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Orthopedic & Neurological Patient Population. Med Surg II. TOTAL JOINT ARTHROPLASTIES. Total Knee Arthroplasty (TKA). Meds Analgesics for Pain: Ocycodone, Percocet, Vicoden, Lortab OR Epidural Anticonstipation: Colace Antibiotics: Cefadroxil, Levafloxacine Antinausea: Zofran

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total knee arthroplasty tka
Total Knee Arthroplasty (TKA)
  • Meds
    • Analgesics for Pain: Ocycodone, Percocet, Vicoden, Lortab OR Epidural
    • Anticonstipation: Colace
    • Antibiotics: Cefadroxil, Levafloxacine
    • Antinausea: Zofran
    • Blood thinner: Coumadin
  • Labs/Diagnostics
    • Hb, Hct, WBC, PT, PTT, INR
    • Post Xray for component placement
  • Medical Equipment
    • PAS stockings or foot pumps
    • O2 @ 2L
    • Foley
    • Hemovac
    • Knee immobilizer
    • CPM
total knee arthroplasty tka1
Total Knee Arthroplasty (TKA)
  • Precautions/Contraindications
    • WBAT
    • No shower if drainage
    • Physician changes the first bandage
    • Hold the Post OP leg during bed mobility for comfort
    • When sitting, bring surgical leg forward for comfort
    • B TKA place walker farther out b/c decreased knee ROM will place feet in front of knees
total knee arthroplasty tka2
Total Knee Arthroplasty (TKA)
  • PT Eval – Unilateral, Bilateral, Unicompartment
    • Goniometric measurement of knee extension - flexion
    • Screen incision
    • Screen Sensory
    • Screen Muscle Strength
    • General mobility of bed, transfers, gait
  • PT POC – 3 Days
    • BID for exercise and gait
    • Stairs, car, tub/shower Tf
    • Cold Pack
    • Change in position elevation (edema management) to sitting with knee flexed (prolonged stretch for knee flexion)
    • Pt Ed: DVT prevention, swelling, ROM
total hip arthroplasty tha
Total Hip Arthroplasty (THA)
  • Meds
    • Analgesics for Pain: Ocycodone, Percocet, Vicoden, Lortab OR Epidural
    • Anticonstipation: Colace
    • Antibiotics: Cefadroxil, Levafloxacine
    • Antinausea: Zofran
    • Blood thinner: Coumadin
  • Labs/Diagnostics
    • Hb, Hct, WBC, PT, PTT, INR
    • Post Xray for component placement
  • Medical Equipment
    • PAS stockings or foot pumps
    • O2 @ 2L
    • Foley
    • Hemovac
total hip arthroplasty tha1
Total Hip Arthroplasty (THA)
  • Precautions/Contraindications
    • WBAT (unless surgery due to osteoporosis or fracture then may have TTWB or PWB)
    • No showering if drainage
    • Hip Precautions – No excessive hip
      • Anterior: Flex or Ext, ADD, IR
      • Lateral: Flex, ADD, ER
      • Posterior: Flex, ADD, ER
      • **Make them meaningful with functional activity examples
      • Should a pt roll onto or away from the surgical side?
