Study sets, textbooks, questions
Upgrade to remove ads
Procedures Cumulative Exam Practice Questions - Unit 1
Terms in this set (134)
What is most important when choosing a device for a pt.?
choose a device that is least restrictive for the patient and the safest and most efficient for all involved
Assumptions for a one clinician dependent transfer
clinician is strong enough, clinician can manage equipment and work around it, patient is cooperative, patient has some voluntary control (head and some ability to weight bear on lower extremity, patient has NO special movement precautions
Vertical Lift transfers
require 2 people at least
person behind controls and supports pt's upper body and is the taller and stronger of the two. Person in front controls and supports the lower extremities
* HIPS and upper body make up most of the weight
TEST: do not hold patients elbow
What kind of movement can a person who had a recent back surgery do?
lumbar fusion, DO NOT DO SEGMENTAL ROLL. DO LOG ROLL!
right side below the knee amputee, 30 years old, good health otherwise can do what transfer?
What allows for the greatest control during a transfer?
supporting the patient close to their center of mass
bed to chair transfer, position the chair where?
1/3 the way down from the head of the bed , at a 45 degree angle from the bed
- remove armrests for squat pivot but leave them for standing pivot
Vertical lift, PT behind the patient is positioned how?
straddling the drive wheel of the chair. one foot is on the floor behind the wheelchair, other foot is on the bed with hip and knee flexed
precautions for front PT in vertical lift
do not bend at the waist or keep legs straight. do not twist , rather lateral weight shift , squat do not crouch. pt's legs are resting on the PT's forearms not their hands
pivot transfers are used for?
pt should be able to PWB on Lower extremity and have some voluntary muscle tone of one or both lower extremities . requires 2 or more people. pt's hips go toward the direction you are moving and head goes away
Most important when transporting a patient out of bed?
never allow pts center of mass to move anterior to the base of support provided by the bed "nose over toes"
screening for gait belt questions?
back, thoracic, or spinal surgeries
Transfer boards require substantial ?
upper body strength for the patient; and most importantly GOOD TRUNK CONTROL (TEST)
2 risks for using a transfer board?
pinched fingers and skin tearing (integument damage)
transfer boards should only be used on what surfaces?
surfaces of similar height or from higher to lower surfaces.
what muscles are used for a transfer using a transfer board?
lower trap (scapular depression) and triceps (extension)
PTs can assist patient in moving pelvis how?
grip the sides of the pts trousers or under ischial tuberosities (Si jts) or lateral aspects of the gait belt or the sides of the draw sheet.
what is newtons 2nd law?
allows us to have reaction force that allows lifting the body off a seat or wheel chair. the more force generated vertically downward through the forearm the more force is generated vertically upward for lifting
positioning the patient for pivot transfer where should their feet be
pivot foot should be forward and prevents obstruction and allows the pt to maintain adequate BOS throughout the transfer
involved leg should be forward and OUT of the way
During a transfer tell the patient where they can hold?
hands can be on PT's arms or hip. NOT on their neck
56 year old woman recently had left THA, how can she transfer? Arrives in a wheelchair how can you transfer her?
long sitting on the edge of the bed (no rolling), from the wheel chair she can do a stand pivot with the right side closest to the table
a 63 year old female with a right tibia fracture wants to scoot up in bed. What do you ask her to do?
ask her to bend L leg only and use her arms to bridge
55 year old male with left quad tear in an immobilizer was upgraded to 30% weight bearing, what transfer can he do?
stand pivot to the right. push off the right leg and both arms
knows how to use the device by themselves
patient performs 75%
PT performs 1-25 %
patient performs 50-75%
PT performs 25-50%
patient performs 25-50%
PT performs 50-75%
pt. requires verbal, tactile cues, directions, or instructions form someone who is close but not touching
therapist performs 75-100%
pt. does not participate in task
close contract guarding
patient requires guarding during performance needs cues and directions
caregiver is close but not touching. similar to standby assist, but the likelihood of the patient needing protection is minimal
caregiver is close to the patient with hands on the patient or safety belt , it is very likely the patient will need protection (min assist)
modified independent assist
patient uses adaptive equipment or assisted device
fitting for crutches
supine 6-8 inches lateral to bottom of heel subtract 16 inches , or standing patients elbows should be flexed 20-30 degrees (height of the ulnar styloid process or GT)
guarding for crutches?
stand on vulnerable side and staggered staa]nce . one hand supinated on gait belt and the other hand over anterior aspect of opposite shoulder
Assisted devices most energy to least
crutches, wheeled walker, standard walker, cane
when is a 4pt gait most often used?
for neuro patients
guarding on steps, position of the PT
- outside foot the same as the patient, inside foot closest to the patient on the step below
going down: outside foot the same step as the patient is stepping to, inside foot on the step below
long term positioning objectives are?
safety, comfort, prevention
how to prevent pressure ulcers and contractures?
