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PHTY2230 > L12: Physiotherapy Practice in Residential Aged Care > Flashcards

L12: Physiotherapy Practice in Residential Aged Care Flashcards

1
Q

Who is admitted to a RACF?

A

Frail older peopleusually with multiple medical conditions who can no longer be managed at home with maximal community assistance

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2
Q

What are 6 types of people who are admitted to a RACF?

A
  1. People with Dementia (±other conditions)
  2. High care Palliative Care Patients
    • Might not want to be in a home or hospital
  3. Respiratory care, pain management
  4. Young disabled people who need 24 hour care
    • Traumatic injury –> just for short term
  5. Transitional rehabilitation for SCI whilst waiting for home modifications TBI with extended post traumatic amnesia period limiting early rehab potential
  6. Respite admissions to ↑ functional ability to cope more efficiently at home
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3
Q

What are 2 types of care in RACF?

A
  1. High care wing
  2. Low care wing
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4
Q

What are dementia villages?

A

Village, streets, bus stops, theatres, religious, culture

Mini Community

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5
Q

Who else might need residential care?

A

Older / younger people with acquireddisability needing extended care whilst undergoing rehabilitation

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6
Q

What are 4 types of care?

A
  1. Staying at Home
  2. Aged Care Home
  3. Respite Care
  4. Transition Care
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7
Q

If older people want to stay at home, a range of services offered by the Australian Government to provide help to older people living in their own homes. What are 11 examples of the services that are given?

A
  1. Assistance with housework
  2. Personal care (bathing, dressing)
  3. Meals and food preparation
  4. Staying physically active
  5. Social support & activities
  6. Transport
  7. Nursing care
  8. Allied health support (physiotherapy, podiatry)
  9. Home maintenance & modifications
  10. Goods and equipment
  11. Counselling services
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8
Q

Why do some older people want to stay at home?

A

Want to remain independent

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9
Q

What is an aged care home?

A

Older adults live in a supported environment where help is available when needed, including access to 24 hour care

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10
Q

What is the benefit of an aged care home?

A

Personal and clinical care

  • Clinical access
    • eg. Physio
    • Dietician
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11
Q

What are 3 characteristics of respite care?

A
  1. ‘Short-term care’ -a form of support for carers
  2. Provides carers with a break from their caring role Or can provide patient with a break as well
  3. Respite care can be for a few hours, days, or longer
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12
Q

What are 5 locations for respite care to take place?

A
  1. In-home respite
  2. Centre-based day respite
  3. Overnight or weekend respite
  4. Community access respite
  5. Residential respite care
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13
Q

What are 4 characteristics of transition care?

A
  1. Hospital inpatient ready for discharge –support still required for recovery
  2. Provides time to consider future long-term living arrangements
  3. Transition care only accessible from hospital
  4. Short-term care that is focused on individual’s goals and particular therapies
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14
Q

What are the 3 services of transition care?

A
  1. Low intensity therapy (e.g. physiotherapy, podiatry)
  2. Access to a social worker
  3. Nursing support for clinical care (e.g. wound care)
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15
Q

What are 2 locations for transition care?

A
  1. Own home
  2. ‘Live-in’ setting (RACF, health facility)
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16
Q

What does ACAT stand for?

A

Aged Care Assessment Team

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17
Q

What are the 3 aims of the ACAT?

A
  1. Conduct a comprehensive assessment of the restorative, physical, medical, psychological, cultural and social dimensions of a client’s care needs
  2. Provide a choice of appropriate services to meet needs
  3. Provide information and refer clients to services that are appropriate and available to meet their needs/preferences
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18
Q

What are the aged care frees (charges: means-tested care fee)?

A

Based on assets/income

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19
Q

What is the basic daily fee in aged care?

A

85% of the single person rate of the basic age pension

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20
Q

Who comprises the RACF team?

A
  1. Residents
  2. Families
  3. Registered nurses
  4. Director of nursing
  5. Clinical nurses in charge
  6. Personal carers
  7. Allied health assistants
  8. Physiotherapists
  9. Visiting GP
  10. Consultant, SP, OT, Podiatrist, Optometrist
  11. Pastoral care person
  12. Cleaning staff
  13. Kitchen staff
  14. Gardener / Handyman
    1. Bus driver
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21
Q

What are 10 roles of the Physiotherapist?

