Plastics

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.
  

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
  

ROM: Range of motion for specific extremity, plane or digit.

• Range of Motion: [enter extremity(ies) affected, degrees of motion allowed]
  
• 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
  

Activity Consults:

• Range of Motion: No greater than 45 degrees in all planes of motion in bilateral shoulders
  
• Weight-bearing: BUE NWB
  
• Venous Flow Coupler: may be disconnected for no more than 10 minutes at a time.
  
• Walker use allowed: Yes, may rest hands gently on walker
  
• Additional Restrictions: No lifting greater than 5lbs, no pushing, no pulling
  
• 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.
  

No weight bearing greater than 10 lbs. No pushing or pulling. No shoulder ROM greater than 90 degrees in all directions.

Restrictions:

Bedrest POD#0: POD#1: Okay to begin working with PT/OT. Weight bearing as tolerated BLE. Must walk with legs shoulder width apart and not have thighs rubbing. Abduction pillow while in bed. No Abduction of surgical extremity. Keep surgical sites dry. Okay to use walker if needed.

Pain/perfusion catheter d/c POD#4 or #5 (5 days max per APS)

Start dangles on POD#2, unless in frame???? If no frame, patient needs OT for posterior splint to prevent equinis

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

we will put the splints here