very patients position often
do not pull or slide patient
head of bed should not be inclined higher than 30 degrees
At risk areas for skin breakdown in supine
scapulae (inferior angle)
sacrum or coccyx
types of contractures possible from prolonged supine
At risk areas for prone skin breakdown
ear or side of face
anterior surface of shoulders
iliac crests or ASIS
knees or patella
dorsal surfaces of the feet
What type of contractures can occur in prone position?
most people dont lay prone long enough to develop contractures
At risk areas for sidelying skin break down
ear or side of face
hip or greater trochanter
lateral femoral epicondyle *underside of posterior leg
medial femoral condyle of inside knee
lateral malleolus of outside ankle
medial malleolus of inside ankle
Types of contractures from being sidelying too long
At risk areas for skin break down from a wheelchair
occiput in a high back chair
scapulae (inferior angle)
Ascending a ramp in a wheelchair
- push forward all 4 wheels on the ground
- increased risk but can do it, tip and do a wheelie and transport either forward or backward
- for very stepp slopes zig zag
- NEVER pull a wheelchair up a slope backward with all 4 wheels on the ground
Descending a ramp in a wheelchair
roll the wheelchair backwards down the slope with all 4 wheels in contact , use wide base of support and use body to slow decent
wheelchair ramps height precautions
30 inches is the maximum rise
minimum clear width is 36 inches
on average which method puts less strain on the caregiver when going up and down a curb with a wheelchair
ascending the curb forward and descending a curd backward provides greater control of the wheelchair and puts less strain on the trasporter
Devices most stable to most mobile
parallel bars, walker, bilat crutches, bilat forearm crutches, bilat canes, hemi walker, quad cane, single point cane, no device
Weight limit for standard walkers, canes, crutches
weight limit for bariatric devices
fitting for devices should have the elbow at what degree of angle and use what landmark?
biomechanical advantage is 20-30 degrees flexion placing elbow extensors and shoulder depressors in optimal function . pt standing with arms at their sides , use their ulnar styloid process or wrist crease
patient instructions for fitting them for an assited device
explain the process beforehand, answer any questions they might have. demonstrate the activity before the pt attempts it, encourage mental rehearsal. it is best to have the patient repeat back how to get up before doing it and rather than asking if they have any questions
Total Hip Percautions
avoid flexion >90
avoid adduction >0
avoid internal rotation >0
- risk is greatly increased when positions are combined
- cannot be sidelying
- sacral area is vulnerable
contraindications for a gait belt
-fractures in thoracic, abdominal, lumbar, or pelvic region
- recent surgeries
- any order in the chart that says not to use one
when are horizontal transfers used?
when the pt can safely bear weight through at least one lower extremity
two types: stand pivot and squat pivot
generally when transferring you transfer the patient on their ____leg?
unless you are doing the opposite for example a neuro patient or end of treatment
types of knee blocking
one to one, two to one block, or two to two block
wheel chair arm rests
desk type arm rests should be reversed so that the highest part is forward for the transfer, so you push off the cushion
what does a chin tuck activate?
what should you never do to a weak limb?
pull or force a weak limb
which is more stable? bilateral canes or a hemiwalker
partial weight bearing is approximately how much?
20-50% weight bearing
a pt. who has mild balance loss and needs to sit and rest should use which type of device?
a rollater walker
3 considerations when choosing a device?
- amount of stability needed
- amount of support needed
- amount of energy cost
only devices that allow full weight bearing through the upper extremities simultaneously such as parallel bars and walkers, or bilateral crutches can be used for ____ weight bearing status
non weight bearing
toe touch weight bearing
toe down weight bearing
25% weight bearing 62 y/o apprehensive about walking should use?
how many fingers should you be able to fit in your gait belt?
as a general rule the assisted device remains with and moves with ?
the impaired lower extremity
Step patterns for stairs
step over step (reciprocal) or step to(non reciprocal)
As a general rule the assistive device remains with and moves with
the impaired lower extremity
ascending stairs without a hand rail
foot of stronger leg on the next step, assistive device and foot of weaker leg advance to the same step.
descending steps without a hand rail
assistive device and foot of weaker leg onto next lower step, strong lower extremity advances to the next step.
With a handrail -if the handrail is on the side opposite the assistive device what do you do with the handrail
hold the handrail for stability
If the handrail is on the same side as the assistive device
the patient can move the device without the handrail or choose not to use the handrail
When going up stairs and guarding the patient where should the therapist be
Whether going up or down stairs the therapist is on the down side
when ascending stairs where should the therapists feet be in relation to the patient
outside foot on the same step as the patient inside foot on the step below.
when using parallel bars where is the therapist at
they are in front of the patient on the way down, behind the patient on the way back.
when can you not use a wheel blocker- what weight bearing status?
less than 50% weight bearing
what is a good assistive device for patients with stamina issues who need to sit down often
a rollater walker
what is safer for a non weight bearing patient with a walker going up a curb - going up backwards or going up forwards
going up backwards
when using a walker on stairs- the closed side of the walker goes where?
close to the patients body
where are the feet of the walker when negotiating stairs?
ascending front feet of walker on the step above which the patient stands and rear feet in which the patient stands.
