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
