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Basic Eval II > Immobilization and Positioning > Flashcards

Immobilization and Positioning Flashcards

1
Q

What are 4 forms of immobility?

A
  • Best rest
  • Casting/ splinting
  • NWB status
  • Issues related to injury
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2
Q

What are 4 benefits of immobility?

A
  • Minimize motion of the body or body part
  • Promotes healing and repair of tissues
  • Allows clot formation for healing
  • Decreases pain and swelling
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3
Q

What 6 muscle changes may occur as early as the first 10 hours of immobilization?

A
  • Atrophy
  • Decreased strength
  • Reduced capillary to muscle fiber ratio
  • Reduced muscle density/ mass
  • Reduced endurance
  • Contracture
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4
Q

What muscles are most affected by immobility?

A

Anti-gravity muscles.

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5
Q

What are the 2 main bone changes related to immobility?

A
  • Loss of bone density

- Calcium deposits in joints

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6
Q

Where is bone mineral density loss the greatest?

A
  • Calcaneous
  • Femoral neck
  • Spine
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7
Q

What are 2 tendon and ligament changes due to immobilization?

A
  • Disorganization of cell structure leading to decreased tolerance for exertion
  • Destruction of ligament fibers and decreased strength at the ligament insertion site
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8
Q

What are 3 cartilage changes that occur due to immobilization?

A
  • Fibrofatty connective tissue adheres to cartilage.
  • Loss of cartilage thickness
  • Pressure necrosis at points of contact
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9
Q

What can happen to the nervous system due to immobilization?

A
  • Compression neuropathy
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10
Q

What is a common position that causes the peroneal nerve to be damaged?

A
  • ER of legs

- Compression at fibular head

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11
Q

What equipment can be used to prevent ER of the LE during immobilization?

A
  • Podus Boot with anti rotation bar and holes cut at the heels that prevent skin breakdown.
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12
Q

What are 3 changes due to immobilization of the joints/ synovium/ menisci?

A
  • Impaired ROM (due to joint changes and muscle shortening)
  • Proliferation of fibrofatty CT in joint space
  • Adhesions
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13
Q

What are 5 cardiovascular changes due to immobilization?

A
  • Reduced CO with increased work of heart, and decreased SV
  • Increased resting HR
  • Reduced endurance (increased HR to submax exercise)
  • Orthostatic hypotension
  • Venous stasis
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14
Q

What are 6 lung/ respiratory changes due to immobilization?

A
  • Decreased cough due to reduced airway clearance/ pooling of secretions
  • Increased likelihood of pneumonia
  • Reduced max ventilatory volume
  • Decreased chest movement = decreased VC
  • Respiratory acidosis (retained CO2)
  • Increased respiratory rate at rest
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15
Q

What are 4 metabolic changes due to immobilization?

A
  • Decreased metabolic rate
  • Increased protein catabolism (wasting)
  • Dilated blood vessels (increased heat/ sweating)
  • Loss of electrolytes
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16
Q

What are 3 blood changes associated with immobility?

A
  • Reduced hematocrit and plasma volume
  • Reduced endurance
  • Reduced temperature regulation
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17
Q

What is a normal hematocrit?

A

M: 45 - 52 %
F: 37 - 38 %

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18
Q

Below what percentage hematocrit is exercise contraindicated?

A

25 %.

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19
Q

What blood borne system increases with immobility, and why?

A
  • The coagulation system increases due to an increase in fibrinogen levels.
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20
Q

What 3 bowel and bladder changes occur with immobility?

A
  • Constipation
  • Increased likelihood of UTI
  • Increased likelihood of kidney stones
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21
Q

What causes an increased likelihood of UTIs in immobilized patients?

A
  • Catheters
  • Decreased fluids
  • Stasis
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22
Q

What serious effect can a UTI have?

A

Decreased mental state.

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23
Q

What 4 mechanisms cause edema due to immobilization?

A
  • Pooling of fluids
  • Fluids produced for healing
  • No skeletal muscle pump
  • No synovial fluid movement.
24
Q

What are 7 psychological changes due to immobility?

A
  • Decreased sensory stimulation
  • Altered body image
  • Withdrawl
  • Hostility
  • Anxiety
  • Isolation
  • Depression
25
Q

What are the two main causes of mortality in immobilization?

A
  • DVTs

- PEs

26
Q

What are the 4 goals of early mobilization of patients?

A
  • Maintain function of non-injured tissue and body areas
  • Preventing DVTs and Pulmonary Embolisms
  • Decreased risk for developing pneumonia
  • Patient education
27
Q

How are 3 types of early mobilization?

