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A 73-year-old female was admitted to the hospital 2 days ago for an elective right total hip replacement due to severe osteoarthritis and pain in her right hip. The surgery involved a posterior surgical approach with replacement of both the acetabulum and the femoral head. Notable past medical history includes osteoporosis, complaints of positional dizziness, hypercholesterolemia, and type 2 diabetes mellitus. The surgical team stated that she must follow hip precautions (no hip flexion past 90°, no internal rotation/crossing of legs) and she could bear weight as tolerated. The physical therapist is asked to evaluate and treat the patient before she is discharged to her two-story home in 2 to 3 days with her husband, who is retired but limited in his physical ability to assist her due to a recent history of back surgery. She will have a few home physical therapy and nursing visits following discharge and then she plans to attend outpatient physical therapy to continue postsurgical treatment of her hip. Her current complaints are pain in her right hip and short duration complaints of dizziness associated with positional changes.

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Based on her health condition, what do you anticipate will contribute to her symptoms of dizziness?

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What are the examination priorities?

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What are the most appropriate examination tests?

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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 patient/client management?

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  • DIZZINESS: Symptoms that can have several meanings to different individuals; may include sensations of lightheadedness, disorientation, imbalance, or vertigo; may be related to increased heart rate (HR), a vasovagal event, syncope, nystagmus, and/or feelings of anxiety
  • NYSTAGMUS: Repeated rapid alternating eye movements that include slow (one direction) and fast phases (opposite direction); direction of nystagmus is named for the fast phase movements
  • TRIAD OF HEAD ORIENTATIONS SIGNS: Three cardinal signs associated with acute unilateral vestibular hypofunction. Signs include: (1) ocular skew deviation (or tilt) where one eye is deviated up and one eye is deviated down, (2) ocular torsion where eyes roll away from head orientation, and (3) head tilt toward the side of unilateral vestibular imbalance.
  • UNIDIRECTIONAL NYSTAGMUS FOLLOWING ALEXANDER'S LAW: Spontaneous and gaze-holding nystagmus usually seen in acute stage of unilateral vestibular hypofunction; nystagmus is horizontal, with the fast phase beating away from the ear with decreased sensory function. Alexander's law indicates that the nystagmus will decrease in intensity when the eyes gaze toward the involved side and increase in intensity when they gaze away.
  • VERTIGO: Sensation of rotation or spinning; person either feels like she is spinning or as if her surroundings are rotating around her
  • VESTIBULAR OCULAR ...

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