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ACEBC > Precautions and Contraindications > Flashcards

Precautions and Contraindications Flashcards

1
Q

Assisted Cough (BIG FAT PIGRR)

A

Bowel obstruction
increased ICP
gastric reflux/hiatus hernia
fragile thoracic cage (osteoporosis, rib metastases, AS)
abdominal aortic aneurysm
trauma to thorax (fractured rib, flail segments, pulmonary contusion, cardiac contusion, acute dysrhythmia, pericardial effusion)
pregnancy
inferior vena cava filters
gastrostomy/jejunostomy tubes
recent abdominal surgery
ruptured diaphragm [not an exhaustive list, includes contraindication (ruptured diaphragm)]

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2
Q

Manual Hyperinflation (HUURP)

A

CI: High frequency oscillation ventilation, unstable head injury, undrained pneumothorax, injury, recent pneumonectomy/lung resection, proximal tumor

PC: hemoptysis, bullae, high RR or PEEP, severe bronchospasm, CVS instability

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3
Q

Percussions / Vibrations / Rib Springing

A

Burns
unstable CV condition,
recent skin graft/flaps,
respectable tumour,
pneumothorax,
fractured ribs,
osteoporosis,
hemorrhage,
metastatic bone cancer,
emphysema of neck/thorax,

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4
Q

Postural Drainage

A

Hemoptysis
aneurism
PE,
patient upset/agitated,
increased ICP,
esophageal anastomosis,
CHF,
recent laminectomy,
unstable CV status,
untreated pnemothorax

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5
Q

Proning

A

Facial trauma, unstable spinal injury uncontrolled cerebral hypertension, burns, open chest or abdomen,

PC: hemodynamic instability, active intra-abdominal processes

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6
Q

Suctioning (Nasopharyngeal)

A

Nasal bleeding,
bleeding disorder,
epiglottitis or coup,
acute head or facial injury,
CSF leakage,
nasal stenosis,
nasal pathology (epistaxis, polyps, septal deviation, infection),
basal skull fracture

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7
Q

Cardiac Rehab

A

No Valsalva,
extensive upper body activity,
isometric or static exercises

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8
Q

Beta Blockers

A

Blunted heart rate and blood pressure response therefore use RPE not age predicted heart rate range

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9
Q

Simple Spirometry

A

MI in the last month
recent stroke/abdominal/thoracic surgery
uncontrolled HTN
recent pneumothorax

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10
Q

Inspiratory Muscle Training

A

Acute respiratory failure, cognitive impairments

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11
Q

Incentive Spirometry

A

Cognitive impairment,
patient unable to deep breathe effectively due to pain,
diaphragmatic dysfunction or opiate analgesia.
Pt unable to generate adequate inspiration with a vital capacity <10 mL/kg or an inspiratory capacity <33% of predicted normal

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12
Q

Lumbar Scan

A

Mandatory Questions: Bowel or bladder changes
saddle paresthesia,
anesthesia,
effect of cough/sneeze/Valsalva (increased abdominal pressure),
neurological symptoms,
bilateral lower extremity symptoms

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13
Q

Lumbar Detailed Articular Ax

A

CI: Spondylolisthesis, fracture, infection, local neoplasm

PC: Osteopenia/porosis, inflammation, active cancer, acute trauma

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14
Q

Lumbar Traction

A

Acute, patient unable to tolerate position, patient has bad response to traction, recent surgery, underlying hypermobility or instability, vascular compromise

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15
Q

Cervical Scan

A

Mandatory questions: Bowel or bladder changes, Bilateral or quadrilateral paresthesia or anaesthesia, 5 D’s (dysarthria, dysphagia, dizziness, diplopia, drop attacks), nystagmus, perioral numbness, headaches coupled with neck pain, recent upper respiratory tract infection

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16
Q

Cervical Detailed Articular Ax

A

CI: Local fracture or inflammation, active neoplasm or infection, acute trauma, local instability, vascular pathology of carotid or vertebral arteries

