OAT Surgical Pt Flashcards
(81 cards)
1
Q
Good techniques for a surgical patient include?
A
- MFR/FPR
- Direct inhibition
- Still
- Indirect
- ST
- Lymphatic pumps
2
Q
When do we stop OMT in a surgical pt?
A
- Tissue relax
- Vasodilation
- Increase HR/RR
- Discomfort
3
Q
CI for surgical pt
A
- Avoid direct manipulation over surgical site for 2 wks
2.
4
Q
CI: ____________ if midline abdominal incision or aortic aneurysm
A
Plexus inhibition
5
Q
CI: Sigmoid release if __________
A
recent left hemicolectomy
6
Q
CI: anterior abdominal incisions
A
Mesenteric release
7
Q
CI: fracture of rib/spine or recent spinal surgery
A
rib raising
8
Q
CI: DVT, LE fractures, or recent abdominal surgery
A
Pedal pump
9
Q
CI: lymphatic treatments
A
- osseous fx,
- bacterial infections with fever >102,
- abscess/local infection,
- certain stages of carcinoma
10
Q
CI: TI release if
A
- upper rib fx
- clavicle fx
11
Q
CI: Liver/spleen pumps if
A
- thoracotomy
- chest tube
- trauma
12
Q
In early postop patient, what procedures should be done in inflammatory stage (1-3)
A
- Facilitate lymph flow, improve mobility, restore biodynamic vitality
- Ex.
- Diaphragm release
- Rib raising
- Lymphatic pump
13
Q
In late postop patient (1-3 weeks), what procedures should be done?
A
- Treat:
- fascia/ tissues,
- SD
- viscerosomatic reflex
14
Q
How does postop OMT help patient?
A
- enhance analgesia
- reduce complications
- recovery
- decrease hospital LOS
15
Q
With atelectasis, we want to keep alveoli expanded. How?
A
- Thoracic inlet MFR
- Abdominal diaphragm release (direct w resp force)
- Rib raising & paraspinal inhibition
- C3-5 SD (phrenic n. via Stills)
16
Q
Post-op ileus = increases hospital stay = d/t ANS dysfunction (SANS>PANS). How do we treat?
A
- Supportive care: diet (NPO => liquids=> ..), stop opiods/anticho, correct electrolytes
- OMT:
- Mesenteric and colon release
- Pelvic diaphragm release
- Paraspinal ST
- SI gapping/sacral rocking
17
Q
What are goals of OMT in hospitalized patient?
A
- Promote homeostasis and ability to cope with disease
- Sleep, ambulation, eating, pooping pain relief
18
Q
What do we use OMT to treat in hospitalized patient?
A
- Dysfunctions that impede homeostasis, NOT long-standing/unrelated problems bc we dont want to use their NRG.
19
Q
What are specific objectives of OMT in hospitalized patient?
A
- Improve MSK fx
- Decrease reflex activity
- Relieve congestion and improve immune release
- stabilze ANS
- Enhance removal/waste from tissue.
- Enhance pulmonary ventilation/o2/cell nutrition
- restore peristalsis and bowel fx
20
Q
What are the 3 most important systems to focus on in hospitalized pt?
A
1. ANS
2. Respiratory
3. CV
21
Q
How do we diagnose hospitalized patients?
A
- Supine
- LR
- Seated
22
Q
When diagnosing spine and pelvis in a hospitalized patient, what does it mean if [too stiff/ too squishy]?
A
- Too stiff: flexed type 2
- Too squishy: extended type 2
23
Q
How do we want to treat hospitalized patients?
A
Combined treatments (Indirect; BLT, indirect MFR; craniosacral => direct; ME, direct MFR, NM inhibition, PINS)
24
Q
What is the goal of omt in a post-surgical patient?
A
Improve physiological function to help recover from illness or stress
25
Goal of OMT is to remove added somatic input and reduce the overall firing rate of segmental interneurons and the devistating, self-perp effects, also called \_\_\_\_\_\_
segmental facilitation
26
how do we reduce segmental facilitation
any procedure that normalized the somatic tissue and reduce nociceptive input
27
What area in OMT should we treat first?
**Facilitated segments**, (gently) because they have a decreased AP and fire off easy
28
How often should we treat facilitated segments?
