OAT: Surgical Patients Flashcards
(90 cards)
1
Q
why the fuck do you do an OSE on a hospitalized patient?
A
literally because it just offers clues for overall asessment
2
Q
good techniques for surgical patients
A
- MFR/FPR
- still technique
- indirect
- soft tissue
- lymphatic pump
3
Q
CONTRAINDICATIONS FOR SURGICAL PATIENT
A
- avoid direct manipulation on/over surgical sites for 2wk\
- abd plexus inhibition if midline abdominal incisions or aortic aneurysm
- sigmoid release if recent left hemicolectomy
- mesenteric release if anterior abdomial incisions
- rib rising if fracture or spinal surgery
- pedal pump if DVT, lower extremity fracture, or recent abdominal surg
- lymphatic tx relatively if osseous fracture, bacterial infection with fever over 102, abscess, or certain stages of cx
- TI release if upper rb fracture/clavicle fracture
- liver/spleen pumps if thoracotmy, chest tube, or trauma
4
Q
early post op: inflammatory stage
A
day 1-3
5
Q
early post op: diuresis stage
A
day 4-6
6
Q
late post op
A
1-3 weeks
7
Q
early post op: inflammatory stage–FOCUS?
A
circulatory and pulm first; prevent atelectasis and maintain circultation
facilitate lymph flow
techniques: diaphragm release, rib raising, lymphatic pump
8
Q
early post op: diuresis stage–FOCOUS?
A
- lymphatic, GI, renal, and ANS
- ensure mobility of thoracic cage and outlet
9
Q
late post op–OMT retults?
A
enhances analgesia, reduce complications, aid in recovery, maybe decrease hospital length of stay
10
Q
why we do OMT them boi in the hospital?
A
- promote homeostasis and patient abilty to cope
- sleep, ambulation, eating, poopin, pain reflief
- treat dysfuntion that impede homeostatic impede homeostatic porcesses
11
Q
issues with OMT in hospitalized pt
A
- privacy
- modesty
- turn off TV
- objects in the way
- surgical incisions and dressings
- decubitous ulcers
12
Q
how to diagnose spine if they not prone
A
- spring along axial spine and pelvis
- if too stiff–flexed type 2
- if too squishy–extended type 2
- tissue texture changes
13
Q
what happens if rapid movements of vertebral unit?
A
create sympathetic motor outburst from the related an also distant facilitated spinal cord segments
14
Q
what happen if pain is experienced at a facilitated segment?
A
creates further facilitation
15
Q
facilitated segments are often the result of what?
A
acute visceral processes
16
Q
muscle has ___ concentration of nociceptors, whereas joint capsules have ____ concentration of nocieptors
A
low; high
17
Q
preoperative examination: biomechanical approach
A
-cervical/thoracic/lumbar/sacrum spinal assesment
18
Q
preoperative examination: respiratory-circulatory
A
-lymphatic assesment, cranial assesment, rib motion
19
Q
preoperative examination: neurologic
A
-somatovisceral and viscerosomatic considerations, TP conuterstrain exam, chap reflex
20
Q
OMT pre-op to reduce mid cervical SD has been shot to what?
A
decrease post op pulmonary complications
21
Q
what is one cause of increased chronic pain?
A
facilitation
22
Q
Pre-op assement for surgical risk factors: Cardiac
A
ejection fraction <35%, presence of JVD, recet MI w/i 6months
23
Q
Pre-op assement for surgical risk factors: pulmonary
A
smoking, COPD, sleep apnea, rib SD
24
Q
Pre-op assement for surgical risk factors: hepatic
A
ascites, bilirubin >2, prothrombin time >16s, albumin <3, encephalopathy
25
Pre-op assement for surgical risk factors: nutritional
```
albumin <3, loss of 20% body wieght over 6 months
-BMI>40 (class 3 obese)
```
26
Pre-op assement for surgical risk factors: metabolic
diabetic ketoacidosis/coma
27
Pre-op assement for surgical risk factors: behavioral
illlicit drug and alcohol use
28
why do even perform post op OMT?
