Patient Care

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46 terms · Chapters 1-8

Independent

Patient does not require any physical supervision or assistance from another person to consistently perform the activity safely and in an acceptable time.

Modified Independent

Patient does not require any physical supervision or assistance from another person to consistently perform the activity safely and in an acceptable time specific equipment or devices are used or more time needed.

Minimal assistance

Patient performs 75% or more of the activity; assistance is required to complete the activity.

Moderate assistance

Patient performs 50% to 75% of the activity; assistance is required to complete the activity.

Maximal assistance

Patient performs 25% to 50% of the activity; assistance is required to complete the activity.

Standby (supervision) assistance

Patient requires verbal or tactile cues, directions or instructions from another person positioned close to, but not touching, the person to perform the activity safely and in an acceptable time. The assistant may provide protection should the patient's safety by threatened.

Dependent assistance

Patient requires total physical assistance from one or more persons to accomplish the activity safely and in an acceptable time; special equipment or devices may be used.

Guarding (close, contact)

Patient requires guarding during the performance of the activity for safety; cues or directions may be used.

Close guarding

Caregiver is positioned close to, but not touching, the patient; similar to standby assistance; the likelihood the patient will require protection during the performance of the activity is minimal.

Contact guarding

Caregiver is positioned close to the patient with the hands on the patient or safety belt; it is very likely the patient will require protection during the performance of the activity.

FIM 7 No Helper (Complete Independence)

Subject walks a minimum of 150 feet (50 meters) without assistive devices. Does not use a wheelchair. Performs safety.

FIM 6 No Helper (Modified Independence)

Subject walks a minimum of 150 feet (50 meters) but uses a brace (orthosis) or prosthesis on leg, special adaptive shoes, cane, crutches, or walkerette: takes more than reasonable time or there are safety considerations. If not walking, subject operates manual or motorized wheelchair independently for a minimum of 150 feet (50 meters): turns around: maneuvers the chair to a table, bed, and toilet, negotiates at least a 3 percent grade; maneuvers on rugs and over doors sills

FIM 5 No Helper (Exception (Household Ambulation)

Subject walks only short distances (a minimum of 50 feet or 17 meters) independently with or without device. Takes more than reasonable time, or there are safety considerations, or operates a manual or motorized wheelchair independently only short distances ( a minimum of 50 feet or 17 meters).

FIM 5 Helper (Supervision)

If walking, subject requires standby supervision, cuing, or coaxing to go a minimum of of 150 feet (50 meters). If not walking, requires standby supervision, cuing, or coaxing to go a minimum of 150 feet (50 meters) in wheelchair.

FIM 4 Helper (Minimal Contact Assistance)

Subject performs 75% or more of locomotion effort to go a minimum of 150 feet (50 meters).

FIM 3 Helper (Moderate Assistance)

Subject performs 50% to 74% of locomotion efforts to go a minimum of 150 feet (50 meters).

FIM 2 Helper (Maximal Assistance)

Subject performs 25% to 49% of locomotion effort to go a minimum of 50 feet (17 meters). Requires assistance of one person only.

FIM 1 Helper (Total Assistance)

Subject performs less than 25% of effect, or requires assistance of two people, or does not walk or wheel a minimum of 50 feet (17 meters).

Standing, Dependent Pivot

Requires at least one person to transfer the patient.
The patient is elevated to a standing position, usually from a bed, plinth, toilet seat, or wheelchair, and pivoted so that the back is toward the object to which the person is lowered.

Double LE lock- FIM 2

May be required to lift the patient to a standing position, to stabilize the (B) knees and hips for the pivot, and to assist to sit.