descending the front wheel of the walker on the step below where the patient stands and the rear feet on the step in which the patient stands.
what is the greatest concern when fitting axiallary crutches
Damage to vessels in the axilla
ascending and descending stairs with a handrail and crutches- what are your options
use two crutches and one hand
make a crutch T
carry the crutch parallel to the handrail pg. 417
the fit for forearm crutches is?
the forearm crutch is 1 - 1 1/2 inches distal to the elbow crease
how much body weight can a cane unload?
fitting a person with a quad cane - you should make sure of "what" about the legs of the cane?
you need to make sure that the shorter legs point towards the patient.
arm rests decrease the weight on the buttocks by how much for a tetrapalegic? for a parapalegic?
what do patients weighing greater than 250 lbs need as far as type of armrest?
they need full length armrests
leg rests for a wheel chair should be able to rise to what angle?
70 is sufficient but 0-90 is normal
what type of wheel chair should be used for bariatric patients
a heavy duty chair
how much weight does a standard wheel chair support
what type of wheel chair has the best shock absorption
folding frame wheel chairs
standard wheel chairs are how many inches
22, 24, and 26
power chairs are how many inches
why would you have abducted wheels for a wheel chair
so you can go faster
what do small wheels in the front of the chair allow
they allow directional changes quickly - position is relative to the drive wheels affect on base of support
how much wheel chairs weigh
steel= greater than 50lbs
measurements for a wheel chair are taken what position for the patient?
seat depth of a wheel chair?
position patient supine with hips and knees flexed to 90 degrees, measure popliteal fold to the back of the hips and subtract 2 inches.
wheel chair fit seat width?
measure the widest part of the hips and add 1 to 2 inches
what does the ADA require for standard door width
a minimum of 32" and maximum of 48"
wheel chair arm rests: how to fit?
position the patients arm next to the trunk flexed at 90 degrees, measure from the olecranon process to the seat surface, and add one inch.
seat to floor height for a wheel chair: how to fit?
it affects functional activities
self propulsion- from popliteal space to the patients sole.
non self propelling- from the popliteal space to the patients sole plus 2 inches.
seat back height for a wheel chair: how to fit?
measured from the seat to the inferior angle of the patients scapula
in what position do you release the wheelchair pushrims
2-3 o clock
How do you confirm the fit of a wheel chair?
Perform a "two finger" check in 6 different spots
what is the best angle of the elbow for maneuvering a wheel chair?
when navigating through a door and pushing a wheel chair what must the clinician be sure of?
that the clinician stays between the patient and the door. when the door opens away clinician goes first and pulls the patient backwards.
if a patient is in a wheel chair and going through a doorway that opens away- how do they approach the door?
they approach the door at the latch side
the maximum a ramp height can be
What are the ADA guidelines for a ramp?
1 inch rise and one foot run
for example and 8 inch step needs an 8 foot ramp
what is an alternative to going straight up a steep incline with a wheel chair?
zig zag up the incline
navigating stairs wit a wheel chair
the stronger clinician is behind the wheel chair leading the activity
Pull rather than push
Ascend stairs backwards Descend stairs forwards
What does caster size determine for a wheel chair?
mobility vs. stability
what is least likely to put the clinician or patient at risk when transferring ?
allowing patient to pull on clinicians flexed arms
during contract guarding is the pt helping the patient much?
1 hand on the patient but no assistance
what is three point gait
assistive device in one weight baring extremity remain in contact with the floor.
what is the difference between step to and step through
step to- lower extremity in swing phase is advanced only as far as the assistive device.
step through- lower extremity in swing phase is advance beyond the assistive device.
two nerves often damaged by axillary crutches
if the patient uses adaptive or assistive devices to ambulate what are they considered?
if a patient performs 25-50%what are they considered?
when is knee blocking necessary?
If no legs are reliably strong, if you block one knee then at least one leg is reliably strong. Block the stronger leg if both are partially reliable.
What kind of transfer would you do for a below the knee amputee who is 30 years old and otherwise good function?
Precautions for a 56 year old woman with a left THA for transfer?
long sit at the edge of the bed and no rolling.
if the patient with a left THA needs transferred how would you position and what transfer would you use?
position- position the wheel chair with the right side closest to the table.
transfer- stand pivot transfer
What are you trying to prevent in long term positioning?
pressure ulcers, contractures, edema, and friction or shear
what is the most common contracture in all positions?
ankle plantar flexion, shoulder flexion, elbow flexion, hip flexion, knee flexion, and hip adduction
recite procedures visula estimate
Sets found in the same folder
Clinical Pathology 1: Week 1
Gait and Functional ROM's
ExRxs Readings Week 1-Kisner
Sets with similar terms
NPTE Equipment and devices
EMT Things To Know
EMT Chapter 35 Lifting and Moving Patients
EMT Chapter 35 Lifting and Moving Patients
Other sets by this creator
Acupuncture Board Exam Practice Questions
Other Quizlet sets
Configuring/Verifying Switch Interfaces
chiffres MMT 4 : p 167 sq fin