Frequtly (even more than 1x/day). As process improves, freq decreases
29
Using the 5 factor model, how do we perform a **pre-op structural exam?**
Supine
**Biomechanical**: cervical/thoracic/lumbar/sacrum assess
**Resp/circulatory:**
* Lymphatic assess
* cranial assess
* Rib motion
**Neurologic:**
* somatovisceral and viscerosomatic
* TP counterstrain exam
* Chapmans
30
What is an OMT pre-op procedure we can do to decrease **post-op pulmonary problems?**
* OMT to reduce **mid-cervical SD (C3-5)**
* somatosomatic reflex that dmgs thoracoabdominal diaphragm (phrenic N)
*
31
Pre-op, if we are concerned about airway w anesthesia, what do we do?
**optimize C-spine** for intubation
32
What is a complicating factor before surgey
prescence of SD (faciltation= one cause of increased chronic pain)
33
TART findings from the **viscerosomatic reflexes** are from _______ pathologies and not primarily ________ dysfunctions
**visceral**, NOT somatic
34
Pre-op, how can we use OMT to manage a patient with cardiac risk factors?
**dec allostatic load =\> improve risk profile**
35
**Pre-op,** how can we use OMT to manage a patient with **pulmonary** risk factors?
**Pre-op,** how can we use OMT to manage a patient with **hepatic** risk factors?
**Pre-op**, how can we use OMT to manage a patient with **nutritional** risk factors?
**Pre-op**, how can we use OMT to manage a patient with **metabolix** risk factors?
**behavioral?**
* tx rib SD
* liver pump =\> help with hepatic congestion
* nutritional support for 7-10 days; WL
* IV fluids/insulin, correct metbaolic acidosis and glucose
* OMT = control pain in those using pain meds
36
Where do we evaluate **lymphatics**?
1. Cranio-cervical junction
2. Cervical-T junction
3. T-L junction
4. Lumbopelvic junction
37
What are post-op complication?
1. Treat patients complaints (back, neck, extremitypain)
38
In **post-othopedic** surgery, what do we treat?
* SD above and below to increase mobility
39
In **post-general surgery,** what do we treat?
* **ANY patients complaints based on needs**: most will get SD from laying in bed too long.
40
What is the FIRST priority in a post-surgical patient?
* healing from surgery; prioritize treatment based on what is needed for discharge
41
What is indicated in ALL **respiratory** disease?
Focused evaluation and treatment of **thorax**
42
When we have restiction motion in inhalation vs exhlation, it may help to suggest pathology. Descibe
* Exhalation SD (reduce excursion of thorax toward inhalation) =\> pneumonia
* Inhalation SD (thorax doesnt want to move toward exhalation) =\> asthma/COPD
43
**CHF**: ________ excursion; _________ compliance
**poor excursion**
**poor compliance**
44
**COPD in a patient in good health**: _______ exursion; \_\_\_\_\_\_\_compliance
* limited excursion
* spine and ribs ARE compliant
45
How do we treat **atlectasis** with OMT?
1. Rib raising
2. Dome diaphragm (Thoracoabdominal/diaphragmatic release)
3. Pectoral traction
4. ST and MFR to C3-5 for phrenic N stimulation
5. Tapotment (chest percussion)
6. Lymphatic pumps
7. Visceroscomatic: T1-6/T2-7 and CNX
46
**Pre-tibia edema** OMT Tx
1. **Lymphatics \***
1. Open thoracic inlet
2. Petrissage and eff
3. Rib raising
4. Lymphatic pump
2. **Viscerosomatic:** T10-L2 and S2-4
47
What occurs in post-op ileus?
**Peristalsis decreases:**
* Returns in **SI** in **24** hours
* **Right colon** =\> 48 hours
* **Left colon** =\> **72** hours
48
OMT for post-op ileus
1. Rib raising (T5-L2) will decrease post-op ileus by 99.7%
2. Mesenteric release
3. Paraspinal inhibition to NL sympathetic (lower GI/T10-L2)
4. OA/AA and sacral rocking to promote parasympathetics
49
What can decrease post-op ileus by 99.7%?
**RIB RAISING AT T5-L2**
50
52 year old female is POD #2 from open laparotomy for ruptured sigmoid diverticulum with abscess formation with c/o constipation, abdominal bloating and discomfort. Patient is afebrile, NPO, surgical drain from abdominal midline, and no bowel sounds in all four quadrants. Abdominal X-ray shows dilated loops of bowel. What is the sympathetic innervation of the colon that will regain its peristaltic activity first?
a) T1-4
b) T2-7
c) T5-9
d) T10-T11
e) T12-L2
51
What is the mainstay therapy for post-op pain?