A
  • PROM
  • AAROM
  • AROM
28
Q

One what type of patients would PROM be carried out?

A

When motion is not possible, severely limited, causes pain,is not safe, or if active movement causes CP distress.

29
Q

What are 3 benefits of PROM?

A
  • Maintain joint and soft tissue mobility
  • Maintain joint and tissue nutrition
  • Increase kinesthetic awareness
30
Q

In what type of patients is AAROM used?

A

Patients who are weak, in pain, have abnormal tone, paresis, or have CP problems.

31
Q

What are 3 benefits of AAROM?

A
  • Maintain joint and soft tissue mobility
  • Maintain joint and tissue nutrition
  • Increase kinesthetic awareness
32
Q

In what type of patients is AROM used?

A

When Pt can move without causing any stress on any body system.

33
Q

What are 3 benefits of AROM?

A
  • Maintain joint and soft tissue mobility
  • Maintain joint and tissue nutrition
  • Increase kinesthetic awareness
34
Q

How does immobility cause skin problems?

A
  • Skin compression
  • Circulation interruption
  • Skin breakdown due to shearing forces
35
Q

How often must a patient be repositioned in acute and rehab phases when in bed?

A

Every 2 hours.

36
Q

How often do patients need to be repositioned in acute and subacute stages when sitting?

A

Push-ups every 15 minutes.

37
Q

How can PTs prevent skin shearing forces?

A
  • Lift; don’t drag
38
Q

What 2 methods can be used to control incontinence?

A
  • Absorbent pads

- Scheduled toileting

39
Q

What are 3 pressure relieving devices used to prevent skin breakdown?

A
  • Alternating pressure air mattresses
  • Splints
  • Seat cushions
40
Q

What non-therapeutic modification can be made to improve a patient’s skin condition?

A
  • Promotion of good nutrition
41
Q

What are 4 proper transfer techniques/ equipment?

A
  • Draw sheets
  • Trapeze
  • Manual Lifts
  • Electric Lifts
42
Q

Since pressure decreases dispersed over larger areas, how can the patient’s environment be modified to apply this principle?

A
  • Pad hollow areas
  • Bridge bony areas
  • Prevent bed linen wrinkles
43
Q

When leaving a patient after treatment, what 5 principles should be followed when positioning them?

A
  • Make them comfortable
  • Promote proper alignment
  • Prevent development of deformities and skin breakdown
  • Provide access to their environment
  • Provide positioning for treatment procedures
44
Q

What are 5 common areas of pressure in the supine position?

A
  • Back of the head
  • Shoulder blades
  • Elbows
  • Sacrum/ coccyx
  • Heels
45
Q

Check book for positioning of supine –> prone

A

Check book for positioning of supine –> prone

46
Q

What are 6 common areas of pressure in a prone patient?

A
  • Cheek/ ear
  • Shoulder
  • Breasts (women)
  • Genitals (men)
  • Kneecaps
  • Toes
47
Q

What are 6 commons areas of pressure in a side-lying patient?

A
  • Ear
  • Shoulder
  • Ribs
  • Hip
  • Knees (int/ext)
  • Ankles (int/ext)
48
Q

What are 6 areas of common pressure in a seated patient?

A
  • Ischial tuberosity
  • Sacrum
  • Elbows, forearms, wrists
  • Heels
  • Hips
  • Scapula
49
Q

What are 12 PT interventions for immobilization?

A
  • Positioning
  • ROM
  • Wound care
  • Education
  • Bed mobility
  • Mobility
  • Ambulation
  • HEP
50
Q

What are 4 PT responsibilities in immobilization?

A
  • Monitor vitals closely
  • Promote upright posture
  • Promote early WB activities
  • Build self-confidence
51
Q

What the next step of graded mobilization after assisted bed mobility and AAROM?

A

Assisted sitting at EOB.

52
Q

If the Pt has adequate LE strength and trunk control to safely stand, what is the next step?

A

Assisted sit-to-stands.

53
Q

If the Pt does not have adequate LE strength and trunk control to safely stand

A

Partial WB exercise, and trunk control activities in sitting.

54
Q

If the Pt can do assisted sit-to-stands, what is the next step?

A

Assisted transfers.

55
Q

If the patient can perform an assisted transfer and is safe to begin GT with RW, what is the next step?

A

GT with RW

56
Q

If the patient cannot perform an assisted transfer and is safe to begin GT with RW, what is the next step?

A

GT with platform walker

57
Q

If the patient can perform GT with RW, what is the next step?

A

Balance and endurance training.

Basic Eval II (7 decks)

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