ADL Exam 2 Review Flashcards
Complications from prolonged immobility
- blood clots
- orthostatic hypotension
- increased insulin requirements
- risk of aspiration
- constipation
- pressure injuries
- decreased muscle mass and strength
- loss of joint ROM, difficulty breathing
- pneumonia
- calcium loss in bones
- general inability to perform daily activities
requires therapist to move patient’s joints through full or available range
range of motion (ROM)
AROM
patient performs movement independently
PROM
movement of a body segment through the full motino possible by an external force (therapist) or uninvolved extremity
striping pattern in which sensory neurons are arranged
dermatomes
sensory neurons
nerves that detect pressure, pain and touch
How people with normal sensation avoid too much pressure on certain bony places
lean forward
shift from one hip to another
scoot bottom back in chair
roll from right side to left
Agency for Health Care Policy and Research statement on re-positioning patients
every 2 hours for bed, 15-30 minutes for seated
Another name for pressure injury
decubitus ulcer
pressure injury arises from
pressure applied to an area of skin over a long period of time
Factors that can cause or exacerbate pressure injuries
friction force
shearing force
comorbidities
Soft tissue contracture sites in supine
hip and knee flexors
ankle plantar flexors
shoulder extensors, adductors, internal rotators
Soft tissue contracture sites in prone
ankle plantar flexors
shoulder extensors, adductors, internal rotator and external rotators
neck rotators
Soft tissue contracture sites in sidelying
hip and knee flexors
hip adductors and internal rotators
shoulder adductors and internal rotators
Soft tissue contracture sites in sitting
hip and knee flexors
hip adductors and internal rotators
shoulder extensors, adductors, internal rotators
Generally desired position to avoid contractures
neutral
Reasons for positioning
avoid contractures
decrease likelihood of pressure injury
comfort
access for therapist to body part
to maximize patient function
areas where 25% of all pressure injuries are found
sacrum
heel
ischium
patella
supine common areas of pressure
scapulae (spine and inferior angle)
spinous processes
posterior iliac crests
ischium
*heels (posterior calcanei)
*sacrum
elbows (medial epicondyle)
back of head (occipital tuberosity)
sidelying common areas of pressure
ear
later ribs
*lateral acromion process
lateral head of humerus
medial/lateral epicondyles
*greater trochanter
medial/lateral condyles
*malleoli
5th metatarsal of foot
prone common areas of pressure
forehead
lateral ear
anterior acromion process
clavicles/sternum
anterior head of humerus
anterior superior iliac spine (ASIS)
tips of toes
patella
sitting common areas of pressure
*ischial tuberosities
scapular and vertbral processes
sacrum
coccyx
medial epicondyle of humerus
calcanei (heels)
restraint
anything that would prevent a patient from being able to move or change position on his/her own
things that might be considered restraints
medications, tying patient to bed or WC, WC cushions, WC toughs, , lap trays, bed rails, seat belt, pillows, towel rolls, bolsters, other positioning devices
A restraint can be ordered by
physician or other licensed healthcare personnel authorized by state and facility
positioning for transtibial amputation
keep hip and knee fully extended, avoid prolonged sitting
positioning for transfemoral or transtibial amputation for some time each day
prone
contracture risk for transfemoral amputation
hip flexion
also external rotation and abduction of hip
positioning for burn patient
discomfort
general goal of positioning limb after stroke
position patient in opposite of position of tone, support for flaccid extremity
contraindicated movements for THA, posterior approach
hip flexion past 90, hip adduction, hip internal rotation
contraindicated movements for THA, anterior approach
hip hyperextension, hip external rotation
general rule for limb edema
position patient’s limb in elevation (higher than the heart)
position to make breathing easier for patients with pulmonary issues
HOB elevated
HOB raised upright to 90 degrees
Fowler’s position
HOB raised between supine and 90 degrees
semi-Fowler’s
reasons for draping
modesty
warmth
access
protects clothing
action to take upon seeing a patient in bed whose skin is red and does not blanch
re-position patient, notify nursing staff and supervising PT; document
patient positioned in supine with towel roll under bilateral knees, pillow under head, and heels elevated with towel rolls to prevent pressure and maximize comfort is an example of which part of a SOAP note?
