Switching from working in a non-orthopedic setting to an acute orthopedic setting can be challenging for occupational therapists less familiar with patients undergoing joint surgery. it is also new and sometimes frightening to other students who have never worked with post-operative orthopedic patients.
It was definitely a difficult change for me personally after working almost exclusively with neurological patients for the first year and a half of my career. I was less familiar with all the precautions and high pain levels, so I had to learn a lot on my own to get into the groove.
Reading: Coffee cup weight bearing
For this post, I wanted to ease your transition by covering the most important issues occupational therapists encounter when working in orthopedic settings.
You will read about major joints as they are the most common orthopedic diagnoses you will see in the acute care, snf, home care, or inpatient rehabilitation setting.
Keep in mind that these are general precautions and your patients may have different situations and needs. always check the doctor’s orders in case something is different. This post mainly includes precautions with some home security. For more information on home safety, see our article, Educating Patients About Home Safety After Orthopedic Surgery.
_______________
hip replacement surgery
After total hip arthroplasty/replacement or other post-fracture hip surgery, your patient may take several precautions.
These may include weight bearing precautions and/or anterior/posterior hip precautions. on the other hand, the individual may not have any restrictions depending on the surgeon. if there are precautions, these are the main ones you will see.
weight bearing precautions
- non-weight bearing: 0% of body weight
- weight bearing in contact with the toes: up to 20% of body weight
- partial load: 20-50% of body weight
- Weight Bearing As Tolerated: This is literally “as tolerated,” so it can be up to 100% if the patient can tolerate it.
- full load: 100% of body weight
- do not step backwards with the operated leg (steer with the non-operated leg when stepping back towards the toilet, a chair, etc.)
- no hip extension
- no external rotation (turning out) of the operated leg
- uncrossed legs
- sleeping on the surgical side when lying on your side (duke health)
- do not bend your hips forward beyond a 90-degree angle (no forward bending)
- uncrossed legs
- do not turn your hips or toes inward (aurora health care)
- Always use the provided assistive device (usually a rolling walker) until cleared by your doctor or physical therapist.
- when ambulating, lead the walker, then the operated leg, followed by the non-operated leg, making sure to keep the walker close
- keep the operated leg elevated and extended with a rolled towel under the heel when sitting or lying down
- avoid twisting the operated leg
- Avoid sitting on chairs or low surfaces. for example, use a bedside toilet over the toilet or next to the bed, as it is more difficult to get up from low toilets after a knee replacement. Some insurance companies provide bedside toilets, but if not, they can be purchased on amazon. the patient can also purchase a raised toilet seat with handles if a bedside toilet is not covered.
- Selling the lower body is also often difficult for knee surgeries, so the hip kit will also be invaluable for getting socks, shoes, and pants on and off.
- do not lean forward more than 90 degrees
- do not lift more than 5 or 10 pounds, as directed by your doctor
- do not twist the trunk during any activity
- In addition to blts, instruct the patient to use the trunk roll method during bed mobility tasks to avoid twisting the spine. this may require some repetition as patients forget this most of the time and may end up squirming when getting out of bed.
- If the patient receives a brace, they should wear it whenever they are out of bed until otherwise directed by the doctor. a great intervention after surgery is to instruct them to put it on without twisting.
- Keep the sling on the affected arm for at least a week, even when sleeping. some resources indicate that the sling should be worn for 4 to 6 weeks while sleeping and being admitted to the community, but this will depend on the surgeon’s orders.
- without pushing up from the affected upper extremity
- The sling can be gradually removed throughout the week to move the elbow, wrist, and hand several times a day, as well as during pendulum exercises (if prescribed)
- do not lift objects heavier than a cup of coffee
- In the supine position, place a small pillow or rolled towel behind the elbow to prevent hyperextension of the shoulder (cleveland total shoulder arthroplasty/hemiarthroplasty protocol)
- no external rotation beyond 30 degrees in scaption (tmi sports medicine)
- not getting up from the chair, the bathroom, the bed, etc. with the surgical arm for x number of weeks (x = doctor’s recommendation)
- no hygiene tasks that extend backwards during bathing with the operated arm until authorized
- The dressing of the upper body is often the most challenging task after this surgery. The best way to educate your patient to complete upper body taping is to wear loose-fitting, button-down shirts and not use the operated arm during the task. To remove the shirt, first remove the shirt from the non-operative arm, and then gently slide the shirt off the non-operative arm.
- To put on a shirt, start with the operated arm first by gently sliding the shirt over it with the non-surgical arm, then pull the unaffected arm in and button it with the non-surgical arm. after donning the shirt, the sling can be put on.
- use the non-surgical arm for all other basic tasks until cleared (grooming, eating, bathing, dressing, cooking, etc.)
precautions in the anterior part of the hip
precautions at the back of the hip
See also: 8 Best Commercial Coffee Makers 2022 – Top Picks, Reviews & Guide
For a list of detailed images of these hip precautions and home safety measures, you can print the required pages from this helpful hip precautions and hip safety brochure from st. vincent.
Whether or not your patient has specific precautions, a hip kit is recommended for dressing the lower body due to the difficulty of leaning forward to put on and take off shoes, socks, and pants.
Hip kits typically include a reacher, a long-handled shoehorn, a long-handled sponge, a dressing stick, and a sock to prevent the patient from breaking precautions and make the task possible.
knee replacement surgery
Total knee replacements require fewer precautions, but can be more painful for the patient than hip replacements.
These tips can help improve a patient’s function and mobility after a total knee replacement.
spine surgery
Spine surgeries, whether elective or not, can also be extremely painful for the patient in the first few days. General precautions are as follows, but keep in mind that they may differ for your patient.
spinal precautions (“the blt”)
For a great resource for your patients, you can print this Activities of Daily Living After Spinal Injury or Surgery brochure from the University of Washington Medical Center.
See also: Bỏ Túi Ngay 39 Cách Đặt Tên Quán Cafe Hay – Độc – Lạ – Ý Nghĩa
and along with previous orthopedic surgeries, hip kits are invaluable for patients undergoing spinal surgery or injury to adhere to spinal precautions and make taping tasks feasible.
/p>
shoulder surgery
Shoulder replacements/arthroplasties are less commonly seen in the rehabilitation setting, as many of these patients go home shortly after surgery. many of these surgeries are seen only 1 or 2 times in intensive care followed by outpatient ot or pt services.
General precautions immediately after shoulder arthroplasty are as follows, but may differ on an individual basis.
adl education after shoulder surgery
Along with the above precautions, patients should also be aware of their operated shoulder during ADL. Additional education about ADLs may include these general precautions:
_______________
I hope this gives you a basic crash course in working with your first orthopedic patients!
if you still feel stuck or need more information on a particular joint be sure to delve into pedretti’s physical dysfunction textbook or radomsky’s physical dysfunction textbook, depending on what your school requires .
both have the most detailed information on occupational therapy in the orthopedic field and will ensure you feel even more confident working with these patients.
And when in doubt, it never hurts to ask your patient’s surgeon for clarification on their protocols.
This post was originally published on February 19, 2017 and was updated on January 12, 2021.
See also: Các loại đổ uống trong quán cà phê mà bạn nên biết | Lạc Đà Vàng