Standing Assisted Pivot

The caregiver assists patient to stand, pivot, and transfer to another seat.The patient must be able to provide minimal (up to 25%) to maximal (75% or more) physical effort during the transfer. Safety is often an issue with this transfer, so the caregiver must be alert at all times. FIM 2-4

Standing, Standby Pivot

Standing, standby pivot requires the standby presence of another person. Patients may be able to stand, pivot, and sit as they move from one object to another. The assistance required may vary from verbal cueing to close, casual, or contact guarding. Safety is still a concern with this type of transfer and you must be alert to provide protection when needed. FIM 5-6

Standing, Independent Pivot

The patient is able to perform the entire transfer safely and consistently without any physical or verbal assistance from another person. FIM 7

Sitting, Assisted Transfer

Patient moves from one surface to a second surface while in a sitting position with the assistance of at lease one person. May require the use of a transfer or sliding board, an overhead bar or frame, overhead straps, or other equipment to bridge the space between the two objects or to permit the patient to use the upper extremities for assistance.The patient may be able to physically assist with the transfer, but requires physical assistance, and must be guarded and protected throughout the transfer. FIM 1-6

Sitting, Independent Transfer

Patient is able to move safely and efficiently from one surface to a second surface while in a sitting position, without assistance from another person. May require the use of a transfer or sliding board, an overhead bar or frame, overhead straps, or other equipment. FIM 7

Sitting, Dependent Lift

One, two, or three persons may be required to lift the patient and move the person from one surface to a second surface. A mechanical lift may be used when the patient is totally unable to physically assist and other persons or equipment are required.

Recumbent, Dependent Lift

Used when the patient is physically unable to assist with the transfer and is unable to be placed in a sitting position. One or more persons or special equipment are required. Special equipment may be a mechanical lift, mechanical transfer stretcher, mattress pad, bed liner (such as a draw sheet), or plastic transfer board.

Upward Movement, Patient Supine

Bring pt closer to edge of bed especially if in center
Bed should be flat (HOB not elevated). Remove pillows from under head & place at head bedboard.
Pt in hooklying so person can assist if able. Support pt's head & upper trunk with arm & lift until inferior angle of scapula clear mat or bed.

Downward Movement, Patient Supine

Easier when small sheet or linen pad is placed beneath patient from upper back to buttock or midthigh area. Two persons on command by leader simultaneously move pt by sliding.

Move To Sidelying, Patient Supine

May need to position close to far edge of bed first. Protect from rolling off bed or mat. Bed wheels locked or blocked!! Maintain contact as you move the patient
Roll patient toward you & guard edge of bed. Keep at least one thigh against edge of bed.

Move To Prone, Patient Supine

Move pt closer to one side pt bed or mat. Arm over which patient will roll should be close to side w/ shoulder ER, elbow straight, palm up, & hand tucked under pelvis or w/ shoulder flexed so arm rests next to ear w/ elbow straight. Sufficient space to allow roll to prone completely? If not, move pt backward while sidelying until sufficient space. Remember sidelying is very unstable-GUARD! Roll patient toward you & guard edge of bed. Keep at least one thigh against edge of bed.

Move To Supine, Patient Prone

If moving toward right side, cross left leg over right leg.
Position right UE close to side elbow straight, palm up, & hand tucked under pelvis or w/ right shoulder flexed &arm positioned close to ear; place other extremity next to side. Move patient toward you to side-lying position. Enough space? If not move pt forward while side-lying. Bed wheels locked, thigh against edge of bed. Guide from side-lying to supine by resisting against posterior left shoulder and pelvis to retard movement to supine. Reposition in center of bed.

Move To Sitting, Patient Supine-->logroll

Move pt closer to one side of bed or mat. Move patient toward you to side-lying position with LE partially flexed. Elevate the trunk by lifting under the shoulder or instructing patient to push up using either or both UE. Pivot LE over edge of bed or mat as trunk is raised. Do not allow to sit unattended or unsupported. Recommended for back patients. Or patient with functional use of only one UE & LE. Your feet positioned should be positionied anteroposterior for better BOS & to avoid twisting your back while lifting the patient. Some patients may experience vertigo (sense of rotation or movement of one's self or of one's surroundings) or syncope (fainting)—have pt pump ankles and wiggle toes.