**morphine**
52
OMT for post-op pain (3)
1. Rib raising + paraspinal inhibtion to NL hyperactive sympathetic activity
2. ST and MFR
3. Visceroscomatic: T1-L2 and CN10/S2-4
53
65 year old male is **POD#3** from CABG (coronary artery bypass graft) surgery c/o chest pain and constipation. He admits that he has zero pain tolerance and has been dependent on his pain medication. He has been begging the nurses for more pain medications. The nurse informs you that he hasn’t been able to drink much fluids and that he has yet to pass a bowel movement s/p surgery. Which of the following OMT techniques in addition to medical management (eg. stool softener & laxative) would most directly address the nurse’s primary concern?
a) Sacral inhibition
b) BLT for C3 FRLSL
c) Mesenteric release
d) Lower extremity petrissage
e) MET for T7 ERRSR
54
OMT for post-op anxiety and delirium
* **Calming techniques:**
* **sub-occiptal inhibition**
* **CV4**
55
Osteopathic manipulative treatment applied after a major
gastrointestinal operation is associated with
1. Decreased time to flatus
2. Decrease post-op LOS
56
in OMT, what is inhibition?
**sustained deep pressure** over hypertonic muscle; pressure directed to **MUSCULOTENDON JUNCTION**
57
In a pt with acute herpetic stomatitis (shallow ulcers), wht is the plan?
SD is where?
**Cervical, thoracic, rib**
1. Antiviral meds
2. ST on hypertonic cervicothoracic muscles
3. ART to rib
58
5 factor OMT model to post-op patient
1. Biomechanical
2. Resp/circulatory
3. Neuro
4. MEtabolic-energic
5. Behavioral
1. Biomechanical
1. Postural muscles, spine and extremties
2. Resp/circulatory
1. Diaphragms (thoracic inlet, thoracoabdominal, pelvic)
2. Venous and lymph drainage
3. Neuro
1. ANS
2. Tx: Sympathetic ganglia, Parasympathetic vagus n and parasympathetic pelvic splancnic
4. MEtabolic-energic
1. if we treat other models first can treat this if we consider relationships
2. homeostasis, NRG balance, reg process, inflamm and repair,
5. Behavioral
1. Psycholical and social activities (Diet, excersie, metal status)
59
The most common manipulative method to modify sympathetic activity in the upper GI tract and small intestine is…
a) OA release
b) Rib Raising to T5-T11
c) Sacral Rocking
d) Muscle Energy to T1-6
e) Counterstain Tender point
b)Rib Raising to T5-T11
* Upper GI (T5-9)
* SI and R colon (T10-11)
60
Regarding the osteopathic treatment of this patient, which of the following structures most likely plays a role in the maintenance of ileus in his post-abdominal surgery period?
* a)Facial nerve
* b)L5 nerve root
* c)Phrenic nerve
* d)Spinal accessory nerve
* e)Vagusnerve
61
Current treatment for post-abdominal surgery patient often indicates the use of SCDs (sequential compression device) for prophylaxis of DVT. What manipulative technique may also be beneficial?
a) Cervical HVLA
b) ME for L on R sacral torsion
c) Gentle effleurage
d) Mid-thoracic paraspinalsoft tissue
e) Paraspinalinhibition
62
Your attending has ordered rib raising and paraspinalinhibition for your post surgical patient. What is the rationale for this treatment?
a) It will normalize CSF flow
b) It will increase parasympathetic activity to intestinal tract
c) It will inhibit rib motion to decrease pain
d) It will reduce sympathetic hypertonicity to intestinal tract
e) It should not be ordered because it is contraindicated in a patient with acute abdominal pain.
63
Your attending has ordered rib raising and paraspinalinhibition for your post surgical patient. What is the rationale for this treatment?
* a)It will normalize CSF flow
* b)It will increase parasympathetic activity to intestinal tract
* c)It will inhibit rib motion to decrease pain
* d)It will reduce sympathetic hypertonicity to intestinal tract
* e)It should not be ordered because it is contraindicated in a patient with acute abdominal pain.
