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A 71-year-old female was admitted to the hospital yesterday after an unwitnessed fall in her driveway that resulted in a left hip fracture. Her husband attempted to help her up but called emergency medical services due to the excessive pain in her left hip. She was transported to the Emergency Department (ED) via ambulance. Presentation in the ED included 9/10 left hip pain (on numeric rating scale, with 10 being the worst pain possible) and a shortened and externally rotated left lower extremity. Radiographs confirmed left displaced intertrochanteric femur fracture. The patient stated that she did not trip and she did not report any loss of consciousness. Prior medical history includes hypertension for 9 years treated with Lopressor (metoprolol/hydrochlorothiazide), osteopenia diagnosed last year and treated with Boniva (ibandronate), and remote history of appendectomy as a teenager. This morning, the patient was scheduled for a minimally invasive anterolateral approach total hip arthroplasty (THA) with regional anesthesia via psoas compartment block and local anesthetic infiltration postoperatively. She lives with her older husband who is debilitated and on portable oxygen due to emphysema. They live in a house with two steps to enter with a rail on the right when ascending the stairs. The patient had surgery this morning and would be transferred from the postanesthesia care unit to the orthopaedic floor this afternoon. Physical therapy is ordered starting on the day of surgery, with weightbearing as tolerated on the left lower extremity.

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Based on her surgical procedure and health condition, what do you anticipate will be the contributors to activity limitations and impairments?

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What are the examination priorities?

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What are the most appropriate physical therapy interventions?

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What precautions should be taken during physical therapy interventions?

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What are possible complications interfering with physical therapy?

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How would this individual's contextual factors influence or change your discharge recommendations?

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  • ANTEROLATERAL APPROACH, MINIMALLY INVASIVE TECHNIQUE: Surgical approach using a substantially smaller incision intended to limit local surgical trauma to muscle and tissue
  • INTERTROCHANTERIC HIP FRACTURE: Fracture of the femur in intertrochanteric region
  • NERVE BLOCK: Local anesthetic drugs injected onto or near peripheral nerves for temporary pain control; commonly performed during orthopaedic surgical procedures, which results in decreased pain and motor function during surgery and in the postoperative period
  • OSTEOPENIA: Loss of bone density resulting in potentially weakened bone strength; defined as 1.0 to 2.5 standard deviations below normal bone density1
  • TOTAL HIP ARTHROPLASTY (THA): Replacement of both the acetabulum and the head and neck of the femur with titanium and/or plastic components

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  1. Describe total hip precautions, including relating the precautions to the type of surgical procedure used.

  2. Identify screening tools used in physical therapy practice to detect deep vein thrombosis (DVT).

  3. Perform a ...

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