A
  1. Help in devising care plans for residents Who need plans and who doesn’t
  2. Identification of resident mobility/safety issues
  3. Liaise with relative/residents regarding ‘best’ equipment(e.g. chairs, walking aids, shoes, clothing)
  4. Arranging ‘try before you buy’ trials of equipment
  5. Teaching carers to handle residents with specific problems / safe mobilisation
    • Transferred using hoists, assistance (1 or 2)..etc
  6. Teach staff safe injury prevention approaches to practice
  7. Assess residents after falls –triage injuries
    • Eg. determine whether its just soft tissue or if its more serious
  8. Provide full resident assessment
  9. Develop exercise and activity interventions for residents
  10. Ensure physio assistant knows how to implement intervention, identify adverse signs and what to do etc.
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22
Q

Physiotherapists involved in the management of residents who will require ______ or ______ programsand in the provision of _____ care

A

rehabilitation; maintenance; palliative

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23
Q

What are 15 assessment and intervention techniques within the 3 different streams of rehabilitation, maintenance an palliative care?

A
  1. Medical/surgical history
  2. Social history
  3. Current Diagnoses
  4. Mobility & Function
  5. Fall & Injury Risk
  6. Strength/Endurance
  7. Dexterity
  8. Posture
  9. Skin & Circulation
  10. Pain
  11. Continence
  12. Swallowing
  13. Oedema/lymphoedema
  14. Respiratory
  15. Cognitive function
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24
Q

What are 5 things you need to find out from the patient in regards to mobility and falls?

A
  1. Is the resident at risk of falling?
  2. What interventions might reduce the risk of falling?
  3. What is the resident able to do safely and independently?
  4. What help does the resident need?
  5. What should that help entail?

Physical impairment (eg. balance)

Environmental (eg. cluttered)

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25
Q

What are 5 specific interventions to reduce the risk of falls and injury?

A
  1. Improve environmental safety
    • Non-slip surfaces, hand rails, variable height chairs, lo-lo beds etc.
  2. Encourage use of hip protectors
  3. Ensure good nutrition, hydration
  4. Improve mobility
    • Provide staff to assist when needed for transfers &mobilising
  5. Educate staff, families &residents re. falls risks
    • E.g. Cataracts –cluttered environment, need for regular eye check
26
Q

How can you improve environmental safety to reduce falls and injury?

A

Non-slip surfaces, hand rails, variable height chairs, lo-lo beds (Beds that a very low to the ground (20cms) and no need to have railings) etc.

27
Q

Why should you encourage the use of hip protectors to reduce falls and injury?

A

Minimise severity of injury

If fall over –> can still sustain injury (eg. NOF) but not as severe

28
Q

How can you improve mobility to reduce falls and injury?

A

Provide staff to assist when needed for transfers &mobilising

29
Q

How can you educate staff, families and residents re. falls risk to reduce falls and injury?

A

E.g. Cataracts –cluttered environment, need for regular eye check

30
Q

What are 8 exercises themes to improve function and reduce the risk of falls (physical activity in residential aged care?

A
31
Q

What are 6 examples of functional strengthening to help with function and reduce falls risk?

A
  1. Replicating a task you do in everyday life
  2. Sit-to-stand
  3. Aspects of gait
  4. Stepping for ascend/descend stairs
  5. Hand strength
  6. Finger dexterity
32
Q

How can multi-tasking help with improving function and reducing falls risk?

A

ability to maintain postural control and stability if doing a motor or cognitive task

33
Q

How can large movements help with improving function and reducing falls risk?

A

ie. Trunk rotation

34
Q

How can deep breathing help with improving function and reducing falls risk?

A
  • Usually prescribed in combination with something else
  • Not usually done in isolation (eg. LL movements + deep breathing)
35
Q

How can social interactions help with improving function and reducing falls risk?

A
  • important for self of worth
  • Encouragement from relationships - not everyone wants it
36
Q

What is happening in this image?

A

Seat exercise: Reciprocal movements of the legs

  • Replicating reciprocal movements during gait
37
Q

What is happening in this image?

A
  • Circulating arms above heads + deep breathing
  • Older people have reduced arm strength
38
Q

What is happening in these images?

A

Passing balls of various sizes and texture around the circle: stimulates reaching sideways, trunk rotation, concentration

39
Q

What is happening in these images?

A

Catching and throwing in all directions

  • Trains reaction time- can they react quickly?
  • Getting them to reach outside BoS- depending where you throw the ball
40
Q

What is happening in this image?

A

Sit to stand practice with and without using arms of chair

  • Make sure demonstrations are accurate (poor technique from the physio will be reciprocated) = be precise in what you do
41
Q

What is happening in this image?

