Ota or pta role treatment fundamentals

OTA/PTA ROLE: TREATMENT FUNDAMENTALS.
1
OTA/PTA Role: Treatment Fundamentals
Part 1A
Term
Definition
Reference*
APA format used here.
Trusted
Site? **
Yes/No
1
Rheumato
id
Arthritis
A usually chronic autoimmune disease
that is characterized especially by pain,
stiffness, inflammation, swelling, and
sometimes destruction of joints.
Merriam-Webster. (n.d.).
Rheumatoid arthritis. In MerriamWebster.com dictionary.
Retrieved February 14, 2022,
from https://www.merriamwebster.com/dictionary/rheumatoi
d%20arthritis
Yes
2
Macular
degenerati
on
Progressive deterioration of the macula Merriam-Webster. (n.d.). Macular
resulting in a gradual loss of the central degeneration. In Merriampart of the visual field
Webster.com dictionary.
Retrieved February 14, 2022,
from https://www.merriamwebster.com/dictionary/macular%
20degeneration
Yes
3
Subtrocha
nteric hip
fracture
The breaking of hip bone situated or
occurring below a trochanter.
Merriam-Webster. (n.d.).
Yes
Subtrochanteric. In MerriamWebster.com medical dictionary.
Retrieved February 14, 2022,
from https://www.merriamwebster.com/medical/subtrochante
ric
Merriam-Webster. (n.d.). Fracture.
In Merriam-Webster.com
dictionary. Retrieved February 14,
2022, from https://www.merriamwebster.com/dictionary/fracture
4
Acute
A very serious or dangerous: requiring
serious attention or action.
Merriam-Webster. (n.d.). Acute.
Yes
In Merriam-Webster.com
dictionary. Retrieved February 14,
OTA/PTA ROLE: TREATMENT FUNDAMENTALS.
2
2022, from https://www.merriamwebster.com/dictionary/acute
5
Total hip
Plastic surgery of a joint (hip): the
arthroplast operative formation or restoration of a
y
joint.
Merriam-Webster. (n.d.).
Arthroplasty. In MerriamWebster.com medical dictionary.
Retrieved February 14, 2022,
from https://www.merriamwebster.com/medical/arthroplasty
Yes
6
Full hip
precaution
s
Care taken in advance of the hip joint.
Merriam-Webster. (n.d.).
Yes
Precaution. In MerriamWebster.com dictionary.
Retrieved February 14, 2022,
from https://www.merriamwebster.com/dictionary/precaution
7
Disoriente
d
Having lost one”s feeling of time, spot,
or character.
Merriam-Webster. (n.d.).
Disoriented. In MerriamWebster.com dictionary.
Retrieved February 15, 2022,
from https://www.merriamwebster.com/dictionary/disoriente
d
Yes
8
Pain
limited
The physical feeling caused by disease, Merriam-Webster. (n.d.). Pain. In
injury, or something that hurts the body, Merriam-Webster.com dictionary.
(pain) confined within limits.
Retrieved February 14, 2022,
from https://www.merriamwebster.com/dictionary/pain
Yes
Merriam-Webster. (n.d.). Limited.
In Merriam-Webster.com
dictionary. Retrieved February 15,
2022, from https://www.merriamwebster.com/dictionary/limited
9
Discharge
A flowing or issuing out.
Merriam-Webster. (n.d.).
Discharge. In MerriamWebster.com dictionary.
Retrieved February 15, 2022,
from https://www.merriamwebster.com/dictionary/discharge
Yes
OTA/PTA ROLE: TREATMENT FUNDAMENTALS.
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Part 1B
Client
Demographic
Information:
Lucy, 70 years old female.
Social History:
Lucy is not active and doesn’t go for trails to visit her family. She wears glasses and
hearing aids in both ears. She manages meals and housekeeping well.
Environment:
Lucy lives with her son and husband in a two-story small farmhouse. There are 3
steps leading into Lucy’ house, with railing. The bathroom and bedroom are on the
upper level of the house.