total hip arthroplasty tha2
Total Hip Arthroplasty (THA)
  • PT Eval – Ball & Socket, Endoprosthesis, Hip Resurfacing
    • Screen ROM primarily at the knee due to precautions
    • Screen incision
    • Screen Sensory
    • Screen Muscle Strength
    • General mobility of bed, transfers, gait
  • PT POC – 3 Days
    • BID for exercise and gait
    • Stairs, car, tub/shower Tf
    • Cold Pack
    • Change in position so no prolonged sitting
    • Pt Ed: DVT prevention, swelling, precautions during fxnal activities
joint programs seen bid
Joint Programs – Seen BID
  • Day of Surgery
    • Sit EOB
  • Day 1
    • Exercises as a group
    • Gait Training
  • Day 2
    • OT Evaluation
    • Exercises as a group
    • Gait Training
    • Tub/Shower Tf, Stairs, Car Tf
  • Day 3
    • Exercises as a group
    • Gait Training
joint programs seen bid1
Joint Programs – Seen BID
  • Gait Training
    • Normalize gt pattern ASAP
    • Step to – Step through – Step through heel strike
  • Exercises
    • AP
    • Quad and Glut Sets
    • SAQ
    • Heel slides
    • SLR for TKA and SLR modified for THA
    • Seated LAQ
    • Seated ROM prolonged stretch for TKA and moderate stretch for THA
total shoulder arthroplasty tsa
Total Shoulder Arthroplasty (TSA)
  • Meds
    • Analgesics for Pain: Ocycodone, Percocet, Vicoden, Lortab OR Epidural
    • Anticonstipation: Colace
    • Antibiotics: Cefadroxil, Levafloxacine
    • Antinausea: Zofran
  • Labs/Diagnostics
    • Hb, Hct, WBC, PT, PTT, INR
    • Post Xray for component placement
  • Medical Equipment
    • PAS stockings or foot pumps
    • O2 @ 2L
    • Foley
    • Hemovac
    • Shoulder immobilizer or a sling
    • CPM usually for home or OP
total shoulder arthroplasty tsa1
Total Shoulder Arthroplasty (TSA)
  • Precautions/Contraindications
    • No active elevation: flexion, abd, scaption
    • No Shoulder ER active or passive x 6 weeks
    • NWB
    • Immobilizer or sling
total shoulder arthroplasty tsa2
Total Shoulder Arthroplasty (TSA)
  • PT Eval
    • ROM elbow to wrist on affected side
    • Screen sensory
    • Screen bed mobility, Tfs
  • PT POC 1-2 Days
    • AROM elbow to wrist on affected side by unfastening different areas of immobilizer or sling
    • Codman’s or Pendulum – keep it PROM
    • How to don/doff immobilizer or sling, change shirt, put on deodorant
microdiscectomy
Microdiscectomy
  • Meds
    • Analgesics: Opiods of morphine, fentanyl; epidurals; oral meds NSAIDS or opiods
    • Antibiotics
  • Labs/Diagnostics
    • Hb, Hct, WBC
  • Medical Equipment
    • Foley
    • O2@ 2L
    • Ted Hose
    • PAS stockings
    • IV
microdiscectomy1
Microdiscectomy
  • Precautions/Contraindications
    • No prolonged sitting more than 30, 45, 60 min
    • Need to change position even if just stand or walk
    • No lifting >10#
    • No excessive bending or twisting
microdiscectomy2
Microdiscectomy
  • PT Eval
    • Screen myotomes
    • Screen dermatomes
    • Screen for edema, incision
  • PT POC 1 day
    • General mobility – usually no assistive device needed
    • LE strength exercises pending screens
    • Initiate core stability with abdominal sets, abdominal set with UE then LE movement and progress to UE & LE movements
    • Log roll supine to sit and sit to supine
laminectomy with discectomy spinal internal fixators spinal fusions vertebroplasty
Laminectomy with DiscectomySpinal Internal FixatorsSpinal Fusions, Vertebroplasty
  • Meds
    • Analgesics: Opiods of morphine, fentanyl; epidurals; oral meds NSAIDS or opiods
    • Antibiotics
  • Labs/Diagnostics
    • Hb, Hct, WBC
    • Xray to check the components
  • Medical Equipment
    • Foley
    • O2@ 2L
    • Ted Hose
    • PAS stockings
    • IV
laminectomy with discectomy spinal internal fixators spinal fusions vertebroplasty1
Laminectomy with DiscectomySpinal Internal FixatorsSpinal Fusions, Vertebroplasty
  • Precautions/Contraindications
    • No prolonged sitting more than 30, 45, 60 min
    • Need to change position even if just stand or walk
    • No lifting >10#
    • No excessive bending or twisting
    • Allograph site per pt tolerance