- shorten hosptial stay
- decrease morbidity and mortality
- decrease post op pain
- facilitate lymphaticc flow and improve diaphragmatic mobility
- increase patient satisfaction
29
CHAP: esophagus
A: bilateral 2nd ICS
P: bilateral b/w TP and SP of T2
30
CHAP: pylorus
A: sternal
P: right T10 at costotransverse joint
31
CHAP: liver
A: right 5th ICS
P: right b/w TP and SP b/w T5 and T6; right b/w T6 and T7 b/w TP and SP
32
CHAP: gallbladder
A: right 6th ICS
P: right b/w T6 and T7 b/w TP and SP
33
CHAP: pancreas
A: right 7th ICS
P: right b/w T7 and T8 between SP and TP
34
CHAP: small intestines
A: bilateral 8-10th ICS
P: upper--b/w T8 and T9 b/w TP and SP
mid--b/w T9 and T10 b/w TP and SP
low--b/w T11-T12 b/w TP and SP
35
CHAP: stomach acidity
A: left 5th ICS
P: left b/w T5 and T6 b/w TP and SP
36
CHAP: stomach peristalsis
A: left 6th ICS
P: left b/w T6 and T7 b/w TP and SP
37
CHAP: spleen
A: left 7th ICS
P: left b/w T7 and T8 b/w TP and SP
38
CHAP: appendix
A: right 12th rib tip
39
CHAP: cecum
A: right proximal IT band
40
CHAP: proximal transverse colon
A: right distal IT band
41
CHAP: sigmoid colon
A: left proximal IT band
42
CHAP: distal transverse colon
A: left distal IT band
43
treatment goals of lymphatic treatment in post op
improve oxygenation and nutrients
| reduce risk of infection, healing time, fibrosis and scarring
44
biomechanical SD in post op: contributing factors
duration of surgery
position in surgery
inactivity
prolong bedrest
45
how often does paitents get post op fever
40%
46
Post op fever--rule of W's
```
wind; POD 1-2
water; POD 3
walking; POD 5-7
wound; POD 7-10
wonder drug; POD 7+
```
47
WIND; POD 1-2
management:
- atelectasis: CXR, deep breath + cough, incentive spirometry
- pneumonia: sputum cultures, antibiotics
48
WATER; POD 3
management: UTI--UA, urine culture, remove foley, antibiotics
49
WALKING; POD 5-7
management: DVT/PE--Us w/ venous doppler, CT andiogram, heparin with warfarin, IVC filter
50
WOUND; POD 7-10
management: wound infection--US/CT, antibiotics, inscision + drainage, wound care
51
WONDER DRUGS; POD 7+
remove unmecessary drugs
52
what is the most likely complication when s/p abdominal surgery?
pulmonary
53
what kind of restricted motion will pneumonia patients have?
reduced excursion of the thorax toward inhalation locally over the area of consolidation
54
what kind of restricted motion will asthma patients (and other obstructive diseases) have?
reduced excursion of the thorax towards exhalation
55
35-60% of thoracic duct lymphatic duct flow is due to
the response and effects of respiratory movements
56
contributing factors to atelectasis
anesthesia and mechanical ventilation
bed rest (bc limit breathing movements)
pain
obesity, smoking, respiratory distress
57
PFT changes related to atelectasis
```
decreased tidal volume
increased inspriatory and expiratory pressures
decreased vital capacity
decreased functional residual capacity
decreased alveolar ventilation
```
58
breathing pattern that leads to atelectasis
shallow breaths without maximal inhalation lead to alveolar collapse
59
OMT management of atelectasis
```
rib raising
thoracoabdominal diaphragm release
pectoral traction
soft tissue and myofascial release to C3-5 for phrenic n stimulation
tapotment
lymphatic pumps
viscerosomatics= T1-6/ T2-7 AND CN10
```
60
contributing factors for pre tibial edema
immobility bc bed rest
systemic inflammation secondary to surgery
insufficient circulation & lymphatic drainage
61
medical management of atelectasis
bronchodilators
mucolytic agents via neb
cough, deep breathing exercising, incentive spirometry, early ambulation
(early mobilization has been shown to decrease LOS by 1.1 days
62
medical management of pretibial edema
venous stasis reduced with early ambulation and SCD
leg elevation if allowed
instructing patients to "spell the alphabet" with their feet
63
what the fuck is SCD?
