Assess for possible neurapraxia, esp femoral and sciatic nerves
  • Immediate D/C planning
  • Independent with HEP
  • Safe with household mobilization
  • Independent with precautions
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31
Q

Will some patients require continued PT in inpatient setting?

A

Yes

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32
Q

Post-op Protocol will vary, however:

  • ______ wedge is often used.
  • Possibly knee immobilizer to prevent ________.
  • Adaptive equipment such as what?
  • Prescribe appropriate AD.
  • AROM/strengthening
  • _________ mobility (avoid pivoting on surgical LE, elevated bed)
A
  • ABD wedge
  • hip flexion
  • long handled reachers, shoehorns, leg lifter, elevated toilet seat
  • functional
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33
Q

What is the usual reason for Total Shoulder Arthroplasty (TSA)?

A

Degeneration of joint surfaces.

34
Q

What is the difference between a total shoulder arthroplasty and a shoulder hemiarthroplasty?

A
  • TSA- humeral and glenoid surfaces replaced

- shoulder hemiarthroplasty- only humeral surfaces replaced

35
Q
  • What is the most common approach to gain access to the humeral head with TSAs?
  • What is another that is becoming more popular and why?
A
  • Deltopectoral (most common)

- Lesser tubercle osteotomy (LTO), reduces amount of subscap dysfunction after surgery

36
Q

What are some complications with TSAs? (3)

A
  • rotator cuff tearing
  • glenohumeral instability
  • humeral fracture
37
Q

TSA Common Precautions:
-Avoid shoulder _________.
-No _______/________/_______ objects with involved upper extremity.
No excessive shoulder motion behind back, especially into ______.
No excessive stretching, especially into ____.
No supporting body weight by hand on involved side.
No driving for __ weeks.

A
  • AROM
  • lifting/pushing/pulling
  • IR
  • ER
  • 3 weeks
38
Q

TSA Patient Education:

  • Use of ______ for the management of pain and inflammation
  • Proper positioning for comfort and maintenance of the integrity of the surgical procedure (no lying on involved shoulder, use towel under elbow when supine).
  • Bringing the hand to the mouth with the ______ held at the side of the trunk.
  • Therapeutic exercise program/HEP.
  • To decrease distal edema, hand, wrist, and elbow active range-of-motion (AROM) exercises and ice packs may be used.
  • Squeeze a ball or sponge will help maintain ______ strength.
A
  • ice
  • elbow
  • grip
39
Q

What are some immediate TSA post-op exercises that can be done? (3)

A
  • Supine passive forward flexion with elbow flexed (Patient may passively move involved arm by using opposite hand to guide the movement).
  • Supine passive external rotation with arm at side and elbow flexed to no more than 30 degrees (Patient may passively move involved arm by using a wand or cane).
  • Pendulum exercises, clockwise and counterclockwise.
40
Q

When are reverse TSAs (rTSA) performed?

A

-When a patient presents with rotator cuff arthropathy, failed shoulder arthroplasty, multiple failed rotator cuff repairs, malunion of tuberosity after fracture.

41
Q

Are rTSA protocol and precautions similar to TSAs?

A

Yes`

42
Q

Joint Infection:

  • How will they present?
  • What are the treatment options?
A
  • fever
  • wound drainage
  • persistent pain
  • erythema
  • Antibiotics
  • Debridement with prosthesis retention or removal
  • 1 or 2 stage reimplantation
  • Arthrodesis (fusion)
  • Amputation (life-threatening conditions)
43
Q

Joint Resections:
-Removal of infected hardware and cement (___________)
-__-step process for reimplantation (Removal of hardware, period of IV antibiotics and antibiotic spacers)
Implant new prosthesis
-Possible ____ restrictions when spacers in place prior to new implantation
-Decreased pain tolerance during this period may adversely affect patient participation in PT
-Girdlestone procedure: may leave significant LLD

A
  • resection
  • 2-step
  • WB
44
Q

PART 3: SPINAL SURGERIES

A

PART 3: SPINAL SURGERIES

45
Q

Are there any cures for neck/back pain caused by things such as degenerative disc disease and herniation?

