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--- medical_student:pt_ot_restrictions [2019/06/22 13:23] – jonathan
+++ medical_student:pt_ot_restrictions [2020/12/29 22:08] (current) – [Pedicled Gracilis Flap] jonathan
@@ Line 1: / Line 1: @@
 ====Activity Orders====
+__General Information__\\
+  * When consulting PT or OT, therapists must know the following information before an evaluation or treatment will be completed. If this information is absent, they will page you for clarification and will not see your patient until this information is obtained.\\
+  * For information regarding weight-bearing statuses and activity order options, refer to chart below.\\
+  * If there are no restrictions for a particular category, simply delete that item (you do not have to write “no restrictions”, therapists will assume that is the case if not mentioned).\\
+  * Once completed, copy and paste this information into a nursing communication “Activity Order” in Epic.\\
+  * If a splint is required for your patient, enter a separate nursing communication order to specify type of splint requested and additional details (see Splint information below).\\
+  * Included on this page are the restrictions of the most common plastic surgery operations, as well as an inclusive list of all information that may be required.\\
-Please put an activity order for each patient. Use the "Activity Order" and write in the comments. Each activity order must include a weight bearing status and a range of motion restriction. Please use the objective terms below and avoid terms like "gentle" weight bearing or ROM. If there is a need for a splint or a sling, please specify what kind of splint you would like and what the wearing schedule of the splint/sling will be.  Same for elevation-if need for strict carter pillow, etc. Included on this page are the restrictions of the most common plastic surgery operations.\\
+__Weight-bearing statuses__
+  * No restrictions: full weight-bearing\\
+  * WBAT: weight bearing as tolerated\\
+  * PFWB: platform weight bearing of UE\\
+  * TDWB: Touch down weight bearing-toe touch weight bearing (LE)\\
+  * PWB: Partial weight bearing (LE)\\
+  * NWB: Non-weight bearing\\
--Full weight bearing\\
--WBAT: weight bearing as tolerated\\
--PFWB: platform weight bearing of UE\\
--TDWB: Touch down weight bearing-toe touch weight bearing (LE)\\
--PWB: Partial weight bearing (LE)\\
--NWB: Non-weight bearing\\
--ROM: Range of motion for specific extremity, plane or digit.
+====Complete List of Possible Restrictions/Precautions====
+  * Range of Motion: [enter extremity(ies), digits affected; degrees of motion allowed for each digit in each plane]\\
+  * Weight-bearing: [enter extremity(ies) affected, weight-bearing status of specified extremity(ies)]\\
+  * Elevation and Dangle: If continuous elevation required, state here. If dangle allowed (limb in gravity-dependent position), state [duration of time dangle allowed + number of times per day]\\
+  * Venous Flow Coupler and/or Vioptix: [enter amount of time coupler may be disconnected] [enter acceptable Vioptix parameters]\\
+  * Additional Restrictions: [enter lifting restrictions (in pounds), gross activity restrictions e.g. no pulling here]\\
+  * Post-operative activity pathway: [please use Activity Status chart to select level of activity in which pt may participate on which POD]. Example = POD 0: Bedrest; POD 1: Out of bed to chair; POD 2: Activity as tolerated\\
+  * Walker use allowed: Yes or No\\
-Example:
-Weight Bearing Status: LUE NWB
-ROM: Keep LUE immobilized in splint
-Splint: Continue volar intrinsic plus splint at all times
-Elevation: LUE elevated at all times while in bed, continue Carter Pillow
 ====DIEP flaps====
-Activity Consults:\\
+  * Range of Motion: Bilateral shoulder ROM no greater than 45 degrees in all planes, hips to remain flexed to at least 30 degrees at all times\\
-POD#0: Bedrest\\
+  * Weight-bearing: BUE NWB\\
-PT/OT\\
+  * Venous Flow Coupler: may be disconnected for no more than 10 minutes at a time\\
-Restrictions: BUE <5 lbs weight limit. No pushing or pulling. Okay to rest hands on walker and for transfers. Limit ROM of shoulders to 45 degrees in all directions. Keep patient flexed at waist at all times including while ambulating and transferring.\\
+  * Walker use allowed: Yes, may rest hands gently on walker\\
-POD#1: OOB to chair\\
+  * Additional Restrictions: No lifting greater than 5lbs, no pushing, no pulling\\
-POD#2: Walk\\
+  * Post-operative activity pathway = POD 0: Bedrest; POD 1: Out of bed to chair; POD 2: Activity as tolerated\\
-At post op visit <10 lb weight limit for 1 month.  No pushing or pulling. Limit ROM of shoulders to 45 degrees in all directions.
