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Exam 2 - Foundational Skills of Patient Care

Terms in this set (62)

Body Mechanics of Safe Patient Handling Movement
Recommendations to consider:
- Using a lift or another person when appropriate
- Using a wide BOS
- Bring the pt close to you
- Use knees for strength
- Don't pivot and twist
- Don't allow pt to hand around your neck
- COMMUNICATE
Most common type of condition PTs have encountered
Musculoskeletal disorders (MSDs)
Common problems associated with occupational injuries in PT
Working in the same position, maintaining static postures of the spine, continuing to work while injured, lifting and transferring pts.

Barriers - culture, lack of policies requiring use of equipment, limited resources for equipment (particularly families)
What is the recommended max weight limit for pt handling tasks?
35 pounds
Body mechanics training has consistently _______ to reduce injuries during pt care
failed
Manual pt handling requirements _____ the capabilities of the general workforce
Exceed
Light, moderate, and heavy weight
Light (11 lbs.)
Moderate (27.5 lbs.)
Heavy (46.2 lbs.)

*35 lbs. between moderate and heavy
Estimation of a person's leg based on their weight:
150 lbs. person
200 lbs. person
250 lbs. person
300 lbs. person
Leg weight:
150 lbs. person = leg weight 24 lbs.
200 lbs. = 31 lbs.
250 lbs. = 39 lbs.
300 lbs. = 47 lbs.
Two therapists transfer a 180 lbs. pt from STS; pt can only partially assist and lift 50% of their own weight. How much weight are the two therapists holding? How much weight is the pt. holding?
90 lbs. for person
45 lbs. for each therapist
Primary roles of PT in the IP setting
Therapeutic exercise, mobility training (bed mobility, tx, gait), determine safe level of functioning, provide info for appropriate discharge
What does the PT do prior to seeing the pt. in an IP setting?
Review the medical chart, talk to the RN/medical staff (RNs, OTs, case manager) regarding pt status and updates
D/C plans are on PT's radar in IP setting from day one. What considerations are there when determining treatment process to get to D/C?
Prior level of function, least restrictive environment, level of support, assistance, emergency plans
Test and Measures in IP setting
Observation
- Positioning and draping

ROM, strength, bed mobility, balance, transfers, gait
Observation of pt in IP setting
Pt position, general appearance - specifically, specialized equipment (beds, life support and monitoring equipment, feeding devices, urinary catheters, oxygen systems, chest drains, ostomy devices, traction, dialysis, intermittent pneumatic compression), integumentary integrity
EEG (Monitors in IP setting)
Continuous recording of electrical activity of the brain. Leads combined to one large cord. Recording is typically remote
ECG (Monitors in IP setting)
Measures electrical activity of the heart muscle and is typically done via telemetry. Pt. wears monitor that automatically connects to remote monitor
Pulse ox (Monitors in IP setting)
Continuous assessment of SaO2. Applied to finger, ear, or toe. Frequently fall off and alert
Heart rate (Monitors in IP setting)
Continuously measures. Alert when outside target range
Automated BP (Monitors in IP setting)
Cuff inflates at regular intervals and then beeps as it displays
Ventilator (Monitors in IP setting)
Lots of settings, lights, bells and adjustments. Don't touch controls. You can't really mess it up, but you can't change it anyway. Position tubing before moving
Intracranial pressure monitor (Monitors in IP setting)
Measures intracranial pressure and ICF pressure

Normal variation is 4-15 mm Hg

Avoid significant neck flexion

Avoid trendelenberg

If hip: flex <90 degrees

No valsalva or heavy resistance exercise
Central venous pressure (Monitors in IP setting)
Measures BP in R atrium through a catheter

Avoid movement causing realignment or kink of IV
- Excessive ROM
Arterial (A) Line (Monitors in IP setting)
Inserted through artery (radial or femoral) allowing
- Continuous BP monitoring
- Repeat blood draws

Avoid:
- Tube occlusion
- Tube dislocation
- Disturbance of needle
- Excessive ROM or tension
Intravenous line (IV)
Placed into lumen of vein, taped in place, forearm is good for PT, hand is most common, foot is good in peds and hard in adults
Bladder Catheter
Multiple forms
Foley is most common

Catheter is inserted in the urethra and a bulb is inflated to maintain position

DON'T PULL ON IT

Drains urine into a collection bag with gravity assist

DON'T hand the bag to high or backflow will result. Allow gravity to work!
Chest tube
Inserts through intercostal space to remove fluid or air from pleural space

Sutured in place, clogging is a serious and most common complication

Page MD immediately once suspected
Jackson-Pratt (JP) drain
Drain fluid out of body through an inserted tube with the power of constant suction

Bulb of JP drain is size of hand grenade
Peripherally Inserted Central Catheter (PICC)
Inserted into large vein with end of catheter in superior vena cava

Cephalic, basilic, and brachial veins are common

Can be left in place for long time

Inserted as a sterile procedure that can be done at bedside

Limit repetitive and end ROM if a PICC line cross the joint

Prevent infection
Swan-Ganz Catheter (Pulmonary Artery Catheter)
Long IV inserted through internal jugular or femoral vein

