Exam 2 Flashcards
what does the term seating refer to?
the ability to be positioned in sitting against gravity with balance and optimal postural alignment
what does good seating correct and/or accommodate?
postural deviation that could lead to:
structural deformity
prevent skin breakdown
assists in spasticity management
allow users to participate in ADLs, functional tasks and recreation
what are the 6 types of wheelchairs?
manual wheelchairs
recliner wheelchairs
tilt-n-space wheelchairs
pediatric wheelchairs
powered wheelchairs
sports and recreation wheelchairs
who specifically uses a lightweight and ultra lightweight manual wheelchair?
those who cannot push a standard chair functionally or need different seat sizing
what are the components to a wheelchair? (5)
seat frame
seat-to-back angle
armrests
leg rests and footrests
wheels and wheel locks
what are the wheelchair accessories? (9)
lapboard
positioning belt
anti-tip devices
hill holder
hand rim projections
brake lever extender
controls
cushions
positioning
what is the optimal seat height for a wheelchair?
2” clearance of footrest from the floor to allow for footrest clearance over thresholds and thigh resting on cushion
what is the optimal seat depth for a wheelchair?
full thigh support to reduce pressure on buttocks and support lower extremities
what is the optimal seat width for a wheelchair?
space to accommodate width of hips without causing pressure to skin
what is the optimal back height for a wheelchair?
below inferior angle of scapula to not interfere with UE propulsion
what is the optimal armrest height for a wheelchair?
appropriate support of the UE
what is the proper breakdown for a folding frame wheelchair?
remove any cushions/supports, leg rests & armrests
pull up on seat upholstery to fold in the middle
lift the wheelchair by the frame to transport
what are 4 client and caregiver trainings for wheelchairs?
proper sitting posture
pressure relief
wheelchair propulsion
transfer training
what are safety considerations for wheelchairs? (5)
brakes and transfers
arm and leg rest
curbs and inclines
wheelchair maintenance
transfers <> wheelchair
what are transfers?
movement of a patient from one position or surface to another
what are 3 considerations to account for before transferring based off the patient’s experience ?
have they done this before?
if they have, how much help did they need?
does the pt regularly use any type of device or orthotics?
what are 7 considerations to account for before transferring based off the patient’s ability ?
strength
joint mobility
balance
pain level
cognition
endurance
motor control
although patient independence is the goal of transfers, what is the primary responsibility during transfers as a caregiver?
provide assist to protect the patient to avoid injury
what are 4 considerations you need to think about when planning a transfer?
purpose of transfer
equipment needed
departure and arrival points –> safe?
assistance needed?
- have a plan A, B, C
- A: realistic plan, B: better than expected plan, C: plan completely falls apart
what is the purpose of a gait belt?
improves safety of both the patient and caregiver
generally, where should you position a gait belt?
most often at the waist
can be higher –> patient comfort and facility dependent
what kind of grip do you have when using a gaitbelt? what muscles are you using?
strong underhand grip - using extrinsic muscles of wrist and hand
- do not use over-hand grip - relies more on intrinsic hand muscles
what are special circumstances where you would place the gait belt in a spot other than at the waist?
colostomy/ileostomy
supra-pubic catheters
feeding tubes
chest, abdominal or spine surgeries
chest tube placement
nephrostomy placement
rib fractures
trauma
fragile skin
age related anatomical changes
patient preference
what are 4 benefits of good body mechanics?
uses less energy
reduces strain on body tissues
produces safe, efficient movement
promotes control and balance
what are some out of bed transfers?
sit to stand
stand pivot
seated transfers –> squat pivot & slideboard
what are situational transfers?
bed to WC
WC to toilet
WC to car
Bed to bed/stretcher
what are some considerations you need to be thinking about when doing a transfer?
patient starting position
wheelchair/target surface position
patient ending position
– stable, safe, comfortable, environmental access
what does a patient need to be able to do to perform a sit to stand transfer?
prepping the position
weight shift
rise (pt pushes down through feet & hands maintaining forward trunk flexion. pt bears weight through BLE to unweight rear end)
stand
what is a stand pivot transfer?
stand with/without assistive device and pivot to target
what is a squat pivot transfer?
modified stand/half squat with physical assist from caregiver and pivot to target
patient & PT have opposite head and hip relationship –> like a seesaw
what are the rules to a squat pivot transfer?
pt can bear weight safely through at least one LE
pt does not come to full stand however can lift and clear bottom from surface –> quick lift over short distance
no devices are used for squat pivot
make sure you remove the arm rest of WC
often more than one person assisting
what are rules for a seated “popover” transfer?
pt is unable to stand due to weakness
pt can lift and clear bottom from surface with or without caregiver assist
pt must possess significant UE strength and trunk control
what are tips for the caregiver in regards to transfers?
- observe?
- problem solve?
- encourage?
