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1 Patient Management > Lecture 5 > Flashcards

Lecture 5 Flashcards

1
Q

PTs must document

A

what you did with a pt
how much assistance you provided

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2
Q

Level of assistance provided

A

Based on the amount of the activity that the patient is able to do on their own

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3
Q

I

A

Independent, 100% of activity done by pt
safely, without verbal or physical assistance, does in acceptable amount of ime

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4
Q

S

A

supervision, 100% of activity without physical assistance
require the physical presence of another person. Verbal cues, safety, provide confidence

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5
Q

Close S

A

close supervision, within personal space

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6
Q

Distant S

A

Distant supervision, in patient room

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7
Q

SBA

A

standby assist

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8
Q

Close SBA

A

close standby assist

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9
Q

CGA

A

contact guard assist
patient is able to do 100% of the activity, but requires a person to be in physical contact. Gait belt would be an example

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10
Q

MIN A

A

Minimal Assist
Patient performs 75-99% of task/activity

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11
Q

MOD A

A

Moderate Assist
patient performs 50-74% of task/activity

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12
Q

MAX A

A

Maximal Assist
patient performs 25%-49% of task/activity

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13
Q

D

A

Dependent
Patient performs <25% of task/activity

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14
Q

Communication as a PT

A

Provide info at a level they can understand
avoid medical terms
be concise
Non-verbal cues
Listen!
Tactile cues and demonstration

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15
Q

Patient education

A

There should be an change occurring in what the pt knows, how the pt performs, the pt’s beliefs/attitudes
Just telling them what to do won’t necessarily get you the desired outcome

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16
Q

Health literacy

A

degree to which individuals have the capacity to obtain, process, and understand basic health info and services needed to make appropriate health decisions

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17
Q

Functional Mobility

A

general phrase for the movement used during daily life

includes bed mobility, transfers, gait, wheelchair mobility, stairs, dynamic balance

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18
Q

Stability

A

how well someone is able to stay put

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19
Q

Mobility

A

how well someone moves out of a position

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20
Q

AMAP

A

as much as possible

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21
Q

ANAP

A

as normal as possible

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22
Q

CC

A

control centrally, assisting physically

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23
Q

DD

A

direct distally, using verbal cues

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24
Q

How functional mobility progresses

A

Stability to mobility
maintain to attain
static to dynamic
Large BOS to narrow BOS
low COG to high COG

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25
Q

Part-task training

A

breaking down task into parts
repetition of specific part (promotes kinesthetic learning)
always finish with whole-task practice (makes it meaningful)

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26
Q

Bed mobility specific skills

A

Rolling
Scooting
Hook-lying
Bridging
Sitting up
Lying down

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27
Q

Objectives of bed mobility

A

to engage patient in early form of mobility
safe-energy efficient movement
teach and increase level of independence

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28
Q

Assess bed mobility

A

pt ability to participate/follow directions
any contraindications
any environmental constraints

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29
Q

Principles of bed mobility

A

Communication
Consent
Explain
Encourage pt to assist

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30
Q

Key points of control

A

Placing hands where majority of person’s body mass lies
Scapula and pelvis
Possible head

don’t pull on limbs

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31
Q

Objectives of short-term positioning

A

allow access to area being treated while maintaining safety, modesty, comfort

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32
Q

Objectives of long-term positioning

A

Prevents contractures and skin breakdown

individuals with decreased sensation, mobility, soft tissue protection over bone, circulation ability to express discomfort. Also muscle paralysis, shear forces & incontinence, poor nutrition

33
Q

Shear Force

A

skin remains stationary as the body moves or shifts due to gravity. the bone creates torsion on tissue

occurs commonly w/HOB elevated above 45°

34
Q

Role of PTs in long-term positioning

A

consultation
education
implementation

35
Q

Principles of positioning

A

support
alignment
weight distribution
Time frame
Skin
Body mechanics

36
Q

Support

A

Trunk, head, and extremeities need to be supported and stabilized

37
Q

Alignment

A

trunk, head, extremities need to be in proper alignment
close to neutral spine as possible

38
Q

Weight distribution

A

evenly distrbuted as possible

39
Q

Time frame of positioning

A

Healthy person should be in a bed position is 2 hours
Sitting = 15 min
Turning schedule for those that can’t turn on their own

40
Q

Goals of turning schedule

A

allows blood flow to return to areas of previous pressure
allow for drainage of different areas of the lungs via gravity to ensure better ventilation/perfusion ratio

41
Q

Outside normal alignment

A

should not be maintained in positioning for more than 30 minutes

Think about a particular joint, what is it at resting position? What is it at non-resting position?

