1.3 Contraindication to treatment Flashcards
Lists of Rx to be awared of
Before initiating (name of Rx), I would clear contraindications and precautions.
- Traction
- Joint mobilizations
- Deep tendon friction massage
- Prone positioning
- Postural drainage
- Precussion/vibration/rib springing
- Assisted cough
- Nasopharyngeal suctioning
- Modalities (MUST include skin testing)
Skin testing for modalities
Sharp & dull test
- TENS/IFC
- NMES/FES
- HVPC
Hot & cold test
- Heat therapy
–> Hydrocollator packs
–> Paraffin wax bath
–> Contrast bath
–> Whirlpool
- Cryotherapy
–> Ice packs
–> Ice massage
- Continous US
- Shortwave diathermy
No skin testing
- Pulsed US
- Low level laser therapy
- UV light therapy
Skin testing example:
Acute De Quervain’s tenosynovitis
–> want to include laser & ice in Rx plan
State the Pt’s problem and corresponding Rx
- Pt is experiencing acute pain due to De Quervain’s tenosynovitis which could benefit from the use of modalities such as laser & cryotherapy to help reduce inflammation and pain
State before Rx: clear CI and perform skin test
- Before using either of these modalities, I would clear contraindications to ensure that both of these modalities are safe to use with this Pt. I would also perform skin test about hot & cold sensation prior to the use of cryotherapy to ensure skin sensation is intact.
Working with chest tube
When mobilizing a Pt with a chest tube, DO NOT…
- Lift drainage container above the site of insertion
- Allow Pt to lay or roll onto chest tube
- Compress, kink, occlude or clamp the chest tube
- Disconnect the chest tube
- Pull or place tension on chest tube
- Knock over or tip the drainage contrainer
- Perform percussions directly over the chest tube
Foley/urinary catheter
While mobilizing a Pt with a foley/urinary cather, DO NOT
* Lift urine bag above bladder
* Pull/place tension on drainage tube
IV line
While mobilizing a Pt with an IV line, DO NOT…
* Pull or place tension on the IV line
* Use portable IV pole
Pt using oxygen therapy
While mobilizing a Pt with oxygen, DO NOT…
- Remove O2 for mobilization
- Use portable O2 tank
- Pull/place tension on O2 tubing
Pt with a cast
Verbalize: I will screen the Pt to ensure there are no issue with circulation.
- Ask the Pt if they are experiencing numbness/tingling
- Ask the Pt to move their fingers/toes
- Observe for any discoloration in the distal extremity
- Educate the Pt to notify their doctor if…
–> the cast starts to feel too loose or too tight
–> any numbness/tingling/skin discoloration in your extremity
Refer to emergency if Pt presents with S&S of cast circulation issues
A/PROM exercise
CI:
- Post-op/injury if ROM causes increased damagne or delays healing of tissue (e.g. #)
Precautions:
- Subluxation or dislocation
- Myositis ossificans
- Acute inflammation/infection
Deep tendon friction massage
CI:
- Infection
- Skin breakdown
- Inflammatory joint disease
- Recent local injection
- Ossification/calcification within soft tissue
- Bursitis
- Connective tissue disease
- Neural irritation
- Long term steroid, anticoagulation/anti-inflammatory drug use
Precautions:
- Elderly or children
- DM Pt
Joint mobilization
CI:
- Fracture (local, not healed)
- Malignancy in area of Rx
- Compromised bone health (e.g. severe osteoporosis)
- Acute inflammation
- Dislocation/ Subluxation
- Bone/joint infection (osteomyelitis)
- Sign of the buttocks
- Neurological S&S of a SCI (spinal mob)
- Empty end feel/ ligament rupture
- Acute/infectious arthritis
- Fusion/ankylosis
- Joint effeusion
- Vertebral aftery insufficieny
- Craniovertebral ligament instability
Precautions:
- Impaired/diminished circulation/sensation
- Hemophiliacs
- Poor skin condition
- Open wounds near area
- Marked skeletal deformity
- Elderly/individuals with weakened connective tissue
Massage
CI:
- Autoimmune disease during flare-ups
- Hemorrhage
- Embolism/DVT
- Migraine headache (inc. blood flow–>inc. severity)
- Fever/flu
- Serious psychological Dx
- Recent surgery
- Sickle cell disease
Neurodynamic testing
CI:
- Spinal cord/cauda equina compromise
- Severe irritability
Resistance exercise
CI:
- Pain with AROM/PROM exercise
- Acute inflammation (isometric ok)
- Joint effusion
- Uncontrolled HT
- Severe cardiovascular disease/unstable symptoms
- Symptomatic congestive heart failure
- Fracture
- Within 4-6 weeks of MI
- Joint/muscle pain during AROM/muscle testing
- Significant: bone metastasis, osteoporosis, low platelet count
Spinal traction
CI:
- Acute sprain/strain
- Acute inflammation
- Recent unhealed fracture
- Vertebral joint instability
- Any condition in which mvt agg. existing problem
- Bone diseases
- Osteoporosis
- Local infections in bones or joints
- Vascular conditions/compromise
- Recent surgery
- Pregnancy