-After 1 month: passive ROM of arms. Relax weight limits. by 6 weeks back to normal activity.
+  * At post op visit <10 lb weight limit for 1 month.  No pushing or pulling. Limit ROM of shoulders to 45 degrees in all directions.\\
+  * After 1 month: passive ROM of arms. Relax weight limits. by 6 weeks back to normal activity.\\
 ====Gynecomastia mastectomy====
-No weight bearing greater than 10 lbs. No pushing or pulling. No shoulder ROM greater than 90 degrees in all directions.
+  * Range of Motion: No shoulder ROM greater than 90 degrees in all planes\\
+  * Weight-bearing: BUE NWB\\
+  * Additional Restrictions: No lifting greater than 10lbs, no pulling, no pushing\\
 ====Latissimus Pedicled Flap====
-Restrictions:
+  * Weight-bearing: NWB to (specify extremity(ies) restricted)\\
+  * Additional restrictions: Use pillow under (specify RUE, LUE, BUE) while in bed to prevent pressure on flap. Use sling at all other times. Patient may have arm at side with sling in place for out of bed activities including ambulation.\\
+====Pedicled Gracilis Flap====
+  * Weight-bearing: BLE WBAT\\
+  * Walker use allowed: Yes, if needed\\
+  * Additional Restrictions: Must ambulate with with legs shoulder-width apart (no thigh to thigh contact), shuffle gait, abduction pillow while in bed, no active abduction of surgical (involved) extremity, keep surgical sites dry.\\
+  * Post-operative activity pathway = POD 0: Bedrest; POD 1: Activity as tolerated\\
 ====Iorio Lower Extremity====
@@ Line 38: / Line 60: @@
 Pain/perfusion catheter d/c POD#4 or #5 (5 days max per APS)
-===Free ALT flap===
+====Free ALT flap====
-Start dangles on POD#2, unless in frame???? If no frame, patient needs OT for posterior splint to prevent equinis
+  * Dangles (limb in gravity-dependent position): Begin on day 2, unless in frame - further information pending\\
+  * Additional Restrictions: pending\\
+  * Splint: Posterior splint required if no frame.\\
+  * Post-operative activity pathway: pending\\
+====Free muscle flaps====
+  * Weight-bearing: NWB to [involved extremity(ies)\\
+  * Elevation and Dangles (limb in gravity-dependent position): Keep (involved extremity(ies) elevated at all times POD 0-5. May begin dangles POD 6 for 5 minutes TID, increasing by 5 minutes per dangle daily as approved by plastic surgery team.\\
+  * Splint: If no frame present, posterior splint required.\\
+  * Post-operative activity pathway: POD 0-3: Bedrest, POD 4-5: out of bed to chair and commode with (involved extremity) elevated at all times, POD 6: Begin dangle protocol per above.\\
+====Splints====
-===Free muscle flaps===
+  * If a patient requires a splint, an order set exists in Epic that will prompt you to enter necessary information needed by PT/OT before a splint can be fabricated. Follow instructions below to place appropriate order. Splints can often be complex, so usually at least one brief phone call in addition to placing Epic order will be required, however, entering this order will give PT/OT helpful initial information to get started.\\
-PT/OT: Keep RLE elevated, NWB, POD#4 okay for bedside commode and chair. POD#6 okay for 5 minute dangles and advance. If no frame, patient needs OT for posterior splint to prevent equinis
+  * For upper extremity splints:\\
+      * In Epic, go to patient's chart > Manage Orders > in search bar, enter "UPPER EXTREMITY SPLINT FABRICATION/PROVISION" > fill out additional information > sign.\\
+  * For lower extremity splints:\\
+      * In Epic, go to patient's chart > Manage Orders > in search bar, enter "LOWER EXTREMITY SPLINT FABRICATION/PROVISION" > fill out additional information > sign.\\