04-01: Patient Management, Body Mechanics, Vital Signs Flashcards
Definition and purpose of HIPAA
Health Insurance Portability and Accountability Act - Protects confidentiality of pt medical info, protects pt record when stored, protects pt records between healthcare providers and insurers
Patient Identifiers
- 18 identifiers
- Name, address, date of birth, last four digits of SS#, Contact info, All ages over 89, Vehicle identifiers, Device identifiers, biometrics, photo images
5 steps of Patient Management
Examination, Evaluation, Diagnosis, Prognosis, Plan of Care: Intervention
Open-ended questions
Questions that require patient to elaborate and give details
Closed-ended questions
Yes or no questions
Four parts to an intervention
- Type: What activity is being done
- Amount: Number of sets/reps
- Duration: How long exercise /activity done
- Frequency: How many times/day was activity done
Preparation for Patient Care
- Be aware of environment at all times
- Prepare treatment area
- Handling of patients
Preparing treatment area
- Sufficient room to work with pt
- Safe environment
- Gather necessary equipment
- Clean any equipment prior to and after treatment
Patient preparation
- Prepare treatment area
- Gait belt
- Keep patient informed (Limit waiting time)
- Appropriate pt dress: modest. safe
- Appropriate footwear: shoes, non-skid socks
- Draping for modesty, treatment
- Observe location of lines and equipment attached to pt
Types of CDC Handwashing
- Handwashing: Plain soap and water
- Antiseptic: Washing hands with antiseptic agent
- Alcohol-based rub: Rubbing with alcohol-containing preparation
- Surgical hand hygiene/antiseptis: Washing or using alcohol-based hand rub before surgery
Hand Hygiene - Visibly soiled
Wash with non-antimicrobial or antimicrobial soap and water
Hand Hygiene - Not visibly soiled
Alcohol-based hand rub for routinely decontaminating hands
When to wash hands
- Hands are visibly soiled with blood or infectious matter
- Touching contaminated items
- Before and after treating patients
- Removal of PPE
Principle of proper body mechanics
- Center of gravity over base of support (BOS should be shoulder width apart)
- Reduces stress on musculoskeletal system during lifting, lowering, pushing and carrying
5 Cardinal Rules of Body Mechanics
- Keep load close to you
- Widen the BOS
- Isometric contraction of trunk (Stabilizes back)
- LIft with legs
- Do not twist
Gait Belt
- Safety device that provides level of control for PTA/PT with pt during transfers and gait training
- Used in case patient starts to fall, loses balance
- Can pull patient close or control lowering to ground
Gait training
Skilled teaching mechanics of normal vs. abnormal movement
Ambulation
No skills required for gait, just movement
Position guarding during gait
- Posterior and slightly lateral to pt (about 45˚)
- On the involved side, feet in stride with pt
If patient has LOB…
- PTA pulls pt towards him creating COG ot PTA/pt over BOS and lowers pt to ground
Verbal Cues
Providing auditory commands for specific action
Ergonomics
Area of physical therapy that includes workstation modification - moving things around to avoid repetitive motions
Vital Signs
- Heart Rate (HR)
- Pulse Rate (PR)
- Respiratory Rate (RR)
- Blood Pressure (BP)
- Temperature (T)
- Pain
Heart Rate
Measure taken over heart (auscultation)
Pulse Rate
- Beats per minute palpated and measured distally
- Most common areas: Radial and Carotid
Resting Heart Rate
HR at rest
Basal Heart Rate
HR after extended rest (ex: nap)
Trophic changes due to impaired circulation
- Loss of hair
- Dry or flaky skin
- Muscle atrophy
- Cool temperature
- Blanching
Pulse Regularity Scale
0 = absent 1 = thready, weak 2 = normal 3 = strong 4 = full bounding
Methods of measuring HR/PR
- Manual palpation
- Auscultation (Stethoscope)
- Doppler (Ultrasound)
- Oximeter (Blood O2 concentrations)
Normal pulse rates
Adults 60-100 bpm
Children 80-100 bpm
Abnormal pulse rates
Bradycardia - slow resting PR 100 bpm
Maximal HR (PR) or Age-predicted Max HR
- Highest HR person should achieve during exercise
- Formula: 220-age
Target HR
- HR attempt to achieve during exercise, between 60-80% of max HR
- Formula: (220-age) x (.60) to (220-age) x (.80)
Locations of palpating PR
Carotid, Brachial, Radial, Femoral, Popliteal, Dorsal Pedal
Systolic Pressure
Pressure exerted by blood against arterial walls when the heart CONTRACTS
Diastolic Pressure
Pressire exerted by blood against arterial walls when the heart IS NOT CONTRACTING (relaxes)
Kortokoff Sounds
Sounds heard through stethoscope when taking BP (5 sounds)
Kortokoff #1
Snapping sound first heard at systolic pressure (Clear tapping, repetitive sounds for at least two consecutive beats is systolic pressure)
Kortokoff #2
Murmurs heard between systolic and diastolic pressures
Kortokoff #3
Loud, crisp tapping sound
Kortokoff #4
Thumping and muting sounds at pressures within 10 mmHg above the diastolic pressure
Kortokoff #5
Silence when cuff pressure drops below diastolic pressure
Parts of stethoscope
- Earpiece
- Binourel piece
- Flexible Tubing
- Stem
- Chestpiece
- Headset: Eartip, Eartube
- Chestpiece: Tunable Diaphragm
BP Ranges
Normal: 120/80
Pre-Hyp: 120-39/80-89
Stage 1 Hyp: 140-159/90-99
Stage 2 Hyp: Greater than 160/Greater than 100
Orthostatic Hypotension
- Drop in BP with changes in position
- Decrease in systolic BP of 20 mmHg or more
- Often occurs after prolonged bedrest
Normal respiratory rate
- 1 cycle = one inspiration + one expiration
- Adult: 12-18 bpm
- Children: 20 bpm
Normal temperature
Afebrile: No fever = normal temp (98.6˚ F)
Febrile: temp above 100˚ F
O2 Saturation
Normal = 100%
Medicare payment = below 90%
Terminate exercise = 88%
Contraindications for Exercise - VS
Resting HR = >100 bpm or 200 mmHg or 110 mmHG
O2 Sat = <90%
Pain
- “new” vital sign
- Subjective, but can be objectified using VAS (numeric scale or facial pics)
Characteristics of pain
- Type
- Location
- Intensity
- Duration
- Frequency
Common Lab Values - Hemoglobin
Male = 14-18 gm/dL Female = 12-16 gm/dL Newborn = 16.5-19.5 gm/dL Children = 11.2-16.5 gm/dL
Common Lab Values - Glucose
100-250 mg/dL
Common Lab Values - BUN
10-20 mg/dL
Common Lab Values - Platelets
150,000-400,000 mm3