- prepare?
observe the transfer and practice providing assistance
problem solve to determine the most effective way to use the patient/family members’ abilities
encourage gradual independence and decreased assistance
prepare home environment to match the level of the ability of the patient/family member prior to discharge
GG level 06:
independent
no assistance is required to complete tasks in normal time
GG level 05:
setup/cleanup
modified independent
pt may require verbal cues, uses assistive device, or requires additional time to complete task
GG level 04:
supervision/touching assistance
supervision, stand by assist, contact guard assist
verbal or tactile cues, directions, instructions positioned close to but not touching pt. therapist has hands on pt and/or gait belt to provide safety as needed
GG level 03:
partial/moderate assistance
min assist: pt performs > 75% of activity
mod assist: pt performs 50-74% of activity
GG level 02:
substantial/max assist
patient performs 25-49% of activity
GG level 01:
dependent
pt requires total physical assistance one or more persons to accomplish the task safely
what are 3 types of supine transfers?
rolling
supine to supine
drawsheet dependent
what are 3 things you should do to ensure a successful transfer?
set up the environment before the transfer
determine the transfer style and level of assist based off patients condition and mobility/balance
ensure safety – gaitbelt, knee & foot placement
what are special populations you could encounter that may need special considerations?
spinal, hip, sternal precautions
hemiplegia
paraplegia
bariatric
cognitive impairment
WB status
true or false. someone with a spinal cord injury will have spinal precautions
false - not necessarily
what are spinal precautions?
BLT:
no bending past 90
no lifting > 8-10 lbs
no twisting–> log roll instead
what movements may be affected by spinal precautions?
bed mobility
hip transfers
sit to stand
what are special equipment used with spinal precautions?
TLSO or LSO
what are posterior hip precautions?
hip should not:
flex past 90
add past midline
IR past neutral
what are anterior hip precautions?
hip should not:
extend past non-surgical LE
ADD past midline
ER past neutral
what movements may hip precautions affect?
bed mobility
sit to stand
transfers
what special equipment may be involved with hip precautions?
hip abduction pillow
elevated toilet seat
considerations when transferring a pt with hip precautions:
- unaffected limb should be closest to target to allow for pivot and transfer to stronger side
- stand with physical assist from caregiver w/ assistive device and step or pivot to target
- the patient should be able to provide 25-75% physical effort during transfer
what kind of surgeries have sternal precautions?
cardiac
what are sternal precautions?
do not use UE to push or pull during transfer
no arm motions that could open up or stretch front of chest
what are special equipment used for pts with sternal precautions?
cardiac pillow
elevated toilet seat
what kind of injuries would have hemiplegia?
CVA, TBI, neurodegenerative
what are hemiplegia precautions?
hemi-side weakness
possible inattention (unaware that side exists)
possible hemi-side sensation loss
what movements might hemiplegia affect?
bed mobility
transfers
what special equipment may be used with hemiplegia pts?
assistive device considerations
ankle foot orthotics (AFO)
UE sling –> only use for safety when transferring. don’t leave on.
How should you transfer a hemiplegia patient?
- unaffected side should be closest to target - may practice affected side first if using for therapy intervention
- affected LE should be blocked to prevent knee buckling in standing
- stand with physical assist from caregiver with/w/o AD and step or pivot to target –> first, weight shift to affected limb w/ knee blocked to test stability and WB tolerance
- allow patient to step toward target w/ unaffected limb while stabilizing affected side –> use your foot to push theirs along
what kind of injury would a paraplegia pt have?
SCI - traumatic and non-traumatic
what are paraplegia precautions?
lower body weakness, flaccidity
usually accompanied by sensation loss
what special equipment may you use with a paraplegic pt?
transfer board/slideboard
custom WC
How do you conduct a slide board transfer?
- assist pt to EOB
- position yourself in front of pt, blocking knees
- position slide board under patient’s R or L hip. ensure stable placement before transferring
- instruct pt to put one hand on slide board, the other can assist w/ pushing off from bed
- hold onto gait belt, rock pt forward 3x to lift bottom from bed. Pt can help push up from bed as able. move approx. halfway across board. assist with guiding pt’s legs as needed
- repeat until pt is seated on intended transfer surface. remove board. assist pt to scoot back as needed
why should you make sure you lift the pt across the slideboard instead of sliding?
potential skin shearing
what are 2 things to make sure of to have a successful slideboard transfer?
double check position of WC and armrest before transferring
reset pt’s feet each time you move across board
what qualifies pt as bariatric?
