110 patient care skills Flashcards
Patients with hemiparesis who use a cane on the uninvolved side demonstrate all of the following EXCEPT
- Reduced mediolateral and anteroposterior sway
-Increased walking speed
-Loss of stability
-Increased stance time on the affected leg
loss of stability
Which statement is NOT true about assistive devices?
-Assistive devices must always be fit while the patient is supine.
-An incorrect fit will adversely affect a patient’s gait pattern.
-When using a device that is held by just one hand (such as a crutch or cane), generally it should go on the side opposite the affected lower extremity.
-Platform attachments are used when a person can’t bear weight through their wrists and/or hands.
Assistive devices must always be fit while the patient is supine.
Your patient is a 79 year-old woman who has just had a right total hip arthroplasy (THA). You are going to gait train her with a walker. What is the best position for guarding this patient as she walks?
-Standing directly behind the patient
-Standing directly in front of the patient
-Standing behind and slightly to the left of the patient
-Standing behind and slightly to the right of the patient
Standing behind and slightly to the right of the patient
Sagittal (median)
divides body into
right and left halves. Flexion and
extension
Frontal (coronal)
divides the body into
front and back. Abduction and
adduction
Transverse (axial, horizontal)
divides
the body into top and bottom.
Rotation
PROM
passive - the therapist or another external force moves the body part through the ROM- THERAPIST DOING THE WORK
AAROM
active assisted - the therapist assists the movement-BOTH PATIENT AND THERAPIST DOING THE WORK
AROM
active - the patient moves the body part without assistance- PATIENT DOES THE WORK
RROM
resisted - the movement is resisted- THERAPIST PROVIDES RESISTANT TO INCREASE STRENGTH
PROM indicatiors
◦ Pain occurs with active contraction
◦ Paralysis or marked weakness
◦ Active contraction is prohibited
◦ Assess joint movement
◦ Counteract negative effects of immobilization
◦ Provide sensory stimulation and awareness
◦ Reduce stress on cardiopulmonary system
◦ To teach movement
range of motion
the amount of movement that occurs at a joint. Range of motion exercises are the movements of each joint and muscle through
it’s available ROM
PROM will not (passive range of motion)
◦ Prevent muscle atrophy
◦ Increase strength
◦ Increase endurance
◦ Assist circulation to the
extent a voluntary
muscle contraction
would
◦ Reduce body fat
benefits of PROM (passive range of motion)
◦ Maintain joint and soft tissue integrity
◦ Maintain mechanical elasticity of muscle
◦ Minimize effects of formation of
contractures
◦ Assist circulation and vascular dynamics
◦ Decrease venous stasis
◦ Enhance synovial movement for cartilage
nutrition
◦ Decrease or inhibit pain
◦ Assist the healing process following
surgery or injury
◦ Sensory Stimulation
What is upright, feet parallel, arms at side of body with palms facing forward called?
Anatomical position
What plane divides the body into front and back?
frontal-abduction and adduction
What plane divides the body into top and bottom?
transverse- rotation
Which ROM includes the therapist assisting ROM along with the patient?
Active-Assisted
- Which ROM includes the therapist or another external force moves the body part
through the ROM?
PROM
T/F PROM can increase strength
false
PROM contraindications
◦ During stages of tissue healing
in which motion could inhibit,
retard or stop repair
◦ Dislocation or unhealed fracture
◦ Immediately after surgery if motion
to the part will interrupt the healing
process
◦ If it makes the patient worse
◦ Usually because of muscle guarding
◦ If patient would benefit from
active exercise
PROM precations
◦ If it temporarily increases pain
◦ In patients taking medication
for pain or muscle relaxants,
because the patient may not be
able to respond appropriately
and movement may be
performed too vigorously
◦ In the region of marked
osteoporosis or in conditions
where bone fragility is a factor.
◦ When it elicits undesired
muscle tone
Normal end feel
full PROM at the joint, and the normal anatomy of the joint stops movement
Abnormal end feel
decreased or increased passive joint ROM or when
there is normal PROM but structures other than the
normal anatomy stop joint movement.
Normal limiting factors (end feel)
◦ Hard (bony) - an abrupt, hard stop. Bone contacts bone. Passive elbow
extension, elbow extension
◦ Soft - when two body surfaces come together. Passive knee flexion
◦ Firm - a springy sensation that has some give when the muscle is stretched.