42
Q

Skin Inspection

A

before and after positioning
know baseline and make sure you do not position the person on an area that already has signs of pressure injury
after: make sure there is no pressure injury

43
Q

Body mechanics

A

monitor your own and that of the person you are teaching to position the patient

44
Q

Known contraindications/precautions positioning

A

THA–you can’t have hip adduction across midline, hip flexion has to be >90, hip IR

45
Q

Considerations when positioning

A

Skin integrity
Contractures
Sensation
Pulmonary/cardiac status
Circulation
Medical equipment attached to pt
pt level of awareness

46
Q

Contracture

A

permanent shortening of muscles, tendons, or other tissues, leading to deformity of joints

muscle and fascia tighten, joint capsule tightens
Named for position that muscle is stuck in
hip flexion, knee flexion, and ankle plantarflexion common

47
Q

Orthopnea

A

can’t breathe lying down

48
Q

Prone

A

belly

49
Q

Supine

A

back

50
Q

Sidelying

A

on side, named for side that is down

51
Q

3/4 prone or 1/4 turn from prone

A

75% prone, but pillows keep you supine
3/4 on your stomach

52
Q

3/4 supine, or 1/4 turn from supine

A

75% supine, but pillows keep you prone

53
Q

Semi-fowler’s

A

HOB angle = 30° is goal, 15-45°
most common patient position in hospital bed

54
Q

Fowler’s

A

HOB angle = 45-60°
can cause shear forces on sacrum

55
Q

Trendelenburg

A

supine, with feet above head

56
Q

Negative consequences of inappropriate positioning

A

Pressure injuries: pressure ulcer, decubitis, ulcer, bed sore
Contractures
Dependent Edema

57
Q

Pressure injuries

A

can occur on any area where there is prolonged pressure and/or shear forces. Frequently occur over boney prominences

58
Q

Progression of pressure injury

A

Hyperemia
Ischemia
Necrosis
Ulceration

59
Q

Hyperemia

A

develops in 30 min to 2hr, appears red, blanches out (turns white & comes back red), returns to normal within an hour

60
Q

Ischemia

A

develops in 2-6 hour, appears as a deep red area, does not blanch, takes several days (after pressure removed) to return to normal
decreased blood flow

61
Q

Necrosis

A

occurs after 6 hours, appears discolored, heard, can take months to heal

death of the tissue

62
Q

Ulceration

A

open wound

63
Q

Dependent Edema

A

Collection of body fluids in distal extremities due to dependent positioning (distal end is lower than level or heart)

fluids pool in gravity dependent areas

64
Q

Devices that help optimize long-term positioning

A

Multi podus, heel floating, neutral position boots prevent plantarflexion contractures

specialized mattresses for pressure injuries

65
Q

Draping for bed mobility/positioning

A

Communicate effectively
Provide privacy
allow for minimal exposure of body parts
allow for maximal exposure of treatment area

66
Q

Transfers steps

A

Identify the INTENT of the transfer
Assess
Determine transfer options for given situation

67
Q

Identify the INTENT of transfer

A

Moving the patient
Teach the patient
Teach a caregiver

68
Q

Assess a transfer

A

Assess the pt ability to physically participate
pt ability to follow directions
contraindications/precautions
environment

69
Q

Determine transfer options for given situation

A

intent
precautions/contraindications
patient’s ability level
your ability level
equipment or second person assistance

70
Q

Environmental poisitoning

A

move area close to you
move person close to you
move footrests/equipment
Lock w/c or equipment
assistive devices
Medical equipment/lines/tubes

71
Q

Wheelchair positioning

A

90° to the stationary chair (without wheels)

72
Q

Steps for successful chair transfer, pt positioning

A

Transfer belt
pt scoots forward on chair
pt feet are placed under and slightly bent & under knees
pt puts hands where they can push up

THEY DO NOT GRAB ONTO YOU

73
Q

Transfer belts

A

increases safety by allowing PT stable site for proximal control (decreases risk of fall by 3.65x)

placed around pt’s natural waist or lower

74
Q

Considerations for transfer belts

A

infection control
proper placement of belt
contraindicated for some
use after discharge?

75
Q

Steps for successful chair transfer, pt communication

A

instruct and gain consent
demonstrate
encourage pt to assist

76
Q

Patient handling in a transfer

A

majority of pt mass, pelvis and scapulae
transfer belt
sheet
keep COG within BOS
perform test lift

77
Q

Total body lifts

A

patient is doing none of the transfer task. Dependent transfers

not the same as transfer aids which allows and intends for pt to do some of the work

78
Q

Zero lift rules

A

manual lifting of pts be minimized and/or eliminated when possible
helps to reduce the # and severity of injuries among hospital staff

79
Q

Patient handling devices

A

these devices allow pt to do some of the work
transfer boards
friction reducing sheets
supine transfer board
pivot disc
transfer/pivot pole
handybar

1 Patient Management (8 decks)

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