BMI > 30
what are bariatric precautions?
generalized weakness
learned helplessness - may not help move
what are special equipment that could be used with bariatric pts?
mechanical lift
transfer board
custom WC
barton convertible bed
what are examples of cognitive/comprehensive deficits?
dementia, neurologic injury, hard of hearing
what are precautions for cognitively impaired pts?
pt/therapist safety
compliance
one step commands
what are special equipment that may be used with cognitively impaired pts?
restraints
limit new, unfamiliar equipment
what would consider a pt NWB status?
traumatic injuries
stay off limb to allow for healing
what would consider a pt PWB status?
must have adequate sensation and proprioceptive awareness in LEs
usually a percentage
what would consider a pt TTWB status? (toe-touch WB)
“touch-down” WB
balance only on toes, not distributing weight through limb by pressure in heel
what would consider a pt WBAT status? (WB as tolerated)
routine elective ortho surgeries
full WB as tolerated by pt
what things must you make sure to document after completing a transfer with a patient?
type of transfer
amount and type of assistance required
amount of time required to complete - extra time or attempts?
level of safety and quality of movement demonstrated
precautions
level of consistency of performance (if performed multiple times)
equipment/devices used
what equipment is used in a recumbent, dependent lift? (aka lateral or horizontal transfer - supine to supine)
draw sheet
plastic transfer board - much larger than slide board
slide sheets (reduced friction)
transfer stretcher
mechanical lifts
what is a hovermatt and who is it most often used with?
air mattress that inflates to off-weight pt for lateral slide
used in ICU and with bariatric pts
what is a sitting, dependent lift?
chair to bed/mat or chair to chair
used when pt is unable to assist
what equipment is used in a sitting, dependent lift?
multiple individuals (two or more are required if no equipment used)
mechanical lift (i.e., hoyer lift)
slide board
what are the 3 different types of mechanical lifts?
hydraulic lift
electrical lift - uses slings
stander lifts
what is a hydraulic lift?
manually operated lift
uses a valve to control increase and release of pressure
base can widen or narrow
pts supported by sling
what does an electrical lift use that a hydraulic lift does not?
rechargeable batteries/AC adapter to power the lift
what 3 things help you determine which transfer to use?
patient’s ability
patient’s experience
goal of the transfer
– functional independence or just going surface to surface?
if patient presents with notable weakness, which side are you most often transferring the pt to?
stronger side
what are you blocking when transferring a pt?
block involved and/or weaker side
block one or both LEs
– stops forward progression of tibia
– can prevent legs from abducting
blocking can help stabilize
block tibia to tibia (not knee to knee)
PT can use foot to assist pt’s foot
what are some guidelines for treating in the ICU?
observe equipment/monitoring devices –> type and location
observe & maintain tubes & lines
evaluate pt’s physical & mental state
observe pt & monitor devices frequently, determine response to treatment & identify significant changes
notify nursing of significant changes & document
what are the following lines for?
- IV line
- arterial line
- PICC line
- central venous catheter
- hickman infusion site
- fluids, meds
- blood draws, BP
- nutrition
- looking at heart function
- fluid balance
what does mechanical ventilation do?
sends controlled flow of O2 into patient’s lungs
- rate, pattern, duration of gas exchange
- volume control or pressure control
what are the 3 types of mechanical ventilation?
assist-control
synchronized intermittent mandatory ventilation
pressure support ventilation
what are examples of noninvasive mechanical ventilation?
NC, face mask, CPAP
what are examples of invasive mechanical ventilation?
endotracheal tube, nasotracheal, or tracheostomy
when is supplemental oxygen needed?
when concentrations of inspired oxygen are insufficient for respiration and patients are at risk for hypoxia and hypoxemia
what are modes of delivery for supplemental oxygen? (6)
nasal cannula
face mask
nonrebreather
tracheostomy - can be mobile w/ this
CPAP
BiPAP
what are some precautions and considerations when working with someone on a mechanical vent?
mental status - pulls at lines
location of vent
length of lines
explain to pt what is going on
levels of O2, meds, etc.
what are ostomy devices and what are the 3 types?
opening in abdomen to allow elimination
colostomy, ileostomy, urostomy
what are chest drainage systems used for?
use to remove air, blood, or other undesirable matter from the patient’s chest or pleural cavity
where are chest drainage tubes placed to remove air?
anterior or lateral chest wall
where are chest drainage tubes placed to remove fluids and blood?
posterior and inferior chest wall
what are urinary catheters used for?
to alleviate urinary retention
rebuild bladder muscle tone
collect urine output and cultures
manage bladder conditions
what are the two types of catheters for males?
indwelling (foley): catheter through the urethra
condom catheter\
what are 3 feeding devices?
nasogastric tube (NG tube)
gastrostomy tube (G tube)
total parenteral nutrition (TPN)
where is an intracranial pressure monitor placed? normal ICP?
screwed into skull between arachnoid membrane and cerebral cortex to measure ICP
normal: 5-10-15 mm Hg
what does an external ventricular drain relieve? what must you make sure to do with this before therapy session?
ICP, hydrocephalus or CSF after a hemorrhage
always clamp before mobility
where is a swan-ganz catheter placed?
into pulmonary artery for cardiac function monitoring
- pulmonary artery pressure, R atrium pressure, pulmonary wedge pressure, etc