A

No

46
Q

What are some types of spinal surgeries performed?

A
  • Discectomy
  • Decompression
  • Laminectomy
  • Fusion
  • Total Disc Replacement
47
Q

Discectomy:

  • What is a discectomy?
  • Usually accompanied by ____________.
  • Also often done with _______: ACDF (anterior cervical discetomy and fusion)
  • Often done on ___________ basis.
  • Orthotic _______ usually not required.
A
  • Removes disc fragments and herniated disc material that compress adjacent nerve roots.
  • laminectomies
  • fusing
  • outpatient
  • bracing
48
Q

Decompression:

  • Removal of _________ elements of vertebral column (lamina, spinous processes).
  • Foramen widened to provide ________ relief on neural elements.
A
  • posterior

- pressure relief

49
Q

Laminectomy:

  • More _________ surgical procedure.
  • Lamina excised to provide more space and relieve _______ on neural elements.
  • Orthotic _________ usually not required.
A
  • involved
  • pressure
  • bracing
50
Q

Fusion:

  • _________ or ________ approaches.
  • Acts to ____________ hypermobile or unstable joints.
  • Fusion material: ________ (i.e., pedicle screws, interbody cages, plates) and ____.
  • Bone source: allograft or autogenous (iliac crest usual site).
  • Will orthotic bracing be prescribed?
A
  • anterior or posterior
  • stabilize
  • hardware or bone
  • Yes, exact type depends on location of surgery
51
Q

A _________________ is an alternative to fusion and is becoming more common.

A

Total Disc Replacement

52
Q

What are some complications of spinal surgery?

A
  • Neurological Injury
  • Infection
  • Cauda Equina Syndrome
  • Dural tear with CSF leak
  • Nonunion
  • General surgical complications
53
Q

List the spinal precautions for spinal surgery.

A
  • Log-rolling technique for getting in/OOB
  • Avoid excessive trunk flexion while seated
  • Limit extended periods of sitting
  • Lifting restrictions to < 5-10 pounds (may vary depending on protocol)
  • There are no LE WB restrictions
54
Q

What is a good way to remember spinal precautions?

A

BLT

-No bending, lifting (<5-10lbs), no twisting

55
Q

Spinal Surgery Evaluation Components:

  • ______/_______ ROM and strength assessment may be limited by spinal precautions.
  • Emphasize ___________ mobility.
  • Know wearing schedule of ________.
  • Ensure ________ knows schedule and how to don/doff.
  • Adhere to post-op spinal _________.
  • Emphasize proper body _________.
  • Schedule pain meds _______ to PT visit.
A
  • Neck/trunk
  • functional
  • orthotic
  • patient
  • precautions
  • mechanics
  • prior
56
Q

With spinal surgeries, they typically have ________ hospital LOS. The initial HEP will be ______ (only) and we will prescribe ____ as necessary for transition to home.

A
  • short
  • walking
  • AD
57
Q

PART 4: TRAUMATIC FRACTURES

A

PART 4: TRAUMATIC FRACTURES

58
Q

What are the (5) ways fractures can be classified?

A
  • Skin Integrity: Open or Closed
  • Site of Fracture: Articular, Epiphyseal, Diaphyseal
  • Classification: linear, oblique, spiral, transverse, comminuted, segmental, compression
  • Extent: Incomplete or Complete
  • Relative Position: Non-Displaced or Displaced
59
Q

Fractures can be managed both ________ and _____________.

A
  • Nonoperatively (Conservatively)

- Operatively (elective, urgent, emergency)

60
Q

Fracture reduction (putting pieces back together) can be done either _______ (_________) or ______ (________).

A
  • Closed (noninvasive)

- Open (invasive) = ORIF

61
Q

Fracture immobilization can be either _________ (cast) or _________ (ex-fix).

A
  • noninvasive

- invasive

62
Q

Fracture Complications:

  • ________ union, ____union, ___union.
  • Loss of fixation or reduction.
  • Deep vein _________, pulmonary or fat _________.
  • ______ damage, such as paresthesia or paralysis.
  • ________ damage, such as blood vessel laceration.
  • _____________ syndrome: 5 Ps
  • Infection.
A
  • Delayed union, nonunion, malunion.
  • thrombosis, emboli
  • nerve
  • arterial
  • Compartment Syndrome
63
Q

What is the difference between delayed union, nonunion, and malunion?

