Foundations/Multi D Flashcards
PPE includes:
Scrub suits, masks, eye protection, gowns, gloves, accessories (caps, beard covers, shoe covers)
PPE Donning Order:
From the bottom up
Gown, mask, goggles, gloves (When raised above the head)
PPE Doffing Order:
Alphabetical order
Gloves, goggles, gown, mask
Contact Precautions:
Wash hands, wear gloves, wear gown, patient dedicated equipment, private/cohort rooms, limit patient transport to essential purposes only
EX: MRSA, staph, VRE, C Diff.
Droplet Precautions:
Wash hands, wear mask, private room preferred, limit patient transport to essential purposes only and patient must wear mask
EX: Strep, flu, COVID-19, Mumps
Airborne Precautions:
Wash hands, wear N-95 respirator, private room with negative air flow (Door must be closed), limit patient transport to essential purposes only and patient must wear mask
EX: TB, Chickenpox, Measles
Vital Signs Include:
Pain, temperature, heart rate, oxygen saturation, blood pressure, respiration, walking speed
Temperature Normative Values:
Normative: 96.8-99.3 degrees F
Average: 98.6 degrees F
Fever: Over 100 degree F
Heart Rate Normative Values:
Adults: 60-100 bpm
Children 1-10 y/o: 70-130 bpm
Newborns: 100-150 bpm
Factors Affecting Heart Rate:
Age, sex, environmental temp, infection, physical activity, emotional status, medications, cardiopulmonary disease, physical conditioning
Respiratory Rate Normative Values
Adults: 12-18/min
Infants: 30-50/min
Factors Affecting Respiratory Rate:
Age, physical activity, emotional status, air quality, altitude, disease, medication
Pulse Oximetry Normative Values:
Normative: 95-100%
Hypoxemia: <90%
Blood Pressure Normative Values:
Normal: <120 and <80
Elevated: 120-129 and <80
Stage 1: 130-139 or 80-89
Stage 2: >140 or 90-99
Crisis: >180 and/or >120
Factors Affecting Blood Pressure:
Age, physical activity, emotional status, medications, size/condition of artery, arm position, muscle contraction, blood volume, dehydration, cardiac output, site of measurement
Cycle of Cross Contamination and Infection:
- Reservoir for organism/host (Person with Covid-19)
- Method of exit for the organism
- Method of transmission of the organism
- Method of entry of the organism into a new host
- Susceptible host (Infection develops in new host)
What is Asepsis?
Absence of microorganisms that produce disease, the prevention of infection by maintaining a sterile condition
What is Medical Asepsis?
Practice that helps reduce the number and spread of microorganisms (PPE)
What is Surgical Asepsis?
Practices that render and keep objects and areas free of all microorganisms (surgical scrub)
Nosocomial/Hospital Acquired Infections:
Pertaining only to infections originating in a hospital
Dependent/Total Assist
Requires total physical assistance from one or more persons to accomplish the activity safely
0-24% of the activity is completed by the patient
Maximal Assist (max A):
Patient performs 25-49% of activity, assistance required to complete activity
Moderate Assist (mod A):
Patient performs 50-74% of activity, assistance required to complete activity
Minimal Assist (min A):
Patient performs 75% or more of activity, assistance required to complete activity
Contact Guarding (CGA):
Caregiver positioned close to the patient with hands on the patient or gait belt, protection required during activity
Standby/Supervision Assist (SBA):
Verbal or tactile cues, directions, or instructions required from caregiver positioned close to patient, but not touching patient performing activity
Modified Independent (Mod I):
Patient is able to perform task independently but uses adaptive or assistive equipment or requires additional time
Independent (I):
Patient can perform transfer without any type of verbal or manual assistance
Verbal Cues:
Verbal or tactile cues, directions, instructions, or set-up required from caregiver but patient able to perform activity without direct assistance
Wheelchair Seat Height Measurements:
Heel of the shoe (with footwear) to popliteal fold. Then add 2 inches to allow clearance of footrests
If a seat cushion is used, do not add inches
Wheelchair Leg Length Measurements:
No patient measurement
Minimum clearance between floor and footplate is 2 inches measured from the lowest part on the bottom of the footplate
Wheelchair Seat Depth Measurements:
Posterior buttock to the posterior aspect of the lower leg on the popliteal fossa
Subtract two inches from patient’s measurements
Wheelchair Seat Width Measurements:
Patients hip width at widest part and add 2 inches
Wheelchair Back Height Measurements:
Varies depending on amount of support needed