A

Kicking a ball around and across the circle

  • More power based- short sharp contractions
42
Q

What is happening in this image?

A

Throwing to a target

  • Dual tasking
  • Hand eye coordination
  • Shifting CoM in seated position
43
Q

Why is dancing a good exercise for elderly people?

A

Dancing classes (eg. salsa and tango)

  • Training balance and incorporate music (able to be engaged)
44
Q

What are 4 other factors within the care plan?

A
  1. Pain Management
    • Improving mobility to reduce arthritic pain
    • Simple modalities such as TENS useful
    • Hot packs (N.B. skin test)
    • Determine type of pain & treat accordingly
  2. Specific problems for that resident
    • Metastases in humerus/thoracic spine: care with handling by staff
    • Cancer: need to consider when choosing treatment for pain
  3. Specific instructions for staff
    • “Sit up for 1 hour post meal if tube feeding….”
  4. Residents with dementia
45
Q

What are 4 characteristics of pain management within the care plan?

A
  1. Improving mobility to reduce arthritic pain
  2. Simple modalities such as TENS useful
  3. Hot packs (N.B. skin test)- Thermal modalities
  4. Determine type of pain (Neuropathic..etc) & treat accordingly
46
Q

What are 2 characteristics of specific problems for that resident within the care plan?

A
  1. Metastases in humerus/thoracic spine: care with handling by staff
  2. Cancer: need to consider when choosing treatment for pain
47
Q

What is a characteristic of specific instructions for staff within the care plan?

A

“Sit up for 1 hour post meal if tube feeding….”

Not want them to aspirate –> must wait at least an hour

  • Fluid might come up and then then they breath the fluid into lungs
48
Q

Why must you wait one hour after meal via feeding tube to do management?

A

Not want them to aspirate –> must wait at least an hour

  • Fluid might come up and then then they breath the fluid into lungs
49
Q

What are 3 reasons why exercise is good for OA?

A

Exercise is not a contraindication –> good treatment

  • Improve flexibility
  • Lubricate joint
  • Reduce contractures
50
Q

Older people experience less pain due to age related changes. True or false

A

FALSE

51
Q

Chronic pain in the elderly can increase the risk of mortality. True or false

A

TRUE

52
Q

Under reporting of pain in the elderly may be due to the assumption that pain is seen as a normal/natural part of life. True or false

A

TRUE

53
Q

What are 5 causes of pressure ulcers?

A
  1. Immobility
  2. Shear Stress
  3. Friction
  4. Moisture
  5. Mental Confusion / Behavioural Changes
54
Q

How is mental confusion a cause of pressure ulcers?

A

Mental confusion

  • Unable to communicate pain
  • Eg. need pad changing = moist
  • Eg. in same position too long
55
Q

Treatment plans and goals are influenced by _____.

A

Status (Rehabilitation, Maintenance, Palliative care)

56
Q

Treatment plans and goals should be proactive and include preventive elements as well as interventions to maximise______.

A

QoL

57
Q

Goals developed with the resident, focused on improving _______. What is an example of this?

A

life satisfaction

e.g. Improve strength/ability sufficiently so can push wheelchair away from Mr J who annoys me

58
Q

What are 4 ways to reduce stress associated with caring 9promoting wellness in staff)?

A
  1. Education regarding falls prevention
    • Evidence indicates enhanced compliance/effect
  2. Encourage an active lifestyle
    • Opportunities for staff members to participate in resident classes
  3. Communication of ‘resident related problems’
    • Collaborative solutions can be developed
  4. Ensuring carers are confident in work practices
59
Q

What are 2 reasons why we need to reduce stress?

A
  1. High staff turn-over
    • ↑Education and training sessions
    • ↑ Pre-employment assessment by physiotherapist
      • Reducing time for resident focused care
  2. High rate of sick leave
    • Need to employ ‘agency’ carers
    • Agency staff not familiar with residents, specific facility protocols
    • Increased rates of staff and resident injuries.
60
Q

What are 2 problems with high staff turn-over due to stress?

A
  1. ↑Education and training sessions
  2. ↑ Pre-employment assessment by physiotherapist
    • Reducing time for resident focused care
61
Q

What are 3 problems with high rate of sick leave due to stress?

A
  1. Need to employ ‘agency’ carers
  2. Agency staff not familiar with residents, specific facility protocols
  3. Increased rates of staff and resident injuries.

PHTY2230 (24 decks)

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