Acute care Flashcards
What are the differences between joint effusion and edema?
Joint Effusion
– Contained by joint capsule
– Feels like a water balloon
– Moves when palpated then returns
Edema
– Fluid in interstitial space
– Press on tissue with finger – dent (pit) remains
• Measurement of edema with circumference is
reasonable accurate and correlates well with CT
scans
What is PRICE, RICE and PRICES?
PRICE: protect, rest, ice, compress, elevate
RICE: all of the above except protect.
PRICES: all the above, add support
With external compression wrapping, what direction do you wrap?
Distal to proximal
What accessories can you utilize to increase compression?
J or horseshoe shaped felt pad held in place with the wrap.
What is internal compression and what are the methods?
Compression of lymph vessels and veins.
– Muscle contractions (if safe)
– ROM, pumping ankles, alphabet, isometrics
What does external compression do for circulation?
Pushes fluid towards the heart (therapeutic and prophylactic for Deep Venous Thrombosis (DVT) and Venous Thrombo Embolism (VTE)
Pushes arterial blood into extremity
– Ischemia, intermittent claudication
When is intermittent compression appropriate and what would you use?
Acute or chronic edema
- Mechanical device (usually pneumatic)
- Inflates to compress part
Whats the most common form of intermittent compression?
Intermittent sequential graded compression
• 3- compartments
– Distal,
– Intermediate
– Proximal
• Inflated for minutes
then deflated then
repeated hours per
day
T/F
Intermittent compression can be combined with cooling?
True
What are the positive effects of elevation?
• Gravity augments lymph flow • Elevation above heart level significantly reduced edema in 20 minutes • Dependent position increases edema (in normals) – Probably more profound in inflammation
What kind of things fall under the “support” category?
Nutrition Education Taping, bracing, crutches, canes, etc. Referral for emotional support Etc.
Bracing and taping are great for acute support, but what are some downsides?
Not much research
Tape stretches within 20-30 minutes
Bracing can inhibit muscle actions (e.g. knee brace inhibit the hamstring from contracting).
T/F
When structure and function of a joint are not severely compromised, it’s still best to be safe and cut out any weight bearing activity on that part of the body.
False,
If not severely compromised, careful and partial weight bearing is better than non weight bearing.
When fitting crutches, what should patient orientation be?
- Low heeled shoes
- Stand with tall posture
- Feet close together
When fitting crutches, how should the crutch tips be oriented relative to the feet?
– 6”(15 cm) from outer margin of shoe
– 2”(5) cm in front of shoe
When fitting crutches, how should the arm brace and hand brace be oriented?
Arm brace
– 1-2” below ant. axillary fold
• Hand brace
– elbow flexed to 30 degrees
What are some abnormal stresses that can come from improper usage or fitting of crutches?
–Lumbar/pelvic subluxation
–Low back strain
–Hip strain
What anatomy is effected by crutch palsy and what are the symptoms?
- Pressure on axillary nerves and vessels
* Temporary or permanent numbness
What should be the orientation of crutches while walking for weight bearing and non weight bearing?
• Non-weight bearing = tripod gait
• Partial weight bearing = tripod or 4-point
gait
How can you instruct your patients so that they don’t experience crutch palsy?
Instruct them to always use an upright spinal posture
Discourage them from resting on the underarm braces.
What are the 7 aspects of tripod non-weight bearing gate with crutches?
• Affected foot fully elevated • Crutch tips move 12 to 15 in. ahead of feet • Lean forward, straighten elbows • Pull underarm brace firmly against torso • Swing both legs between crutches • Step onto unaffected foot • Recover crutches to forward position
What is swing-to gait and swing through gait?
Swing-to gait: bring fit to crutches (easier, less coordination)
Swing-through gait: foot lands in front of crutches (faster, more coordination).
What’s another name for tripod partial weight bearing gait?
Four point gait.
What is tripod non-weight bearing gait?
• Affected leg and crutches move forward together
– Partial weight placed on affected leg
What are the two gait options when going up and down stairs?
Tripod gait: tripod gait if no handrail, curbs
• “The good go up, the bad go down”
Handrail gait – Preferred, safer
– Both crutches under one arm
• Away from railing
• Crutches remain on affected side if possible
What is the proper steps to going up and down stairs with handrail gait?
Going up: unaffected side goes first, follow by crutches and bum leg.
Going down: crutches down, then affected leg, then unaffected leg.
What is the proper steps to going up and down stairs with tripod gait?
Going up: unaffected leg goes first, followed by crutches and bum leg.
Going down: Crutches and affected leg go down first, then unaffected leg. `
What kind of footwear should patients wear when fitting a cane?
Low heeled street shoes
What is the appropriate length for a cane?
Superior aspect of greater trochanter
T/F
Cane is to be used on the side of involvement
False,
cane’s are to be used on the OPPOSITE side of involvement.
T/F
Cane is to move with the involved side
True