A
  • Delayed union: Healing slowed down.
  • Nonunion: No healing.
  • Malunion: Abnormal healing.
64
Q

What is Compartment Syndrome?

A
  • A painful and dangerous condition caused by pressure buildup from internal bleeding or swelling of tissues.
  • The pressure decreases blood flow, depriving muscles and nerves of needed nourishment.
65
Q

What are the 5 Ps of Compartment Syndrome?

A
  • Pain
  • Pallor
  • Paresthesia
  • Pulselessness
  • Paralysis
66
Q

Favorable Factors for Bone Healing:

  • Early __________
  • Early ____________
  • Maintenance of fracture reduction
  • _________ age
  • Good ________
  • Minimal _____-_______ damage
  • Patient ___________
  • Presence of _______ _______
A
  • mobilization
  • weight bearing
  • younger
  • nutrition
  • soft-tissue
  • compliance
  • growth hormone
67
Q

Unfavorable Factors for Bone Healing:

  • Tobacco smoking
  • Presence of disease, such as diabetes, anemia, neuropathy, or malignancy
  • ________ deficiency
  • Osteoporosis
  • Infection
  • Irradiated bone
  • Severe ____-_______ damage
  • Distraction of fracture fragments
  • Bone loss
  • Multiple fracture fragments
  • Disruption of _________ supply to bone
  • _____________ use
A
  • vitamin
  • soft-tissue
  • vascular
  • corticosteroid
68
Q

Pelvic Fractures:

  • Categorized according to disruption of the ___________.
  • What are the (3) types and explain them.
  • What usually causes pelvic fractures.
A

-pelvic ring

  • Type A: No disruption, is painful, but heals well.
  • Type B: Partial disruption.
  • Type C: Complete disruption, requires surgical fixation.

-MVC, can cause life threatening hemorrhaging.

69
Q

Femur Fractures:

  • _________ is associated with femoral shaft fractures.
  • __________ can also occur due to a femur fracture and can cause hypovolemia and shock.
  • Proximal femur fractures are subdivided into what (3) fractures?
A
  • High energy trauma
  • Hemorrhaging
  • trochanteric, head, and neck
70
Q

Tibial plateau fractures are usually due to _______ ______ to the proximal tibia and can cause complications at the popliteal artery and peroneal nerve.

A

direct trauma

71
Q

Calcaneal fractures are most often associated with ______ loading and direct trauma.

A

axial loading

72
Q

Both LE and UE fractures in the acute care setting are more than likely due to ________ _________ or ______________.

A
  • medical complication

- multitrauma

73
Q

Multitrauma Fractures:

  • What is the most common cause of multitrauma?
  • These patients may have multiple ____ restrictions.
A
  • MVC

- WB restrictions

74
Q

PART 5: MEDICATIONS

A

PART 5: MEDICATIONS

75
Q

What are NSAIDs used for?

A

NSAIDs are relatively inexpensive and are frequently the first line of medication used to relieve pain and reduce inflammation.

76
Q

What are the (3) main areas of adverse affects with NSAIDs?

A
  • GI
  • Kidney
  • Heart
77
Q

What are opioids used for?

A

Opioids are used mostly to treat moderate to severe pain.

78
Q

What are the 2 most common side effects of opioids?

A
  • Constipation

- Respiratory Depression

79
Q

What is PCA?

A

Patient Controlled Analgesia

-Patient can self-administer analgesic: as-needed and preprogrammed.

80
Q

What are common side effects of anasthesia?

A
  • Neuromuscular weakness (drowsiness)

- Impaired airway clearance

81
Q
  • What is the most common AE of antibiotics?
  • Which antibiotic can cause C.diff?
  • Which antibiotic can cause tendon rupture?
A
  • diarrhea
  • Clindamycin
  • Fluoroquinolones

S4- Acute Care (15 decks)

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