PC: Osteoporosis, anti-coagulant medications

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17
Q

Cervical Traction

A

S/S of vertebral artery compromise, cervical myelopathy, rheumatoid arthritis, TMJ dysfunction, glaucoma, cervical instability

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18
Q

Pelvic Assessment

A

Mandatory questions: Bowel or bladder changes, saddle paresthesia, anesthesia, perianal numbness, clicking or feeling of giving way (pubic symphysis)

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19
Q

Dix Hallpike (BPPV)

A

Cervical spine instability, VBI, Arnold-Chiari malformation, acute whiplash, RA, prolapsed IV disc with radiculopathy, cervical myelopathy

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20
Q

Resistance Exercise

A

CI: acute inflammation, joint effusion, severe CVD, #, joint muscle pain during AROM or isometric testing

PC: osteoporosis/osteopenia, fatigue, medications, inappropriate temp and clothing

Avoid: Valsalva, ballistic uncontrolled movements, pain, dizziness, usual SOB

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21
Q

Massage

A

Autoimmune disease during flare ups, fever, haemorrhage, embolism, DVT, flu, migraine, serious psych diagnosis, recent surgery, acute RA, sickle cell disease, pneumonia

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22
Q

DTFM

A

CI: Infection/skin breakdown, inflammatory joint disease, recent local injection, ossification/calcification, bursitis, neural irritation, anticoagulant or anti-inflammatory drug use

PC: elderly, children, diabetics (due to decreased sensation)

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23
Q

Stretching

A

Bony block, recent #, acute inflammatory process of the joint, sharp or acute joint pain, hematoma or tissue trauma, contracture or soft tissue is providing stability to area or function (ex. tendodesis grip), hypermobile segment, recent corticosteroid injection to involved tissue

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24
Q

PNF (Neuro)

A

Precautions: avoid quick stretch on hypertonic muscles, gentle stretch and care on hypotonic muscles, care to not promote invariant movement patterns, watch for substitutions

25
Q

Sliders and Tensioners

A

CI: Undiagnosed condition, conditioning worsening, severe irritability, presence of hard neurosigns

26
Q

Traction

A

CI: acute, patient can’t tolerate traction position, bad response to manual traction, recent surgery, underlying hypermobility or instability, malignancy, SSx of spinal cord or cauda equina compression, ankylosing spondylitis

PC: pregnancy, respiratory problems, osteoporosis, spondylolisthesis, hypermobility/instability, claustrophobia, extremely restricted ROM, little improvement with rest

*always check: BCI, neuro test, neuromobility, neurocondution, stability

Cervical CI: VBI, TMJ dysfunction, RA, down syndrome, cervical myelopathy, glaucoma

27
Q

Joint Mobilizations

A

CI: #, neoplasm, acute inflammatory condition, apparent hypermobility or instability n direction of techniques, bone/joint infection, spinal cord sign or symptoms, spasm or boney end feel

PC: impaired circulation or sensation, osteoporosis or compromised health, haemophiliacs, poor skin conditions, open wounds, discomfort in treatment positions, marked skeletal deformity

28
Q

Joint Manipulations

A

, joint instability in the direction of manipulation, inflammatory joint disease, malignancy, bone disease, osteoporosis, open wound or skin lesion in area, poor circulation or sensory deficit in the area, spasm or increased pain with test pull, unsure of health or diagnosis, patient doesn’t want to be manipulated, patient is on anticoagulants, haemophiliacs, inability of patient to relax

Precautions for Novice Manipulators: pain or instability proximally in the lower kinetic chain, uncertainty about indications of technique, children, diabetics, elderly, positive straight leg raise (for talocrural manipulation)

Infection/skin breakdown, inflammatory joint disease, recent local injection, ossification/calcification, bursitis

29
Q

THR – Posterio-lateral Approach

A

No hip flexion past 90 deg, No IR or ER, No hip adduction past midline for first 3 months

30
Q

THR - Lateral Approach

A

No hip flexion past 90 deg, no IR, no hip adduction past midline for first 3 months