- Severe cardiac/pulmonary problems
- Malignancy
- Inflammatory/infectious arthritis
- S&S of cord compression/cauda equina
- Bad response/pain during manual traction
Additional CI for cervical traction:
- S&S of vertebral artery compromise
- Cervical myelopathy
- Rheumatoid arthritis
- TMJ dysfunction
- Glaucoma
Exercise for pregnant women
CI:
CP related
- Hemodynamically significant heart disease
- Restrictive lung disease
Pregnancy related
- Incompetent cervix
- Multiple gestration with risk of preterm labor
- Presistent 2nd or 3rd trimester bleeding
- Placenta previa after 26 weeks of gestation
- Preecelmpsia/pregnancy induced HT
- Rupture membranes
Precautions:
CP related
- Severe anemia
- Chronic bronchitis
- Heavy smoker
MSK related
- Orthopedic limitation
- Extreme morbid obesity/unweight
Pregnancy related
- Unevaluated maternal cardiac dysrhythmia
- Intrauterine growth restriction in current pregnancy
Hx of…
–> Extremely sedentary lifestyle
–> Precipitous labor
Poorly controlled…
–> Type 1 DM
–> Seizure disorder
–> Hyperthyroidism
Stretching
CI:
- Acute infection/inflammation
- Forcing a joint beyond normal ROM
- Movement restriction due to certain surgery (e.g. THR)
- Unhealed #
- Joint effusion
- Hematoma
- Sharp/acute joint pain
- Recent corticosteroid injection to the involved tissue
- Hypermobility/instability in direction being stretched
- Bony block limits motion
Precautions to stretching:
- Limb soreness >24hrs after stretching
- Osteoporosis
- Newly united fracture
Positioning a Pt in prone
CI:
- Unstable SCI
- Unstable ICP
- Facial trauma
- Burns over ant. aspect of body
- Open chest/abdomen due to injury/surgical procedure
Precautions:
- Hemodynamic instability
- Active intraabdominal process (e.g. infection)
Assisted cough
Contraindication:
* Ruptured diaphragm
* Inferior vena cava filter
Precaution:
* Bowel obstruction
* Increased ICP
* Gastric reflux
* Fracture
* Abdominal aortic aneurysm (AAA)
* Trauma to chest
* Pregnancy
* Gastrotomy
* Recent abdominal surgery
* Cardiac instability
* Fragile or rigid rib cage
* Thorax/spinal trauma
Percussions, vibrations and rib springing
CI:
MSK issue
- Fractured ribs
- Osteoporosis
CP issue
- Oxygen desaturation
- Subcutaneous emphysema of neck and thorax
- Poor/unstable cardiovascular status
- Recent bright red hemoptysis
- Pneumothorax
- Pulmonary embolism
- Recent pacemaker insertion
Neuro issue
- Unstable head injury
- Increase ICP
- Uncontrolled seizures
Other condition
- Hemorrhage tendency
- Metastatic bone cancer
- Resectable tumor
- Recent skin graft
- Pain intolerance to treatment
Precaution:
* Bronchospasm
* Bruising
* Patient upset/agitated
* Tube feed - stopped 30 minutes prior to treatment to minimize risk of aspiration
Nasopharyngeal suctioning
CI:
Nasal/face issue
- Nasal bleeding/bleeding disorder
- Nasal stenosis
- Nasal infection
- Nasal pathology (e.g. septal deviation)
- Acute head/fascial injury
Potential damage to CNS
- Basal skull fracture
- CSF leakage
Potential damage to upper resp. tract
- Epiglottitis or croup
CP issue
- Cardiovascular instability
Pt unable to tolerate
- Increased restlessness and agitation
Postural drainage
CI:
Blood vessel & Circulation
* Unstable cardiovascular status
* Increased intracranial pressure
* Congestive heart failure
* Aneurism
Lung related
* Untreated pneumothorax
* Hemoptysis
* Pulmonary embolism
Others:
* Esophageal anastomosis
* Recent laminectomy
* Patient upset/agitated
CI to Cardiopulmonary exercise
Heart related:
- Acute myocardial infarction
- Unstable angina
- Severe aortic stenosis
- Uncompensated CHF
- Active pericarditis, myocarditis, or endocarditis
Vessel related:
- Acute DVT
- Aortic aneurysm
Blood pressure related:
- Uncontrolled systemic hypertension
- Resting systolic BP (SBP) >200 mm Hg or resting diastolic BP (DBP) > 110 mm Hg that should be evaluated on a case by-case basis
- Orthostatic BP drop of >20 mm Hg with symptoms
ECG related:
* Resting ST-segment depression or elevation (>2mm)
* Third-degree atrioventricular (AV) block without pacemaker
* Uncontrolled atrial or ventricular dysrhythmias
* Uncontrolled sinus tachycardia (>120 beats per minute)
Systemic related:
* Acute systemic illness or fever
* Uncontrolled diabetes mellitus
* Recent embolism
* Thrombophlebitis
* Severe orthopaedic conditions that would prohibit exercises
* Other metabolic conditions
Neuro related:
- ICP > 20 mmHg
Precautions to cardiopulmonary exercise
Heart related:
* Pulmonary hypertension
* Bradycardia/ Tachycardia
* Moderate valvular disease
Repiratory related:
* Unstable asthma
Systemic related:
* Diabetic patient with autonomic denervation of heart
Resistance training with cardiac Pt
CI:
- Symptomatic CHF
- Uncontrolled HT
- Severe valvular disease
- Unstable symptoms