Move to sitting, patient supine->shortsit

Move pt closer to one side of bed or mat and flex hips & knees with feet flat (hooklying). Fold arms (or allow patient to help) and raise pt trunk until reaches a sitting position. Pivot the patient by supporting under the thighs & behind the back to a short sit or dangle position. Be careful! Do not allow to sit unattended or unsupported, even briefly. Some patients may experience vertigo or syncope—have pt pump ankles and wiggle toes. Some patients may lack sufficient strength or balance to remain sitting w/o support.

Standing transfer

One NWB LE would fit into this procedure also. Allowing pt to hold LE up by self and deciding if you can trust pt's ability. Supporting NWB LE w/your hand or a strap.

Standing, Dependent Pivot

Apply safety belt. Position w/c 45-to-60° angle to bed midway between head & foot of bed/mat. Brakes on w/c casters forward or to side. Remove pt's feet from footrests to flat on floor. Remove footrests. Position feet // or anteroposterior. Remove armrest closest to mat/bed. Move pt forward in chair & get COG forward.
DO NOT ALLOW pt to hold around your neck or shoulders. Hands on your hips may be acceptable, but not preferred. Simple commands. Tibial lock.

Standing Assisted Pivot, Stronger Knee Stabilized

Easier & safer to always transfer leading toward stronger extremities, but can improve proprioception & kinesthesia toward weaker. Should eventually teach either direction. Blocking stronger ensures one extremity stable. If lead to left, stabilize left knee by putting your left foot to medial border of left foot & your left knee to lateral area of pt's left knee. *Note-This is only one way to do this technique. Grasp safety belt w/ your ® hand & control pt with left hand on posterolateral thorax.

Standing Assisted Pivot, Weaker Knee Stabilized

Will allow pt to  use of LE's & improve indep.
Pt leads toward strong side (left), stabilize weaker (®) by placing your left foot next to lateral area of right foot & your left knee on medial side of right knee. Grasp safety belt w/ your left hand & control pt with your right hand on posterolateral thorax. Desk armrests reversed. Stronger LE more posterior to weaker
Do not use right UE or clothes as point of control
Allow pt to stand briefly to get balance& check light headedness or dizzy. Patient pivots & reaches with nearest UE to bed & sits.

Independent Standing Bed to W/C

Position & lock w/c as previously described
Hips to edge of bed, feet on floor (// For elderly or anteroposterior. Instruct pt to push to standing & reach for nearest armrest. Start to pivot & reach for far armrest then sit. Reposition footrest, place feet on footrests & move hips back into chair. Caution: Recent THR must avoid hip ADD, rotation & excessive flexion (60-90°). Must not pivot on that extremity when standing.

Standing Assisted Pivot w/ footstool

Pt leans back against the plinth, then simultaneously steps up on stool and pushes back onto the plinth with the stronger or least painful LE (you may need to guard opposite LE) Hint - "Good goes Up" onto the stool. Use UEs to stabilize while sliding onto or off the plinth. When coming down from plinth, weaker LE lands on floor first. Hint - "Bad comes Down" to the floor. View instructions for weight bearing vs. non-weight bearing. Caution: Advise pt to push down onto footstool NOT to push forward to avoid sliding or tipping the stool.

Sitting Transfer (Sliding) Board Transfer

You are required to do a demo of the transfer-board the first time a patient is to use the device. This can be done be sitting on the surface the pt is transferring to. You don't have to demo from a chair to the surface.

PWB = partial weight bearing

Prescribed, measured % of weight is allowed. Must confirm % with PT or physician. Use a bathroom scale to assure proper #.

NWB = Non-weight bearing

NO pressure on involved extremity. Not even touch while standing or moving↔standing! It is okay to rest foot on floor while sitting.

TTWB = Toe touch weight bearing or TDWB

Touch down weight bearing. Extremity may rest on floor, negligible WB, touch on floor is for balance/stability only.

FFWB = Flat foot weight bearing

FWB = full weight bearing or 100% of body weight permitted with/without (A) device.

WBAT = weight bearing as tolerated

Weight bearing depends on patient tolerance to pain.
PT/PTA must tell patient of consequences of excessive WB too soon.

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