sequential compression device
| it compresses the legs in a proximal direction every 2-3 mins
64
OMT management of pretibial edema
lymphatic treatments
| viscerosomatic=T10-L2 and S2-4
65
treating atelectasis and pretibial edema falls under which model?
respiratory circulatory
66
treating post op ileus falls under which osteopathic model
metabolic energetic
67
contributing factors to postop ileus
```
anesthesia
extensive surgical manipulation
extended bedrest
narcotic use
electrolyte abnomalities
```
68
when does peristalsis return to the bowels?
small intestine--24hr
right colon--48hr
left colon--72hr
69
signs and symptoms of post op ileus
slight abdominal distention
absent bowel sounds
dilated loops of bowel on xray
70
medical management of post op ileus
- no specific therapy?
- just fuckin wait to for them to poop before u try advancing diet
- reduce opiods for pain management
- correct any underlying electorlyte abnormalities
71
OMT management of post op ileus
- rib raising at levels T5-L2
- mesenteric release
- paraspinal inhibition to normalize sympathetic activity
- OA/AA treatements and sacral rocking to promote parasympathetic activity
72
what are the benefits of OMT for post op ileus
decreased time to first fart and decreased post op hospital stay
73
mainstay therapy for post op pain
FUCKIN OPIOIDS
74
side effects of opioids
```
respiratory depression
nausea
vomiting
clouded sensorium
constipation
```
75
treating post op pain is considered which model?
neurologic
76
contributing factors to post op pain
duration of operation
degree of operation trauma
incision type
intraoperative reaction
77
medical management of post op pain
gentle handling of tissues
expedient operations
good muscle relaxation
opiods for pain management
78
OMT management of post op pain
- rib raising w/ paraspinal inhibition to normalize hyperactive sympathetic activity
- soft tissue and myofasical release
- viscerosomatic=T1-L2 & CN 10/ S2-4
79
____ and _____ are normal in patients undergoing surgery
anxiety and fear
80
a history of what may exaggerate patients response to surgery
under lying depression or chronic pain
81
contributing factors to anxiety and delirium related to surgery
drugs>>psychosis: meperdne, cimetidine, corticosteriods
electrolyte abnormalities
delerium tremens (alochol withdrawl seen POD 2-3)
hypoxia, sepsis, ARDS
82
treating anxiety and delirium is part of what model?
behavioral
83
define delirium
visual hallucinations, delusions, acute orientation difficulties, memory impairment
-sx wax and wane and are temporary, secondary to underlying cause
84
medical management of anxiety and delirium
- treat underlying cause
- supportive care: frequent reorientation, remove barriers to communication, optimise sleep-wake cycle
- anxiolytics
- antipsychotics
85
OMT management of anxiety and delirium
calming techniques: subooccipital inhibition and CV4
86
5 model OMT approach to Post Op PT: biomechanical
- postural muscles
- spine
- extremites
- myofascial relationships of the organs
87
5 model OMT approach to Post Op PT: respiratory-circulatory
- diaphragms: thoracic inlet, thoracoabdominal, pelvic
| - venous and lymphatic drainage
88
5 model OMT approach to Post Op PT: neurological
- ANS
| - treat sympathetic ganglion, parasympathetic vagus N, and parasympathetic pelvic splanchnic
89
5 model OMT approach to Post Op PT: metabolic-energetic
- treating the other models first can therby treat this model taking into consideration the relationship to the interal organs and endocrine glands
- homeostasis , energy balance, regulatory processes, inflammation and repair, absorption of utrients, and removal of waste are all targeted goals
90
5 model OMT approach to Post Op PT: behavioral
psychological and social activities: diet and exercise, and mental status
