Lecture 7

Question 1

PT roles in acute care

Answer 1

reverse or limit complications of bedrest
understand clinical implications of vitals/labs/tests
prescribe exercises & teach mobility
proper fitting of AD
caregiver training
discharge recommendations

Question 2

Discharge recommendations

Answer 2

from their evaluation, PTs determine the pt’s current and anticipated needs for assistance and medical equipment and makes recommendations for discharge destination

PTs are KEY in determining discharge destination
when its not followed, pt are 3x more likely to return to hospital

Question 3

Standard hospital beds

Answer 3

there are NO standards across hospitals

usually have brakes, height adjustment, tilt adjustments, siderails, bed alarm

usually handle 350 to 500 lbs

Question 4

Bed and chair alarms

Answer 4

used for pts at increased risk for falls
will go off any time pt tries to get up
notifies the care team

Question 5

Low beds

Answer 5

goes as low 7” from the floor
for shorter pts or those w/unique mobility impairments

Question 6

Bariatric beds

Answer 6

typically have a weight capacity of 1,000lbs

Question 7

Overhead trapeze

Answer 7

increases patient independence
decreases friction and shear during transfers

Question 8

Air mattresses

Answer 8

can be either an entire mattress or simple mattress overlay

variable number of air cells for pressure dispersion

air cells alternate pressure to allow blood flow to reach all areas of body

you still have a turning schedule

Question 9

Air-fluidized beds

Answer 9

-2,000 lbs of glass beads, covered by polyester sheet

warm pressurized air is pushed through beads

polyester cover allows moisture and air to pass through

skin is kept drier and warmer, pressure is relieved

Question 10

Problems of air-fluidized

Answer 10

expensive
heavy
difficult to transfer pts out of

Question 11

Cardiac chair

Answer 11

recliner that allows person to be in more of upright position

allows patient to avoid bedrest and tolerate gravitational challenges

Question 12

Sequential compression devices

Answer 12

decrease likelihood of deep vein thrombus formation in the LEs. used in conjunction with multiple strategies, including mobility and anti-coagulant medications

simulates muscle contractions, helps to pump blood

Question 13

Low-flow oxygen

Answer 13

delivery via nasal cannula or mouth mask w/bag

oxygen is MEDICATION, PT does not alter

Room air = 21% O2. Usually about 24-40% given to pt

non-emergency if detaches, just reattach

Question 14

Oxymask

Answer 14

increasingly common delivery choice when higher flow of oxygen is required, or pt is a mouth breather

mask with holes

non-emergency if detaches, just reattach

Question 15

Urinary catheters

Answer 15

indwelling or external

do not allow to become kinked or pulled out. can cause infection or spillage

do not allow collection bag to touch the floor, or raise bag above level of pts bladder

non-emergency if disconnected. contact nursing to reconnect

Question 16

Indwelling urinary cathether

Answer 16

called foley catheter

don not allow collection bag to touch the floor, or raise bag above level of pts bladder
drain bag if full

Question 17

External urinary catheters

Answer 17

purewick, usually for those with vaginas
condom, usually for those with penises

Question 18

Chest tubes

Answer 18

drain fluid and/or air out of pleural cavity

helps to reinflate collapsed lung, connected to a drainage tube

container must remain upright and below output tube at all times. Kickstand must be 90° from container when set on floor
can kink, clog, or disconnect

if detaches, EMERGENCY. Get help ASAP as lung can recollapse

Question 19

Peripheral intravenous lines

Answer 19

named for where the line ends up in the body

PT can mobilize pt with IV lines
you can have nursing disconnect for more mobility.

most common sites are anterior forearm or dorsum of hand

not an emergency if detached, but messy and painful. Get nursing ASAP

Question 20

Infiltrated IV site

Answer 20

when IV fluids goes into the tissue instead of the vein

symptoms include swelling, pain, numbness tingling, blanched/cool skin, dampness in dressing over IV site

Question 21

Central lines

Answer 21

centrally located tube or line that is passed through a vein to end up in the thoracic portion of the vena cava or in the right atrium.

Most common placement: femoral, subclavian, jugular

EMERGENCY if disconnected.

Question 22

Purposes of central lines

Answer 22

administers certain drugs, fluids, total parenteral nutrition, blood transfusion, monitor central venous pressure, obtain venous blood

can be temporary or long term
types: traditional, PICC, port

Question 23

PICC line

Answer 23

peripherally inserted central catheter. two areas of insertion

precautions as PT:
avoid taking BP in limb with the PICC line
avoid pressure under axilla (no crutches but can use walker)

Question 24

Nasogastric tube

Answer 24

for feeding or suctioning fluids out of stomach

Precautions as PT:
HOB must be >30° when feeding
PT can push hold button if pt needs to lie flat for mobility. can be disconnected
they come out easily
avoid neck flexion

if disconnected, non-emergency but turn off pump and contact nursing

Question 25

Drains

Answer 25

used to pull fluids. out of cavities
clipped below area. used in vasectomy, abdomen surgeries, joint replacement. helps to avoid hematoma

be cautious during mobility so as not to allow bulb to get pulled or squeezed. Some physicians do not want mobilization. can place bulb in going pocket or clip bulb to gown

not an emergency, PT can fix unless it becomes contaminated

Question 26

Negative pressure wound therapy

Answer 26

wound vac

decreases fluid accumulation in a chronic wound and facilitate healing

can be disconnected from power source and run on battery. attach to walker or IV pole using its clamp

Question 27

Disposable powered negative pressure system

Answer 27

decreases fluid accumulation in a wound and facilitate healing after surgical wound, stays on up to 7 days

helps to close surgical incisions and then thrown away

Question 28

Ventilators

Answer 28

different from respirators
can be invasive or nonivasive

prevent tension on tube. Drain anything out of tube before moving. Nurse can take off ventilator for short time. Movement of tube can cause bronchospasms

assume emergency if disconnected

Question 29

Invasive ventilator

Answer 29

via artificial airway, either via endotracheal tube or tracheostomy tube. used for short term or long term. don’t put any pressure or pulling on tubes

Question 30

Noninvasive ventilator

Answer 30

administration of ventilatory support without using an invasive artificial airway. Examples are CPAP or BiPAP

Question 31

Intracranial pressure monitoring

Answer 31

intraventricular catheter; most common, invasive, and accurate

subarachnoid screw or bolt (more accurate & invasive)

epidural sensor (least accurate, invasive)

only do activities in prone, most likely PROM. you cannot mobilize these pts

do not move pts head past 30° above horizontal or more than 15° below horizontal

emergency if removed