31
Q

THR – Anterior Approach

A

No hip extension, no ER, no hip adduction past midline for first 3 months

32
Q

Total Shoulder Arthroplasty

A

Immobilization 24hours for 1 week, nightly for 1 month, sling for 4 weeks

33
Q

Reverse Total Shoulder Arthroplasty

A

Avoid IR for 6 weeks

34
Q

Laminectomy

A

Neutral spine, Log roll for rolling side to side

35
Q

Spine Unstable

A

Maintain neutral spine at all times, bed rest, HOB at 0deg, 2-3 person turns at all times

36
Q

Spine Stable but requires protection

A

Neutral spine at all times

37
Q

Sternotomy

A

No pushing for STS, no lifting 10lbs above waist, no push/pull over 5 lbs

38
Q

Osteoporosis

A

No spinal flexion + rotation, Precaution for manual therapy (extension is good!)

39
Q

Heterotrophic Ossification

A

Forced PROM, serial casting

40
Q

Muscular dystrophies

A

Avoid eccentric exercises

41
Q

Multiple Sclerosis

A

Fatigue easily* Contraindications to exercise: heat, and pregnancy, Recommend: interval training

42
Q

Cerebral Palsy

A

Monitor hip subluxation – be suspicious if pt cannot ABD leg more than 45 deg

43
Q

Flaccid Shoulder Post Stroke

A

No pulleys for ROM exercises above 90 degrees flexion and abduction

44
Q

COPD

A

No breath stacking – and only exhale through purse lips

45
Q

Thrombocytopenia (150,000 – 400,000)

A

<50,000: avoid activities with contact or risk of falling

40,000-60,000: low weights (1-2lbs), stationary bike low resistance, walking or ADLs

20,000-40,000: low intensity, low weights (0-1 lbs), stationary bike no resistance or minimal, walking and ADLs

<20,000: risk of spontaneous bleed unrelated to trauma

10,000-20,000: doctor approval, active ROM exercises, walking, ADLs

<10,000: no exercise, only essential ADLs, prevent falls and injury

46
Q

Rheumatoid Arthritis

A

Acute phase: no stretching (may stretch the synovial membrane and cause irreversible damage)

47
Q

Exercise and RA and OA

A

PC: swollen joints at risk for capsular stretch and rupture, OP bone at risk for #, use machines and resistance bands rather than free weights

CI: Increase pain, fatigue or AM stiffness, sudden pain at joint or joint deformity, joint becomes red, swollen and hot after doing exercise (within 24 hours), decreased muscle strength and function (local myositis), neurological SSx (CV involvement), SOB on mild exertion

48
Q

Pregnancy

A

Exercise: Antepartum bleed, preterm labor, ruptured membrane, incompetent cervix/changes, Valsalva, exercise techniques that stress the PF and abdominals, rapid uncontrolled movements

Avoid: deep heat modalities or electrical stimulation, manual therapy

Positioning: supine is not contraindicated for short periods of time, prone is not well tolerated, inversion positioning

49
Q

Exercise and Burns

A

CI: exposed joint, fresh skin graft, DVT, compartment syndrome

50
Q

ART

A

Infusion bag must be kept above insertion line, notify RN if transducer disconnected, ROM restrictions (no hip flexion past 90 deg with femoral ART line)

51
Q

PICC

A

Do not mobilize until proper insertion confirmed with x-ray

52
Q

Patient Controlled Analgesic

A

Do not push the button for the patient

53
Q

Epidural

A

Check sensation and movements prior to mobilizing, if dislodged get help immediately

54
Q

NG tube

A

Keep HOB at 30 deg when feeds are on, Do not suction from the same nare that NG is placed

55
Q

Chest tube

A

Keep below site of insertion to prevent backflow

56
Q

Urinary catheter

A

Keep below site of insertion to prevent backflow

57
Q

General Subjective Hx - Cancer

A

Unexplained weight loss, night pain, night sweats

58
Q

General Subjective Hx -Visceral Dysfx

A

Non-mechanical behaviour pain, abdominal pain/cramping, pain on urination, pain post-eating/indigestion/reflux

59
Q

Central Vestibular Disorder

A

Direction changing nystagmus, inconsistency in test result

ACEBC (6 decks)

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