Passive ankle dorsiflexion when the knee is in extension, hip abduction
abnormal end feel
◦ Hard – OA-osteoarthritis-pop!
◦ Soft – synovitis, edema-inflammation prevents movement
◦ Firm – capsule, muscle, or ligament shortening/tightness
◦ Empty - patient requests movement be stopped, usually secondary to pain, so there is no end feel; bursitis, inflammation- stopping because it hurts
crepetis
noise inside a joint
IV Lines
Purpose is to either hydrate the person, administer IV
antibiotics, or provide electrolytes for the patient.
T/F If the IV pump is not flowing then the nurse should be called
true
Arterial line
Inserted into an artery. Used to draw arterial blood,
measure arterial blood pressure, deliver medication
Swan Ganz Catheter
◦ Pulmonary artery catheterization. Inserted into a large vein (subclavian v., femoral v., internal jugular v.) and moved into the pulmonary artery. Use to monitor
cardiac output.
◦ Precautions- Do not get anyone up with femoral line.
70 degree limit in flexion for femoral,
Life threatening if pulled out, apply pressure and call for help!.
Limit shoulder flexion to under 90 degrees for subcl. Limit cervical motion with jug placement.
Hickman
◦ Implanted into a vein for long term placement. Used
to administer meds (chemotherapy), blood collection,
dialysis
◦ Precautions – limit ipsilateral shoulder movements (same side shoulder movements), BP measurements, no aquatic therapy until healed.
Hemovac/ JP Drain
To drain excess fluid and blood from surgical sites.
If you notice the bag is full call the nurse to have him or her empty it.
When moving pt. have them hold the drain so that it does not hang
EKG leads
Monitors heart electrical activity
Most are now battery-powered
You shouldn’t have to mess with them
If for some reason a lead falls off you can either call the nurse or you can replace the lead if you feel comfortable doing so.
If a telemetry patient will be leaving the nursing unit, you must notify the nurse.
Nasogastric and Feeding Tube
Suctions stomach contents or allows the nurse to feed the pt.
Safety pinned to the gown so that it does not come out
When hooked to the suction you can either call the nurse to unhook if ordered or you will have to do PT in bed
(PEG) Percutaneous Endoscopic
Gastrostomy Tube/ feeding tube
Allows pt. to be fed
through a skin opening
into the stomach
PEG Tube/ Percutaneous Endoscopic
Gastrostomy Tube—Therapy Precautions
Head of bed must be 30 degrees.
If you need to reposition the patient, Nurse needs to be notified to stop PEG tube feeding otherwise patients can aspirate (food/liquid into
lungs)
Many patients with PEG tubes also have endotracheal tube
Foley Catheter
Drains urine from the bladder.
Ensure that the bag stays lower than the pt. waist.
Ensure that the bag stays off of the ground.
Never pull this line.
What is the name of what is inserted into an artery and used to draw arterial
blood, measure arterial blood pressure and deliver medication?
Arterial line
T/F It is ok to get a patient up to a chair with a femoral Swan-Ganz Catheter.
False
_____ drain excess fluid and blood from surgical sites.
JP drain and hemovac
____is inserted into the stomach through the nose and suctions stomach
contents and can be fed by this.
Nasogastric tube
Head of the bed must be elevated 30 degrees with what?
PEG Tubes
External Urinary Catheter
Non- Invasive catheter that draws urine away from body
Sequential Compression Device
(SCDs)
- The sleeve placed over a patient’s legs and
applies compression to aid in venous return - Often used on surgical patients
Oxygen
Keep pt. at the same rate as he or she was in bed.
If you need an extension, let the nurse know.
Chest Tube
Drain fluid and or blood from the chest cavity.
Do not pull, if the tube displaces the pressure will not meet the needs of
the lungs and the lungs will collapse.
If the pt. expresses that they are having difficulty breathing, let the nurse
know.
breathing tube inserted through the nose
Endotracheal tube
breathing tube inserted directly into the neck
Tracheostomy
Stoma bags
Colostomy, ileostomy bags
Colostomy, ileostomy bags
Bag for collection of fecal material from
surgically created hole (stoma) in abdomen.