    • Corset or Brace pending level of the surgery
      • May don in supine, sit or standing
      • Some orders may state “brace on when up”
      • Some orders may state “no brace if bed to bathroom”
laminectomy with discectomy spinal internal fixators spinal fusions vertebroplasty2
Laminectomy with DiscectomySpinal Internal FixatorsSpinal Fusions, Vertebroplasty
  • PT Eval
    • Screens of muscle strength for myotomes
    • Screens of sensory for dermatomes
    • Screen of integument for edema, incision
  • PT POC 1-3 days
    • General mobility – may need assistive device
      • Higher than norm so no flexion and RW so no activation of back extensors
    • LE strength exercises pending screens
    • Initiate core stability with abdominal sets, abdominal set with UE then LE movement and progress to UE & LE movements
    • Log roll supine to sit and sit to supine
anterior cervical discectomy c s fusion
Anterior Cervical Discectomy, C/S Fusion
  • Meds
    • Analgesics: Opiods of morphine, fentanyl; epidurals; oral meds NSAIDS or opiods
    • Antibiotics
  • Labs/Diagnostics
    • Hb, Hct, WBC
    • Xray to check the components
  • Medical Equipment
    • Foley
    • O2@ 2L
    • Ted Hose
    • PAS stockings
    • IV
    • Soft or hard collar
anterior cervical discectomy c s fusion1
Anterior Cervical Discectomy, C/S Fusion
  • Precautions/Contraindications
    • No forced C/S ROM – ROM for daily activity
    • Brace on when up and supine
    • Swallow in upright position
anterior cervical discectomy c s fusion2
Anterior Cervical Discectomy, C/S Fusion
  • PT Eval
    • Screen ROM and strength of UE (sometimes LE if tumor or cord involvement)
    • Screen swallow and recommend SLP if unable to swallow by lunch time
  • PT POC – 1-2 days
    • Gentle C/C isometrics
    • No excessive AROM or no PROM of C/S
    • Log roll for supine to sit and sit to supine
    • Scapular motion to pt tolerance
    • Gait – focus on relaxed shoulders and arm swing
    • Exercise for strength pending strength screen
    • Usually no assistive device unless LE impacted
slide24

INTERNAL & EXTERNAL

FIXATORS

Most patients are sent home from ER in a cast for elbow to wrist, ankle fractures and return for surgery in approx 1 week with a LOS of 1 day in the hospital. PT to reassess gait but pt has been mobile at home prior to surgery

wrist or elbow
Wrist or Elbow
  • Meds
    • Analgesics for Pain: Ocycodone, Percocet, Vicoden, Lortab OR Epidural
    • Anticonstipation: Colace
    • Antibiotics: Cefadroxil, Levafloxacine
    • Antinausea: Zofran
  • Labs/Diagnostics
    • Hb, Hct, WBC, PT, PTT, INR
    • Post Xray for component placement
  • Medical Equipment
    • PAS stockings or foot pumps
    • O2 @ 2L
    • Foley
    • Possible ace wrap for External and ace wrap/ace wrap with splint for internal
    • May have sling
wrist or elbow1
Wrist or Elbow
  • Precautions/Contraindications
    • NWB 4-6 weeks
    • External fixator keep pins clean
    • Some internal fixators will be removed in future
wrist or elbow2
Wrist or Elbow
  • PT Eval
    • Assess ROM and Strength above or below site
    • Assess sensory
    • Assess edema
  • PT POC – 1 day
    • Mobility
    • Pt Ed: ROM above or below site, precautions
ankle femur or pelvis
Ankle, Femur or Pelvis
  • Meds
    • Analgesics for Pain: Ocycodone, Percocet, Vicoden, Lortab OR Epidural
    • Anticonstipation: Colace
    • Antibiotics: Cefadroxil, Levafloxacine
    • Antinausea: Zofran
  • Labs/Diagnostics
    • Hb, Hct, WBC, PT, PTT, INR
    • Post Xray for component placement
  • Medical Equipment
    • PAS stockings or foot pumps
    • O2 @ 2L
    • Foley
    • Possible ace wrap for External and ace wrap/ace wrap or short cast with splint for internal ankle; ace wrap/ace wrap or long cast with splint for internal femur
ankle femur or pelvis1
Ankle, Femur or Pelvis
  • Precautions/Contraindications
    • NWB 4-6 weeks
    • External fixator keep pins clean
    • Some internal fixators will be removed in future
ankle femur or pelvis2
Ankle, Femur or Pelvis
  • PT Eval
    • Assess ROM and Strength above and below site