Passed into pulmonary artery

Provides Pulmonary Artery pressure and immediate CV status

Avoid shoulder flexion past 30-60 degrees, hip flexion past 30 degrees of hip abduction
Guidelines about leads in IP setting
Leads attach sensors or electrodes to recording device:
- Don't pull on them
- Don't stress them
- If they fall off, ask where they go (CI, nurse, tech)
- Be cautious of gait belt position
- Know the length of the lead and how it must be positioned during mobility activity
- Position the leads BEFORE moving the pt
Special considerations for positioning
Sensory loss, paralysis, incontinence

Skin inspections, change position every 2 hours
Why worry about positioning a pt?
Effective treatment
Pressure relief
Preventative positioning
Repositioning techniques
Pressure should be relieved or redistributed

Avoid increased pressure or shearing forces

Use transfer aids - protect the pt and you

Avoid transferring them onto medical devices (tubing)

Avoid bony surfaces with existing non-blanchable erythema

Consider risks of contractures
Go back to preventative positioning
...
Preventative positioning for areas of burns and/or skin grafts
Avoid positions of comfort

Position of comfort is the position of contracture
Purposes of draping
Protect pt's modesty; provide warmth, protect wounds, scars, stumps, clothing, etc.; expose specific body segment(s) for examination and treatment
Draping technique
Explain procedure to the pt/client

Secure edges of clean linen

Remove or reduce folds and wrinkles beneath the pt

Hospital gowns DO NOT provide effective coverage
Examples of UE Gross ROM and Strength Assessments
Shoulder depressors, Lats, lower traps, pec minor, shoulder flexors and extensors, elbow flexors and extensors, wrist extensors, finger flexors
Examples of LE Gross ROM and Strength Assessments
Glute max, glute med/min, hip flexors/adductors, quads, hamstrings, tib ant and peroneals, gastroc/soleus, erector spinae
What to assess in bed mobility?
Scooting in bed with and without draw sheet: side-to-side, up and down; scooting in sitting; rolling; turning; need for equipment: trapeze bar, bed rail, transfer sheet; sidelying to sit and reverse
Purposes of assessing bed mobility
Independence in transfers, skin preservation, prevention of contractures, documentation for determination of hospital after-care or placement
When do you use a gait belt for transfers?
ALWAYS use a gait belt, your professional judgement and a mechanical lift as appropriate
What do you check for in transfers within the environment?
IV, catheter, other lines, additional equipment, a clear path, LOCK bed and w/c, footwear, clothing, etc.
Automatic failure if these safety measures are not performed in transfers
Gait belt, booties (socks DO NOT count)

locks: bed, w/c

guarding: hands on gait belt - guards pt and does not leave pt unattended

Pt is left with both side rails by HoB up in locked position
Types of transfers
Sit to/from stand using pivot transfers with varying levels of assist and assistive devices (AD)

Slide board transfers

Draw sheet transfer
Bed mobility and transfer terminology
Independent
Modified independence
Supervision/stand by assistance (SBA)
Contact guarding
Minimal assistance
Moderate assistance
Maximal assistance
Dependent
In terms of bed mobility and transfer terminology, what qualifies a person as being independent?
No physical supervision or assist from another person to consistently perform the activity safely
In terms of bed mobility and transfer terminology, what qualifies as modified independence?
Pt uses adaptive devices or assistive devices

Pt requires extra time to complete the task
In terms of bed mobility and transfer terminology, what qualifies a person as requiring supervision/SBA?
Pt requires verbal directions, or instructions from another person positioned close, but not touching the pt/client. May provide protection if safety is threatened
What is contact guarding?
Provider positioned close tot he pt with their hands on the pt or safety belt and it is very likely the pt will require protection during the activity
What percentage qualifies as minimal assist in bed mobility and transfers?
Pt performs 75% of the activity
What percentage qualifies as moderate assist (mechanical lift?) in bed mobility and transfers?
Pt performs 50-74% of the activity
What percentage qualifies as max (mechanical lift?) assist in bed mobility and transfers?
Pt performs 25-49% of the activity
What qualifies as dependent transfer?
Mechanical lift

Pt requires total assistance from another person or piece of equipment
Total hip replacement (THR) precautions
Avoid on affected limb: hip flex >60-90 degrees, adduction, or rotation, or extended beyond neutral flexion/extension
Special considerations for low back pain (LBP) in transfers
Log roll instead of segmental rolling
Special considerations for SCI in transfers
External and internal appliances
- Avoid distracting and rotational forces
Special considerations for osteoporosis in mobility
Log roll vs bending, twisting (mechanical lift?)
Special considerations for burns in mobility
Avoid a shearing force on burn wounds, graft site or area from which graft was taken (e.g. sliding)
Special considerations for hemiplegia in mobility
Avoid pulling on weakened or paralyzed extremity
What is documented in bed mobility and transfers?
Type of movement/transfer
- Pivot transfer, slide board transfer, scooting

Amount of assistance required and number of people assisting or equipment (including mechanical lift) used
- Min A x2, Mod A of one, etc.

Surfaces moving between and/or type of mobility
- Bed to w/c, w/c to chair, rolling L, scooting up

Precautions
Define a modified 2 point gait pattern
Use of one AD. The AD and the opposite LE are lifted and moved simultaneously; wt is then shifted to these supports. Repeat.
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