Lucy’s husband is not in good health. Her son, David Helps with His Care and More
Recently Started to help with looking after the house as well (doing things such as
lawncare, grocery shopping and home repairs).
Reason for
Admission:
Left subtrochanteric hip fracture.
Relevant Medical
History:
She is healthy but was diagnosed with Rheumatoid Arthritis
In her wrists /hands and feet 2 days ago. She was also recently diagnosed with
macular
degeneration. Lucy wears glasses and hearing aids in both ears.
Pre-admission
Functional Status:
Lucy has fallen twice in the last 2 months (once in the bathroom and once in the
kitchen) and often forgets where she leaves things. Lucy Has been known to forget to
take her medications, playbills and turn off the oven after preparing a meal.
Present/current
Functional Status
She is not following the weight-bearing precautions reliably. She also seemed very
pain limited and has asked for additional pain medication, even though sometimes the
medication made her extra sleepy.
Lucy needs moderate assistance x1 with all of her transfers now (for example, getting
on/off the bed, chair and toilet).
She is getting stronger; however, she doesn’t follow the direction provided
consistently making her at risk of dislocating her hip. Lucy’s Discharge is scheduled
for days from now.
Part 1C
Question1: What were the problems and resulting risks threatening Lucy’s safety at home prior
to her admission?
OTA/PTA ROLE: TREATMENT FUNDAMENTALS.
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Answer: She is an old woman with a diagnosed case of Rheumatoid Arthritis. This makes her
vulnerable to future bone deformities. She must go to the upper floor for the bathroom and
bedroom. Her husband is not well too so he is unable to assist her walk to the bathroom stairs. As
a result, it was likely for her to fall and fractured her bone.
Question 2: What problems and resulting risks represent the first three days after Lucy’s
surgery? Explain.
Answer: Lucy did not do well on the first 3 days after surgery. She was drowsy, confused and
tired. She needed maximum assistance x1 for bed mobility. She has a low appetite and sleeps a
lot. She did not move in bed on her own due to the drowsiness but was able to engage with the
OTA/PTA for short periods of time. The most common risk factors in such a situation may
include Deep-venous thrombosis and other embolic events due to lack of mobility of Lucy. It can
result in cardiac arrest and sudden death. So, the first three days after surgery were very
important to maintain critical care of Lucy due to the fear of any arthroplasty related
complications.
Question 3: What problems and resulting risks were present on Dec 5th? Explain.
Answer: On December 5, 2018, Lucy sat on the side of the bed with minimal assistance x 1.She
walked a short distance with a standard walker and was trans ferritin to a lounge chair by her bed
with the help of the PT and PTA. Lucy completed a standing pivot transfer with moderate
assistance x2. On this day Lucy appeared disoriented and reported hip and back pain, which has
affected her ability to participate in rehab. Her problems are associated with certain risk factors
of her arthroplasty. General pain may last for several weeks after a total arthroplasty and
sometimes even months. It may cause bruising which lasts for 1-2 weeks after surgery. However,
care should be taken when varied activities right after surgery may cause the implant to get
OTA/PTA ROLE: TREATMENT FUNDAMENTALS.
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loose. The loosening implant is also the cause of severe pain as could have happened in Lucy’s
condition.
Question 4: What problem and resulting risks to Lucy were identified on Dec 6th? Explain.
Answer: She was not following weight-bearing precautions reliably. This could have damaged
her situation. She was having extreme pain in the hip joint and back. The Pain medications she
asked for were those that could make her sleep. As she began to walk with moderate assistance,
multiple tendons, muscles, and ligaments around the hip-joint were agitated with the mild level
of activities she performed. This caused her hip and back pain.
Part 2
Question 2: What problems and resulting risks were present the first day after Lucy’s surgery?
Explain the treatment would provide at this stage to reduce/remove the risk and maximize Lucy’s
changes for a full recovery.
Answer: First three days after surgery, it is important to go for general post-operative measures.
It is important to discuss the patient with the plan for recovery and rehabilitation. It is aimed to
make Lucy go home as soon as possible, help her quickly regain his strength and begin an
independent life again. It is also important to discuss that healing and repair vary from patient to
patient.