64
**Suboccipital Decompression** adds gentle traction to what ganglion?
**superior cervical ganglion** and **vagus nerve** (related to the OA and suboccipital tissue)
65
Suboccipital decompression technicque
1. Doc places finger pads in pts s**uboccipital sulcus/groove**
2. Carry elbows medially, adding lateral traction to subocc tissue
1. add traction to occipupt
3. hold until release is felt
66
Cervical Ganglia Inhibition
1. Doc places fingerpads on **articular pillars** of patients cervical spine
2. move fingers in a**nterior-superior direction**
67
Posterior Abdominal Diaphragmatic Releases: (Releasing the Lumbar Spine/Crura) (BLT), what segments of spine are evaliated
**T12-L3**
68
Posterior Abdominal Diaphragmatic Releases: Releasing the Lumbar Spine/Crura (BLT)
PT supine; doc at side of table
1. Doc evals T12-L3
2. Contacts SP on either side of vertebral unit that has SD
3. Move it in directions that exag FOM: F/E, rotation, SB
69
**Rib Raising**
•Position: Patient is seated with arms crossed in front of the chest. Physician stands in front of the patient.
1. The patient's arms are supported on the physician's chest, and the physician's hands reach around the patient to contact the patient's ______ on both sides
2. The physician leans so that ______________ occurs and simultaneously carries the contact with the patient's ribs, ______ and \_\_\_\_\_\_\_\_.
3. The physician's hand contacts with the patient's rib angles ____________ and the procedure is repeated until all of the patient's ribs have been raised. A focused effort may be placed on any region that exhibits the greatest restriction.
1. rib angles
2. extension of patients thoracic spine
3. anterior and superior
4. superior and or/ inferior
70
**Thoracic inlet release** opens \_\_\_\_\_\_\_
**terminal lymphatic drainage**
71
Thoracic inlet release is a ______ technique
**BLT**
72
Abdominal diaphragm release is a _______ technique and improves what
* **direct MFR** with resp cooperation
* improves **respiratory biomechanics** and **lymphatic drainage** from lungs
73
**Abdominal Diaphragm Release**
1. With the patient supine, the physician grasps the sides of the rib cage.
2. Observe the respiration to determine \_\_\_\_\_\_\_\_\_
3. Carry the diaphragm to the ___________ barrier in rotation, sidebending, and flexion/extension.
4. The patient takes some deep breaths as the physician maintains the fascial barrier while resisting __________ on the side with best motion.
5. Recheck.
1. With the patient supine, the physician grasps the sides of the rib cage.
2. Observe the respiration to determine the **most restricted hemidiaphragm.**
3. Carry the diaphragm to the **restrictive** **barrier** in rotation, sidebending, and flexion/extension.
4. The patient takes some deep breaths as the physician maintains the fascial barrier while **resisting inhalation** on the side with best motion.
5. Recheck.
74
job of rib raising
**improve resp biomechanics**
**lymphatic drainage**
**normalize sympathetic tone**
75
**Rib Raising (prone)**
1. Apply ____________ traction to the _________ rib angles until ________ motion of the chest is observed.
2. Maintain _________ traction until tissues soften.
3. May be applied once to each rib group or rhythmically for several cycles.
4. Treat bilaterally.
1. anterolateral
2. posterior
3. anterior
4. anterolateral
76
**Cervical Soft Tissue job**
* 1. **Normalize** **parasympathetic** tone to lungs
* **2. remove cervical SD** that may affect the innervation of the **abdominal diaphragm arising from C3-5**
77
**cervical ST** treats from _______ =\> \_\_\_\_\_\_\_\_\_
**cervicothoracic** to **occipitocervical** junctions
78
**Thoracic Pump with Recoil**
* A lymphatic pump used to (3)
1. **aerate alveoli**
2. **prevent atelectasis**
3. **mobilize lymphatic fluids**
79
**Thoracic Pump with Recoil**
* 1. Turn the patient’s head to one side.
* 2. Physician places his palms on the patient’s chest with hands spread over the chest or medial and lateral to breasts for female patients.
* 3. Have the patient take a deep breath and let it all out. During ______ the physician follows the thorax (gentle springing may be applied). Maintain the compressive force and instruct the patient to \_\_\_\_\_\_\_\_\_. Resist _________ motion, and when sufficient force accumulates, \_\_\_\_\_\_\_\_\_\_
* 4. Repeat as needed.
* =\> compress during exhalation
* =\> resist inhalation
* =\> suddenly release compression
80
Note: The r**ecoil portion** of this **[thoracic pump w/ recoil]** technique is **contraindicated** in _________ patients.
**COPD**
81