For standard adult w/c, measure from the seat of the chair to the axilla, then subtract 4 inches
Patient must be measured sitting on cushion if cushion will be used
Wheelchair Arm Rest Height Measurements:
From the seat of the chair to the olecranon process with the patient’s elbow flexed at 90 degrees, then add 1 inch
Patient must be measured sitting on cushion of cushion will be used
Purpose of Cushions for Wheelchairs:
- Improve pelvic position
- Relieves pressure
ICF Model: Body Functions:
The physiological functions of body systems (including psychological functions)
ICF Model: Body Structures:
Anatomical parts of the body such as organs, limbs, and their components
ICF Model: Activity:
The execution of a task or action by an individual
ICF Model: Participation:
Involvement in a life situation
ICF Model: Environmental Factors:
The physical, social, and attitudinal environment in which people live and conduct their lives. These are either barriers to or facilitators of the person’s functioning
ICF Model: Personal Factors:
Demographic information about the patient. Attributes that are static at the time of impairment
Define Disability
A person who has a physical or mental impairment that substantially limits one or more major life activity
Physical/Mental Impairment:
Any physiological disorder or condition, cosmetic disfigurement, or anatomic loss affecting one or more of the body systems
Reasonable Accommodation:
Making modifications at the job site/workplace that enable a person with disabilities to easily perform a specific job
Undue Burden:
An action necessary to provide reasonable accommodations that would cause the employer/owner significant difficulty or expense
Qualified Individual with a Disability:
A person who can perform the essential functions of a given job/activity with/without the benefit of reasonable accommodations
ADA: Ramps:
Width: 36” Minimum
Rise: For every 1” of rise, you need 12” or 1’ of run
Length: Ramps can be up to 30’ long before a flat area is needed
ADA: Wheelchair Passage Width:
- 48” is the minimum width needed for an ambulatory person to pass a non-ambulatory/semi-ambulatory person
- 60” is the minimum width needed for two ambulatory/semi-ambulatory people to pass
ADA: Landings:
Ramps shall have level landings at bottom and top of each ramp and each ramp run
- The landing shall be at least as wide as the ramp leading up to it
- The landing length shall be a minimum of 5 feet in length
ADA: Turns:
- If ramps change direction at landings, the minimum landing size shall be 5x5 feet
- Right and left hand turns need a 5x5 foot landing
- U-turns require a 5 ft by twice the ramp width landing
ADA: Handrails:
- If a ramp run has a rise greater than 6” then it shall have handrails
- Handrails should be 34-38” in height
ADA: Edge Protection:
Ramps and landings with drop-offs shall have curbs, walls, railings, or projecting surfaces that prevent people from slipping off the ramp. Curbs shall be a minimum of 2” high
ADA: Door Width:
Minimum: 32”
Preferred: 36”
ADA: Safety/Grab Bars:
24-30” long, height and position according to the patient’s needs
- Grab bars MUST be attached to floor, wall stud, or reinforced underlay
Ascending Stairs:
- Up with the good
- Strong side next to the railing (if possible)
- Advance strong LE to the next step
- Advance assistive device to the next step
- Advance injured LE to the next step (or may move with assistive device)
Descending Stairs:
- Down with the bad
- Strong side next to the railing (if possible)
- Advance assistive device to the next step
- Advance injured LE to the next step
- Advance strong LE to the next step
Fitting a Cane:
- Greater trochanter or ulnar styloid and angle at the elbow
- Assess the height of the cane/walker according to patient comfort and effective function; watch them use it
Fitting Axillary Crutches:
- 2” below axilla (can use 2-3 fingers)
- 2” lateral and 4-6” anterior to foot
- Hand position should allow 20-25 degrees of elbow flexion
Fitting Forearm Crutches:
- 2” lateral and 4-6 inches anterior to foot
- Hand position should allow 20-25 degrees of elbow flexion
- Cuff placement should be in the proximal third of the forearm approximately 1-1.5” below the elbow
Parallel Bars:
- Parallel bars provide maximum stability, security, and safety
- Allow the patient to work on pre-ambulation and balance activities
- Initial instruction in a gait pattern might begin in the parallel bars
Health Condition:
Pathology, disorder, disease, injury, trauma or congenital anomaly. Usually diagnosed by a physician
Physical Therapy Diagnosis:
