Flashcards in Exam 1: Monday 8/24/15 Deck (50):
Name some medications that thin blood.
If a patient's is having their blood thinned, what type of test do they have done to check blood viscosity?
Prothrombin time (PTT)
What measurement does prothrombin time (PTT) give you?
Time to clot
What is INR and why was it made?
International normalized ratio- it was made because normal clotting time was so variable from one place to another
What is considered a normal INR?
When thinning blood, what should INR be?
Between 2.0 and 2.5, some references say up to 3.0, but Bringman said to use these numbers
If a patient has a known clot, what INR will they be bumped to?
Name the 2 types of DVT
occlusive- completely stops blood flow
non-occlusive- narrows the canal, can grow the length of the vessel, but doesn't stop blood flow
How will a DVT present objectively?
Might be painful, tender, warm, redness, (+) Homan’s (not a good test though), Well’s DVT score
What should you do if you suspect a DVT in the hospital?
If you suspect tell the nurses, don’t weight bear, call the doc, probably not going to do exercises
Check bilaterally, is this pain new?
Name the signs and symptoms of blood that is too thin
Bruising with things that shouldn’t cause
Little bruises all over the place
Might get petechiae- small red or purple spot in the skin
Cuts keep bleeding
Nosebleed- compression, something to catch the blood, lean forward
Can get internal bleeding- particularly bowels- if they have hemorrhoids, history of ulcers
Blood in urine- a big one
Coughing up blood- respiratory infections
What is considered a normal hemoglobin?
normal is around 12-13 g/dL
Under what g/dL hemoglobin may you not work with a patient?
A patient in the hospital has been in bed for some time now with an Hgb of 7g/dL. What are you concerned about?
bedsores and pneumonia and atrophy
A patient in the hospital has been in bed for some time now with an Hgb of 7 g/dL. How would you make your case to the physician to let you work with that patient?
use an O2sat monitor while working them, ask them how they feel- are they symptomatic?- check BPs, can put them on O2 as well if the doc wants, but we're concerned about atrophy, bedsores and pneumonia now
If working with a patient on blood thinners in OP, what do you need to ask specifically?
See if they’re actually taking their meds/getting their blood checked; Are they taking any supplements or something that might thin their blood? Does it double the effect?
What kinds of things can thin the blood?
Blood thinners can be amplified by leafy green vegetables, especially darker greens, vitamin E is supposed to be a blood thinner.
If a patient overdoses on blood thinners, what do we give them to thicken their blood?
vitamin K to thicken blood
Who is our general total shoulder patient?
Lots of overuse that leads to OA/horrible OA to the point arm becomes non-functional
Bad enough fall/fracture
Why is an older patient with rotator cuff impingement a candidate for a total shoulder?
creates rotator cuff tear- elderly aren’t considered good candidates for rotator cuff repair, lots of lifting restrictions, at LEAST 12 weeks, and still at risk of a tear- bad mechanics lead to impingement, so we go in and replace it
What is the difference between a total shoulder arthroplasty and a reverse total shoulder?
A total shoulder replaces the original anatomy while a reverse total shoulder reverses the convex and concave surfaces to give greater biomechanical advantage.
Which has better outcomes in ROM: TSA or a reverse total shoulder?
Reverse total shoulder is better- 90 degrees is considered "good" in a TSA
The PT is seeing a total shoulder for the first time. What questions might you want to ask?
What was your PLOF?- big
What is your home like?
Were you using an assistive device before?
Did you rely on that shoulder to use that assistive device? Do you need that arm for functional bed mobility?
When seeing a total shoulder patient in the hospital, what kinds of items and devices may they have in their room?
Might have a sling, might have an ice pack, might have a JP (jackson pruitt) drain, may have a pain delivery system- may be PCA (patient controlled)
How does a PCA work?
The patient gets a basal rate of pain medicine and can get a certain number of pushes an hour in addition to that basal rate- you NEVER push the button
What is the issue with family or others pushing a PCA for a patient?
They may not really be in enough pain to warrant extra pain meds and enough pain meds can subdue the brainstem and the body’s basic functions- breathing/sleep/wake cycles decrease- they better have a CO2 monitor on, or they may code
What is a Naloxone injection used for?
It is used to reverse opioid overdose by knocking opioids off of all your neural receptors all at one time. Patients that have this injection will return to normal almost immediately, however all of their pain will come back very quickly.
What are Codman's exercises and what is the issue with them?
Pendulum exercises for the shoulder- most patients don't shut off their muscles enough to really do the exercises correctly
When working with a shoulder patient, what should you not forget?
elbow, wrist and hand!
Why should you never have a patient squeeze a tennis ball?
too much resistance and splays the hand out into a rounded shape where isn’t not supposed to rather than a sloped back of the hand
What ADL's are good to address with a shoulder patient?
toileting, showering- washing hair
What should a shoulder patient avoid similarly to a TKA?
long showers and soaking in a bathtub early after surgery- risk of infection
Why are a lot of your total shoulder patients at risk for infection?
sweat in southeast GA, and in a sling, yeast, elderly may be not taking regular showers/baths but sponge bathing, elderly like using powders which just hold on to moisture and keeps it there
What do you want to address with a total shoulder patient to avoid infection?
try to get them to get air flow so moisture doesn't build up, get them to wash it at least once a day
When addressing toileting with a total shoulder patient what do we want to think about?
assess balance, ROM in shoulder to wipe themselves- typically with the dominant arm
In addition to normal PT stuff, what else should you assess in a total shoulder patient?
What does a tibial plateau fracture predispose us to?
Typically what sort of stress leads to a tibial plateau fracture?
varus or valgus stresses, not usually straight axial loading as the bones are made to withstand that
What type of fracture is a tibial plateau fracture usually?
Compression fracture that leads to a step off- this is what predisposes them to the OA as now the joint has more wiggle room
How might the doctor diagnose a tibial plateau fracture?
Using a dye study
What are the two options for dealing with a tibial plateau fracture?
If it's not displaced you can leave it to heal on its own
If it's significantly displaced, they may do a wedge where they put a screw in the approximate the bone back close to its normal height, or if it's really bad, a true wedge may be put in rather than a screw.
How does a tibial plateau fracture patient present in the clinic?
Pain and NWB status with an immobilizer or drop lock brace
What do you want to avoid with a tibial plateau fracture?
Extreme ROM- it adds compression to the tibial plateau
How do we treat a tibial plateau fracture?
protocol driven, by the time they are free to FWB they will most likely have lost muscle and ROM- hard to figure out what to do with them when NWB- gonna be using a walker and need help with learning how to take stairs with crutches, using a wheelchair, ambulating with a walker NWB, etc
What is the MOI in a patellar tendon rupture?
too much eccentrics makes it pop muscles fire so hard it pops it, typically they started to fall, caught themselves, then fell- happen bilaterally a lot too
What will a patient with patellar tendon rupture look like walking into your clinic?
in an immobilizer they can walk and weight bear on it, post surgery, however ROM is going to be stuck at dead zero for a while
What are we worried about with a patellar tendon rupture patient after surgery?
Because they are locked out at 0 for some time, we are worried about a DVT; need to be in TED hose and doing tons of ankle pumps to move blood
After a total hip (posterolateral approach), how may a patient sleep?
lay on their back or on the side of their surgery (uncomfortable but don’t want them going into extreme adduction)
After a TKA, what should a patient avoid when sleeping?
pillows under the knee