    • Assess sensory
    • Assess for edema
  • PT POC – Ankle 1 day, femur/pelvis 3 days
    • General mobility
    • Stairs
    • Assistive device
    • Pt Ed: ROM above and below site, assistive device
orif hip
ORIF Hip
  • Meds
    • Analgesics for Pain: Ocycodone, Percocet, Vicoden, Lortab OR Epidural
    • Anticonstipation: Colace
    • Antibiotics: Cefadroxil, Levafloxacine
    • Antinausea: Zofran
  • Labs/Diagnostics
    • Hb, Hct, WBC, PT, PTT, INR
    • Post Xray for component placement
  • Medical Equipment
    • PAS stockings or foot pumps
    • O2 @ 2L
    • Foley
orif hip1
ORIF Hip
  • Precautions/Contraindications
    • Usually NWB, but sometimes TTWB, rarely PWB
    • No hip precautions (fixators past the joint, however, following the hip precautions will be more comfortable for the patient)
orif hip2
ORIF Hip
  • PT Eval –
    • Screen ROM primarily at the knee due to hip pain
    • Screen incision
    • Screen Sensory
    • Screen Muscle Strength
    • General mobility of bed, transfers, gait
    • For pt’s in traction waiting for surgery
      • When is the surgery scheduled
      • What is the pt’s cognition or pain level for pre-surgical education or exercise on non-fractured side, breathing exercises, relaxation for pain relief
  • PT POC – 3 Days
    • Similar to THA but usually less aggressive
    • Exercise and Mobility
    • If from a fall, many times pt is afraid of mobility
    • Pt Ed: DVT prevention, swelling, precautions during fxnal activities
pelvis fx rib fx gout osteomyelitis bunionectomy halo
Pelvis Fx, Rib Fx, Gout, Osteomyelitis, Bunionectomy, Halo
  • Meds
    • Analgesics
    • Antibiotics for osteomyolitis, halo
  • Labs/Diagnostics
    • Gout: uric acid
  • Medical Equipment
    • PAS stockings
    • Possible O2 if needed
    • Bedpan/urinal
pelvis fx rib fx gout osteomyelitis bunionectomy halo1
Pelvis Fx, Rib Fx, Gout, Osteomyelitis, Bunionectomy, Halo
  • Precautions/Contraindications
    • All usually NWB weight bear status (except Halo)
      • Bunionectomy surg boot with wt through heel
    • Pelvic fx avoid prolonged sitting
    • Rib fx
      • Difficult if need of assistive device
      • Guard/Splint for cough/sneeze
      • Deep breathing per pt tolerance
      • Watch placement of gait belt
    • Halo
      • Cleanliness of pins for Halo
      • Eat in upright position for Halo
      • May use wedge for supine for comfort
pelvis fx rib fx gout osteomyelitis bunionectomy halo2
Pelvis Fx, Rib Fx, Gout, Osteomyelitis, Bunionectomy, Halo
  • PT Eval
    • Screen ROM and Strength
    • Pain levels
    • Bed mobility
  • PT POC – Pending pain, lab results
    • Breathing exercises
    • Needed ROM
    • Needed Strength bedside
    • Tf NWB to sit in chair
    • Use of assistive device
orthopedic considerations
Orthopedic Considerations
  • Weight Bearing Status
    • WBAT/WBTT: wt bear as tolerated
    • PWB: partial wt bear, usually 50% of body wt
    • TTWB: toe touch wt bear, usually 10% of body wt or 10# of wt
    • NWB: non wt bear, must hike hip or bend knee or both, may rest on floor but NWB once transferring
  • Gait Training
    • Focus on step length with step to and progress step through
    • Focus on heel strike
    • Focus on midstance to push off
    • NWB focus on hip hike and knee flexion
tia cva occlusion cva bleed
TIA, CVA Occlusion, CVA Bleed
  • Meds
    • TIA/CVA Occlusion: anticoagulants heparin, coumadin, antiplatelet, aspirin, plavix
    • CVA occlusion: TPA if within 24 hours
    • CVA bleed: antihypertensives
  • Labs/Diagnostics
    • MRI/CT Scan (TEE, angiography, echo of heart, SPECT, chest xray for enlarged heart)
    • TIA, CVA Occlusion: carotid doppler
    • TIA: CBC, PT, PTT, INR, Immunoglobins, electrolytes, sediment rates, lipid profile
  • Medical Equipment
    • TIA/CVA IV, foley, O2 @ 2L, PAS stockings, TED hose
    • CVA bleed: May have ICP
tia cva occlusion cva bleed1
TIA, CVA Occlusion, CVA Bleed
  • Precautions/Contraindications
    • Usually 24 hr bedrest
    • BP usually still on the high side so not to drop BP too quickly
    • Dependent position of the hemiparetic side