Takes the medical (health) condition/pathology and puts it in the framework of the ICF model to define how it effects the person’s function and how the condition causes disability
Activity Limitations:
Difficulties an individual may have in performing actions, tasks, and “usual activities”
Participation Restrictions:
Problems an individual may experience in involvement in life situations
Differential Diagnosis:
A systematic process to classify an individual into a diagnostic category
Acute Care Setting - Hospital:
- Inpatient services to clients with unstable medical conditions
- 24 hour/day highly skilled medical services from physicians, nursing, and health professionals
- EX: Community hospitals, large medical centers, level 1 trauma centers, and specialty hospitals
- PT is valuable in reducing hospital length of stay and preventing patient readmission
Inpatient Rehab Facility (IRF)/Acute Rehab Facility (ARF):
- Inpatient care to residents that are relatively medically stable
- 24 hour nursing care, a minimum of weekly physician visits, and must be able to participate in at least 3 hours, 5 days per week of skilled therapy, at least 2 therapy services required
- Average LOS = 13.1 days
Long Term Acute Care Hospital (LTACH):
- Requires very close medical supervision (slightly less than hospital as patient is considered stable)
- Can receive therapy services, but likely limited in time
Sub Acute/Skilled Nursing Facilities (SNF):
- Inpatient care with 24 hour nursing supervision
- Must be able to tolerate at least 1 hour of skilled physical rehabilitation per day up to 2.5 hours
- Patients typically stay longer than 2 weeks
Assisted Living with Respite Care and Home Health Services:
- Private pay for temporary stay in assisted living facility
- Respite care - a short period of relief from something difficult or unpleasant
Home Health Care (HH):
- Services including skilled nursing and rehabilitation
- Delivered in the home setting
- Patients must be home bound
Long Term Care Facilities (LTC):
- Varying levels of supervised living arrangements (RN/LPN)
- Clients are unable to safely manage independent living
Integ System - Function:
- Temperature regulation
- Protection
- Sensation
- Excretion
- Immunity
- Blood reservoir
- Vitamin D synthesis
Burns - Superficial:
- Epidermis only, no blisters
- Red, Painful
Burns - Superficial Partial Thickness:
- Epidermis and superficial dermis
- Blisters, red, painful
Burns - Deep Partial Thickness:
- Majority dermis
- Hair follicles/sweat glands intact
Burns - Full Thickness:
- Subcutaneous fat layer
- Minimal pain
- Susceptible to infection
- Increased depth = decreasing pain
Burns - Subdermal:
- Muscle, bone, adipose tissue injury
- Insensate
Cardiopulm Care- Core Vital Signs:
- Heart rate
- Respiratory rate
- Blood pressure
- Edema
Orthostatic Hypotension:
- Significant drop in BP due to pooling of blood in peripheral vessels
- An important part of fall risk assessments
Assessing Orthostatic Hypotension:
- SBP decrease of 20 mm Hg or more
- DBP decrease of 10 mm Hg or more
- HR increase of 10 bpm or more
Sternotomy Precautions:
- No lifiting over 10 pounds
- No pushing/pulling with arms
- No shoulder flexion over 90 degrees
- No shoulder horizontal abduction
- Heart hugger vest for cough (pillow for splinting)
Posterior Hip Precautions:
- No hip flexion greater than 90 degrees
- No hip adduction past midline
- No hip internal rotation
Anterior Hip Precautions:
- No hip extension past neutral
- No active hip abduction
- No hip external rotation past neutral
Total Knee Precautions:
- No twisting of LE in weight bearing position
- No sitting with legs crossed
- Avoid low soft chairs
- Do not forcefully bend operated knee
- Do not kneel on operated knee
- Use of walker (days/weeks/as needed)
Shoulder Precautions:
- NWB and immobilized constantly unless receiving PROM
- Surgeon prescribed PROM of shoulder
- No abduction or extension past neutral
- AROM elbow, wrist, hand
Amputation Management:
- Positioning and compression for edema control
- Positioning to avoid contractures (avoid hip and knee flexion positioning)
- Benefits of early ROM, strength, mobility training
- Discussion of pain management, phantom pain
Spinal Precautions:
- No twisting of the spine
- No bending of the spine
- No exercises/ lifting that will increase intra-abdominal pressure extensively
National Institutes of Health Stroke Scale (NIHSS):
- 0-42 scale
Very Severe: >25
Severe: 15-24
Mild/Moderately Severe: 5-14
Mild: 1-5
White Blood Cells:
Adult: 5,00-10,000
Critical: ,2,500 or >30,000
Hemoglobin:
Male: 14-18
Female: 12-16
Critical: <5 or >20
Hematocrit:
Male: 42-52%
Female: 12-16%
Critical <15% or >60%