Objective
device used for proper positioning following a total hip replacement
hip abduction pillow (or abductor wedge) to prevent hip adduction
dependent (FIM 1)
patient is unable to assist in any way with bed mobility
maximal assist (FIM 2)
patient is able to preform 25-49% of the task
Moderate assist (FIM 3)
patient is able to perform 50-74% of the task
Minimal assist (FIM 4)
patient is able to perform 75% or more of activity
Contact Guard assist–No associated FIM-not used for FIM
requires hands-on only assist
Supervision/Stand by Assist (FIM 5)
No assist, no hands-on guarding, but therapist feels that he/she must be close to patient
Modified independent (FIM 6)
patient is able to perform task without assistance, including verbal or tactile cues, but patient requires use of an assistive device or equipment
Independent (FIM 7)
able to perform task with no assistance (no cues, no hands-on, no device/equipment)
Which technique is utilized to assist a patient with low back pain or SCI to get in, out of bed?
log roll
bed mobility includes:
any movement in the bed for repositioning or to prepare to get into or out of bed
FIM
Functional Independence Measure
a measure of disability, or what the patient can actually do, records progress on 18 items
FIM
What to avoid when moving patient with CVA
avoid pulling on involved limbs
ADA doorway or hallway width
minimum: 32inches
recommended: 36 inches
ADA door handles
operable with one hand, no greater than 48 inches and no less than 34 inches from floor
ADA ramps
1:12 ratio (~8%); 36 inches wide
ADA Wheelchair turning radius
60 inches
undue burden
any action necessary to provide a reasonable accommodation that would cause an employer significant difficulty or expense
major life activities
communicating, working, walking,
standing, lifting, bending, caring for oneself, breathing,
learning, seeing, hearing, speaking, reading, thinking,
sleeping, concentration, eating, performing manual tasks
disability
Physical or mental impairment that substantially limits a major life activity
qualified individual with a disability
Must have knowledge, skill, mental and physical capabilities to perform essential elements of job
reasonable accommodations
Modifications that will enable persons with disability to perform specific job
– Physical accessibility of workplace
– Adjusting work schedule
– Assistive devices such (teletypewriter, large print manuals)
Americans with Disabilities Act
serves as a law recognizing persons with disabilities as minority groups who deserve equal opportunity
true leg length
ASIS to base of medial malleolus
apparent leg length
umbilicus to base of medial malleolus
landmarks used to measure length of upper extremity
anterior tip of acromion
tip of middle finger
landmarks used to measure girth of upper extremity
tip of ulnar styloid
olecranon process
landmarks used to measure girth of lower extremity
inferior pole of patella
base of lateral malleolus
uses artificial kidney to remove waste and extra fluid from the blood; small amount of blood is taken out and filtered through a machine-then blood is returned to body; takes 4 hours; done 3x/week
hemodialysis
cleanses blood inside body by having plastic catheter surgically inserted into abdomen; abdomen is filled with dailysate; waster and extra fluid is drawn out into the dialysate
peritoneal dialysis
head down position of bed
Trendelenberg
head up/feet down position of bed
reverse Trendelenberg
measures pressure in right side of heart; allows for blood samples to measure blood oxygen flow
pulmonary artery catheter (Swan Ganz)
normal intracranial pressure
5-15 mmHg
abnormal intracranial pressure
anything greater than 20mmHg
HOB elevation for ICP
above 30 degrees
allows medications, blood, nutrients, fluids to be entered directly into blood; allows for extracting blood samples; used often for chemotherapy to prevent repetitive sticks
central venous catheter (CVC)
indwelling right atrial catheter placed in vein under collar bone; used for drawing blood, administering meds, providing nutrition and fluids
Hickman catheter
measures blood pressure continuously; inserted into radial artery
arterial line
DVT prevention
TED stockings
intermittent compression
medications such as Coumadin
S/S of deep vein thrombosis
erythema
edema
heat
pain
has 2 tips that rest just below nose and blow oxygen up into nasal passageways; for patients requiring little to moderate oxygen concentration and temporary need for O2
nasal cannula
mask that covers nose and mouth; delivers higher concentration of oxygen
oronasal mask
measurement of oxygen delivery
Liters (L)
Usually utilized when long term catheter use is required; is immediately removed
straight catheter
Inserted surgically just above pubic symphysis
suprapubic catheter
Applied externally, only for males
condom catheter
Inserted through the urethra into the bladder, held in place by a small balloon; urine drains into bag
Foley catheter
bed designed for spinal cord injured patients or surgical patients that cannot move on their own; can remain in spinal traction because bed turns patient
Turning frame (Stryker)
has silicone-coated beads in mattress, suspended by heated air; for patients with wounds or at risk of wounds
Air fluidized support bed (Clinitron)
segmented mattress with individually filled air bladders; for patients with pressure injuries or at risk for pressure injuries
Low air loss bed
wider and longer beds; heavy duty-can hold up to 1200 pounds
bariatric bed