The first days after surgery are critical for Lucy. It is highly advisable to use assistance aids,
walkers, or crutches to any kind of mobility. Regular exercise is important, but it should be for
short distances, usually 300 feet. Meals should be offered in sitting-up posture. A walker or cane
can assist prevent a person from falling and dislocating or damaging their new hip. Strangers
should be cautious around walkers with canes. Strangers are less likely to bump, jostle, or
OTA/PTA ROLE: TREATMENT FUNDAMENTALS.
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frighten a person using a cane or walker in public places. Over time, most patients can reduce
their reliance on canes and walkers (Youm et al., 2005).
Certain precautions are also advised right after surgery: Lucy should not bend her hips and knees
more than 90 degrees. She should not cross her legs. If she needs to put on socks, it is important
to lift her leg up. These precautions are needed to avoid any kind of dislocation of her hip
replacement. The dislocation can cause severe pain and she is already drowsy, confused under
the effect of general anesthesia that was followed as a management protocol to perform her
surgery. Lucy may wake up from general anesthesia with a “Triangular Pillow” in between her
legs. It would help her legs slightly spread. During these initial days it is advised to use the
pillow while resting in bed and sleeping. It is OTA/PTAs and surgeons’ duty to take care of her
body posture and maintain her movements to a certain degree possible to avoid dislocation and
any further complications (Youm et al., 2005).
Intra-articular analgesia and antibiotics are administered to refrain from pain and any on-going
inflammation or sepsis. It brings patients a certain relief while performing simple exercise and
when in general state of motion. NSAIDs are preferred anti-inflammatory drugs and Lucy may
be using them already to control her symptoms related to Rheumatoid arthritis.
The pain medications usually provided are Oxycodone (1 tablet every 5-6 hours) and Ultram (1
tablet every six hours). NSAIDs and Tylenol (as an alternative) are recommended to be used for
first three days,
Question 3: What problems and resulting risks can be present on December 5th? Explain the
treatment you would provide at this stage to reduce/remove the risk and maximize Lucy’s
changes for full recovery.
OTA/PTA ROLE: TREATMENT FUNDAMENTALS.
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Answer: On December 5, Lucy was in a moderate state of health and much better. It means that
initial protocols went well, and her condition was under control until now. It is advised to do
mild exercises in bed. Lucy should be instructed to bend or flex her ankle as well as contraction
and relaxation of her quadriceps and gluteal muscles.
Five to ten minutes of exercise every hour is enough to regulate the blood flow. In this way,
Lucy’s sleep would not compromise.
It is important to follow certain weight-bearing guidelines to manage the patient well. A patient
is requested to put a small amount of weight on the affected side, slowly the weight is meant to
be increased. The pressure bearing on hips varies according to the type of implant or prosthesis
used, type of surgery performed and how the fixation was done. In old age as for Lucy, the
condition of her natural bones is soft, reflecting osteoporosis as the leading cause in post-me
pausal women. It is important to tell her that the healing would be slow, and she needs to practice
weight bearing exercises regularly as directed to gain maximum strength and fasten the
phenomenon of blood regulation, healing and repair of her fracture.
For this type of bone structure, it is suggested to have cemented prosthesis to take full advantage
of weight-bearing exercises. Besides this enteric-coated Aspirin (325mg) with meals is also
advised to reduce the risk of postoperative blood clot formation.
Question 4: What is the problem and resulting risk that can be identified today, December 6th?
Explain the treatment you would provide at this stage to reduce/remove the risk and maximize
Lucy’s changes for a full recovery.
Answer: As Lucy complains of extreme pain and needs pain medications that might initiate
sleep. There is a need to change to opiates. A full evaluation for the risk of side effects for such
OTA/PTA ROLE: TREATMENT FUNDAMENTALS.
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medications should be considered. Tylenol Acetaminophen is prescribed if she doesn’t suffer
from any liver disease. Similarly, Advil (Ibuprofen) and Aleve (Naproxen) are to be considered
if there is no previous history of ulcers or gastro-intestinal bleeds.