    • Injury to the hemiparetic side
tia cva occlusion cva bleed2
TIA, CVA Occlusion, CVA Bleed
  • PT Eval
    • Mental status/Cognition
    • Screen ROM, strength
    • Screen sensory
    • Screen Reflexes, Tone
    • Screen Coordination
  • PT POC
    • TIA 1 -2 days for general mobility
    • CVA 3-5 days for general mobility, upright and sitting, standing gait, focus on above areas of need
      • Think neuro, musculoskeletal, Cardiopulm, Integument
aneurysm hydrocephalus brain tumor craniotomy encepholopathy tbi
Aneurysm, Hydrocephalus, Brain Tumor, Craniotomy, Encepholopathy, TBI
  • Meds
    • Anticoagulants heparin, coumadin
    • Antiplatelet, aspirin, plavix
    • Antihypertensives
    • Antiseizure
    • Antispastic
    • Antibiotics
    • Meds for other systems impacted
  • Labs/Diagnostics
    • MRI/CT Scan
    • CBC, PT, PTT, INR, Immunoglobins, electrolytes, sediment rates, lipid profile
  • Medical Equipment
    • IV, foley, O2 @ 2L, PAS stockings, TED hose
    • May have ICP or shunt
aneurysm hydrocephalus brain tumor craniotomy encepholopathy tbi1
Aneurysm, Hydrocephalus, Brain Tumor, Craniotomy, Encepholopathy, TBI
  • Precautions/Contraindications
    • Shunt guided by symptoms of headache
    • Seizure Precautions
    • Helmet if open skull (sometimes skull in place in abdomen for later reattachment)
    • Most will have head of bed at least 30-45 elevation at all times
aneurysm hydrocephalus brain tumor craniotomy encepholopathy tbi2
Aneurysm, Hydrocephalus, Brain Tumor, Craniotomy, Encepholopathy, TBI
  • PT Eval
    • Mental status/Cognition
    • Screen ROM, strength
    • Screen sensory
    • Screen Reflexes, Tone
    • Screen Coordination
  • PT POC
    • General mobility
    • Upright and sitting, standing gait, focus on above areas of need
      • Think neuro, musculoskeletal, Cardiopulm, Integument
parkinsons ms gb
Parkinsons, MS, GB
  • Meds
    • Parkinsons – Sinemet, deep brain stimulation, reason for admit
    • MS – Interferons, muscle relaxants, antianalgesics, antidepressants
    • GB – Respiratory, Cardiac, IgG, possible plasmapheresis
  • Labs/Diagnostics
    • Parkinsons – respiratory, cardiac, urinary so general blood tests and diagnostics, if for dx of parkinson perform neuro exam and may perform CT or MRI; any reason for admit
    • MS – CSF, MRI, any reason in admit
    • GB – CSF, CBC, EMG
  • Medical Equipment
    • Parkinsons – IV, O2
    • MS – IV, O2
    • GB – Vent, PAS stocking, TED hose, foley, O2, IV
parkinsons ms gb1
Parkinsons, MS, GB
  • Precautions/Contraindications
    • Parkinsons
      • Bradykinesia
      • Swallow
      • Respiratory
    • Multiple Sclerosis
      • Respiratory
      • See in am
      • Avoid overheating
    • Guillian-Barre
      • Respiratory
      • Pain when recovering
parkinsons ms gb2
Parkinsons, MS, GB
  • PT Eval
    • Mental status/Cognition
    • Screen ROM, strength
    • Screen sensory
    • Screen Reflexes, Tone
    • Screen Coordination
  • PT POC
    • General mobility
    • Upright and sitting, standing gait, focus on above areas of need
      • Think neuro, musculoskeletal, Cardiopulm, Integument
spinal cord injury
Spinal Cord Injury
  • Meds
    • Methylprenisone to reduce inflammation
  • Labs/Diagnostics
    • Xray, CT scan
    • Non surgical: systems impacted
    • Post surgical labs: Hb, Hct, PT, PTT, INR, WBC
  • Medical Equipment
    • IV
    • Foley
    • Possible vent for C3 or higher
spinal cord injury1
Spinal Cord Injury
  • Precautions/Contraindications
    • Levels T6 or higher – autonomic dysreflexia
    • Levels C6, C7 – watch stretch of finger extensors for tenodesis, and stretch of hamstrings for long sit stability
    • Hypotension
      • Use of belly binder, TED hose
spinal cord injury2
Spinal Cord Injury
  • PT Eval
    • Mental status/Cognition
    • Screen ROM, strength pending level of injury
    • Screen sensory pending level of injury
    • Screen Reflexes, Tone
  • PT POC
    • General bed mobility
    • Sitting balance
    • Slideboard transfers
    • W/C skills
    • Respiratory
    • ROM and stretching
    • Strength of levels above SCI