ortho part 1

Question 1

what are the primary goals for PT for acute ortho patients

Answer 1

1. early restorative mobility for max function

2. reduce risk of secondary complications

Question 2

what kind of image is an xray?

Answer 2

negative image: the more dense, the more absorption

Question 3

what method is used to read images?

Answer 3

ABCS - alignment, bone, cartilage, soft tissue

Question 4

how does a bone scan work?

Answer 4

greatest concentration of radiation absorption is the site of greatest metabolic activity

Question 5

what does a T1 weighted MRI tell you?

Answer 5

anatomic detail (think neuro pics)

Question 6

what does a T2 weighted MRI tell you?

Answer 6

underlying pathology

Question 7

what are signs of severe anemia?

Answer 7

fainting, chest pain, angina, and heart attack

Question 8

how does anemia present in the eyes

Answer 8

yellowing

Question 9

how does anemia present in the skin

Answer 9

pale, yellow, cold

Question 10

how does anemia present in respiratory system

Answer 10

SOB

Question 11

how does anemia present in the MSK system

Answer 11

weakness

Question 12

how does anemia present in the GI system

Answer 12

change in stool color

Question 13

how does anemia present in the CNS

Answer 13

fatigue, dizziness, and fainting (severe)

Question 14

how does anemia present in the blood vessels

Answer 14

low blood pressure

Question 15

how does anemia present in the heart

Answer 15

palpitations, increased HR, chest pain (severe), angina (severe), heart attack (severe)

Question 16

how does anemia affect the spleen

Answer 16

enlarges it

Question 17

what does general anesthesia do

Answer 17

produces a progressive and reversible CNS depression

Question 18

how might a general anesthesia patient present after surgery

Answer 18

drowsy, impaired cognition, weak, increased bronchial secretions, ventilation may be necessary

Question 19

where does anesthesia go?

Answer 19

needle into the subarachnoid to CSF

Question 20

how does an epidural work?

Answer 20

intermittant delivery of pain meds via PCA pump

Question 21

how does a peripheral nerve block work?

Answer 21

anesthetic bolus or catheterized into a specific nerve

Question 22

what type of anesthetic is given for TKA?

Answer 22

local femoral nerve block - effects quad activation/strength

Question 23

what is the most common anesthetic for and why should i care

Answer 23

exparel (bupivicane) - non opiod lasts up to 72 hours but side effects are dizziness, drowsiness, nausea, and constipation

Question 24

what anticoagulant is given post op to prevent DVT

Answer 24

low molecular weight heparin (warfarin) can be given up to 6 weeks post op

Question 25

name some types of opioids

Answer 25

oxycodone, hydrocodone, morphine, codeine, buprenorphine, fentanyl, tramadol

Question 26

how are opioids delivered in the acute setting

Answer 26

patient controlled analgesia (PCA) pumps

Question 27

when do you wanna schedule tx for a patient on opioids?

Answer 27

at max dose effect

Question 28

what is your primary informant in a CVP review of systems?

Answer 28

vitals

Question 29

what do you review in an MSK ROS?

Answer 29

observe for abnormalities and general strength screen

Question 30

upon primary observation of a patient, what should you consider

Answer 30

lines/tubes/equipment as well as how the room is set up

Question 31

what are the three scales for pain?

Answer 31

NPRS, VAS, and Wong-Baker

Question 32

what four things should you consider for integumentary integrity?

Answer 32

1. scars 2. bruising/cuts 3. surgical site/incision 4. limb color

Question 33

what do you screen for in sensory integrity

Answer 33

1. compartment syndrome 2. peripheral nerve injury 3. peripheral neuropathy

Question 34

what do you do in the involved extremity for ROM?

Answer 34

goni (for knees mostly), functional ROM, note what is limiting full range

Question 35

what do you do in the involved extremity for muscle strength

Answer 35

MMT, functional strength, what they can do before getting OOB

Question 36

approximately how much more effort is required to use a standard walker versus unassisted ambulation? versus a wheeled walker?

Answer 36

200% 100%

Question 37

what are four performance measures

Answer 37

10 meter walk test TUG 6MWT activity measure for post acute care (AMPAC) 6-clicks

Question 38

where do most in patient ortho patients end up

Answer 38

return to home

Question 39

exhaustive list of post op complications

Answer 39

``` Adhesions Constipation Contracture Delayed Wound Healing DVT/PE Infection Mal-union Muscle Guarding/Spasm Orthostatic hypotension Prosthetic Failure ```

Question 40

how do you decrease post op pain muscle guarding or spasm?

Answer 40

gentle rom, cold/heat depending on location of pain/spasm, and TENS

Question 41

how do you decrease post op edema?

Answer 41

elevation and active muscle pumping

Question 42

how do you prevent CVP complications post op

Answer 42

active LE exercise, deep breathing/coughing exercises, aerobic activities

Question 43

how do you prevent unneccessary joint stiffness/contractures post op

Answer 43

ROM exercises

Question 44

how do you decrease muscle atrophy across immobilized joints

Answer 44

isometrics

Question 45

how do you minimize loss of motion and strength in areas prox/distal to involved structures?

Answer 45

AROM and resistive exercises

Question 46

how do you improve functional mobility while protecting involved structures

Answer 46

AD, education, mobility training

Question 47

what do you education a patient and family on post op?

Answer 47

positioning post op precautions or contraindications exercise programs