Osteopathic Approach To The Hospitalized Patient

Question 1

What to do first before starting OMT?

Answer 1

Ensure there is an order on the chart for OMT

Identify the reason both on the chart and to the patient

Review the patients chart and do a quick assessment
- look for any contraindications

Question 2

What should you do with a patient upon seeing them for the 1st time for treatment?

Answer 2

Explain OMT

Explain why they are getting the treatment

Explain risks and benefits

OBTAIN CONSENT
- verbal is fine but needs to be documented

Question 3

Do you have to repeat the history and physical before OMT if the physcian has already done it?

Answer 3

Yes

Question 4

Chart review parts

Answer 4

Review for past medical history of

• cancer
• osteoporosis
• fractures
• disc herniations
• MSK disorders

Past surgical history for

• old/new surgeries
• bad labs
• current vital signs

Medications
- pain control specifically (must be stable)

Look for pending orders for

• DVT or PEs
• NSTEMIs
• suspicious Mass

these can all be contraindications

Question 5

What techniques are usually safe for hospital treatments?

Answer 5

CS

FPR

MFR

BLT/LAS

Viscerosomatic

Lymphatic

Cranial manipulations

Question 6

General contraindications

Answer 6

CVA’s

Intracranial hemorrhage

DVT/PE

MI

Newly diagnosed cancers

Unstable/uncooperative

Fracture

A true febrile illness w/out antimicrobial treatment

Question 7

The goal of OMT

Answer 7

Return the patient to as close to baseline as possible

- dont overwhelm the patients system and dont try to cure everything

Question 8

Common complaints in the hospital that can be treated w/ OMT

Answer 8

COPD/asthma

Pneumonia

Headaches

Neck/back pain

Non cardiac chest pain

Edema

Constipation, diarrhea, illeus

Postpartum care

Poor suckling

Question 9

Affects of post surgery to be aware of

Answer 9

GI tract slows down

Kidney functions slow down

Bladder may be distended due to urinary retention or spasms

Pulmonary function often decreases

Condition slows

Cardiac perfusion is altered

Question 10

Sequelae of intubation

Answer 10

3 things

Hoarseness

Sore throat

Cervical dysfunction (usually extension)

Question 11

Post op fever with 4 Ws

Answer 11

Wind (check for pulmonary)

Wound (check for open wounds/ internal bleeding)

Water (check bladder distention and UTIs)

Walking (check for DVT/ edema)

Question 12

MOPSE study

Answer 12

OMT use in hospital has shown to

• decrease length of hospital stay
• decrease length of IV antibiotics
• increases patient satisfaction
• decreases rate of complications
• decreases need for pain control

Question 13

Sympathetic effects on the lungs and GI tracts

Answer 13

Lungs:

• bronchiolar smooth muscle relaxes
• respiratory epithelium increases number of goblet cells and secretions

GI tractor:

• sphincters contract
• secretion and motility decreases

Question 14

Parasympathetic affects on the lungs and GI system

Answer 14

Lungs:

• bronchiolar smooth muscle contracts
• respiratory epithelium decreases number of goblet cells and secretions

GI tractor:

• sphincters relaxes
• secretion and motility increases

Question 15

Treating the pulmonary and GI system consists of

Answer 15

Lymphatic techniques

• thoracic inlet
• respiratory diaphragm
• respiratory pumps

Balance sympathetics
- rib raising and viscerosomatics

Balance parasympathetics
- OA