However, there is risk of developing constipation due to sedation induced by sleep, pain
medications, low fluid intake and decreased activity of Lucy. Daily entail of two tablets of
Senokot is advised if issue of constipation ensues. If Lucy would be still constipated alternatives
like Miralax, Bisacodyl suppository can be prescribed.
Dressings should be placed until this time. It is alright if the dressings are removed after about 7
days. A steri-strip should be kept intact. A patient is advised to shower off the dressings but
avoid scrubbing. Bathing in a hot-tub and submerging the incision in water is strictly forbidden
as it can increase the risk of infection. Small amount of blood discharge plus numbness is normal
at the site but it is not recommended to use Bacitracin as an ointment (Duggal et al., 2015).
A physical therapist can assist a patient in meeting certain rehabilitation objectives. If the
patient’s house includes a lot of staircases, for example, the physical therapist may make
preparing the patient for walking up and down stairs a priority. The physical therapist will give
exercises to prepare the hip for flutter kicking if the patient desires to swim freestyle.
Physical therapy is critical to hip replacement rehabilitation, regardless of personal objectives.
Patients who frequent their physical therapy visits and do the exercises suggested by their
therapist heal faster and have improved results than those who do not.
Follow Up
1. Make an appointment and instruct Lucy to contact the office to schedule a follow-up
appointment 10-14 days following your operation.
OTA/PTA ROLE: TREATMENT FUNDAMENTALS.
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2. A discussion of intra-operative results, x-rays, and any questions Lucy may have will be
covered at the visit.
3. If required, dissolvable stitches will also be removed at that time.
4. If she develops a temperature (greater than101.5), chills or significant drainage from the
surgery, any calf discomfort, or prolonged lower limb numbness, she should call the
office right away.
5. She is welcome to contact the workplace with any questions or concerns.
Many women are inclined to perform too much at once soon after hip replacement surgery,
risking damage or dislocation. Those around, on the other hand, put off returning to a usual
schedule for longer than necessary. To establish the correct mix of exercise and rest, each patient
must work with a doctor and a physiotherapist. As hip training and advancement stabilize sizes,
that balance will shift over time possibly for a year.
Timeframe
Explanation of OTA/PTA Role
First 3 days after
surgery
Relieve pain and the effect of general anesthesia.
Tell precautionary measures.
Walk for a short distance (150ft).
Take care of body posture to avoid dislocation.
(Sarac et al., 2021)
Dec 5th
Start Aspirin 325mg to avoid blood clot formation.
Start mild to moderate weight bearing exercises.
Regular exercise for a few minutes every hour.
(Almeida et al., 2018)
Today, Dec 6th
Start Narcotic doses for sleep induction and pain relief.
Senokot if constipation ensues.
Remove the dressings.
Tell bathing precautionary measures.
OTA/PTA ROLE: TREATMENT FUNDAMENTALS.
Regular exercise and consider follow up.
(Almeida et al., 2018)
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References
Almeida, G. J., Khoja, S. S., & Piva, S. R. (2018). Physical activity after total joint
Arthroplasty: a narrative review. Open access journal of sports medicine, 9, 55–68.
https://doi.org/10.2147/OAJSM.S124439
Duggal, S., Flics, S., & Cornell, C. N. (2015). Intra-articular Analgesia and Discharge to
HomeEnhance Recovery Following Total Knee Replacement. HSS journal: the
musculoskeletal journal of Hospital for Special Surgery, 11(1), 56–64.
https://doi.org/10.1007/s11420-014-9414-8
Sarac, N., Samade, R., & Jain, S. A. (2021). Comparison of Postoperative Occupational Therapy
and Narcotic Use in Two Carpometacarpal Arthroplasty Approaches. Plastic and
reconstructive surgery, 148(2), 223e–233e.
https://doi.org/10.1097/PRS.0000000000008152
Youm, T., Maurer, S. G., & Stuchin, S. A. (2005). Postoperative management after
total hip and knee arthroplasty. The Journal of arthroplasty, 20(3), 322–324.
https://doi.org/10.1016/j.arth.2004.04.015
…