Therapeutic mobilization in acute care Flashcards
Peripheral vascular disease includes what two condition
- Peripheral artery disease
- Chronic venous insufficiency
What is peripheral artery disease
Blocked circulation to the legs and/or feet
What % of elderly population have PAD
12-29%
Is PAD under or over diagnosed
under
What are the risk factors to PAD
Smoking, hypertension, diabetes, high cholesterol, aging, heredity
What is the pathophysiology of PAD
- Arteriosclerosis (hardening of the arteries)
- Atherosclerosis (a plaque in the artery that cuases narrowing); thisis a type of arteriosclerosis
- Acute thrombus
What are signs and symptoms of PAD
- Intermittent claudication
- Weak pulses
- Skin on legs hairless and shiny
- Rest pain and/or night pain
- Gangrene, ischemic wounds
- Loss of sensation or motor function, loss of pulses, extreme pain
What are the diagnostic tests for PAD
- Palpable pulses/pulse volume scale
- Doppler US
- CT angiogram
- Ankle brachial Index (0.4-0.9 = moderate, <0.4 = severe)
What is the medical treatment of PAD
- Management of risk factors, lifestyle changes diabetes management, medication
- Surgery (thrombectomy, angioplasty, arterial bypass)
- Wound care
- Amputation
What is the role of PT pre-op for PAD
Walking program
What is the post-op role of PT in PAD
- Check for mobility and weight bearing orders
- Assess colour, warmth, motor and sensation of operated limb
- Ensure adequate pain control prior to mobilization
- Asses mobility, retrain gait, prescribe a gait aid
- Progress to help patient regain mobility and function
What is chronic venous insufficiency
Pooling of blood in the legs from inadequate venous return
is Chronic venous insufficiency (CVI) more common in men or women
women
What are the risk factors for CVI
Age, genetics, females, obesity, smoking, inactivity
what is the pathophysiology of CVI
Weak and ineffective valves; blood builds up and puts pressure on valves and vein walls
What are signs and symptoms of CVI
- Leg tightness, tingling, swelling, itching, redness and/or pain after prolonged sitting or standing
- Swollen ankles
- Varicose veins
- Can progress to edema, DVT, venous ulcers, stasis dermatitis
- Venous ulcers are typically over the medial malleolus, are not painful and have lots of exudate
What are the diagnostic tests for CVI
Vascular/doppler ultrasound
What is the medical treatment for CVI
Risk factor modification
Compression
Wound care
Surgery
Acute PT treatment for CVI
- Exercise
- Ankle pumping to assist/encourage venous return
- Compression therapy
- Education to minimize LE dependency
What are characteristics of surgical patients
- Admitted for surgery
- Transferred from another ward
- Day surgery, no overnight stay required
- may be acute or chronic conditions
- have the affects of anaesthetic & surgery!!
What are the characteristics of medical patients
- Admitted for further assessment
- Failure to thrive
- May transfer to a surgical ward
- Includes ER
What position does the bed need to be in if patient has an NG tube
head of bed needs to be above >30 degrees
What is the general sequence of events for mobilizing a client
- Preparation
- Subjective
- Preparation of environment, equipment, space, setting, support
- Objective (ippa + functional mobility)
- Treatment & re-assessment
- Charting
What are some general considerations when performing an objective assessesment on the patient
- Medical lines
- Affects of anaesthetic and surgery
- post-operative medications (pain medication)
- Surgical incisions
Urinary catheter needs to be kept at what level? Chest tubes
below site of bladder
Below site of incision
What AROM do you conduct before mobilizing
- Shoulders flexion and extension
- Elbows flexion and extension
- hand - open and close a grip
- Hips - heel slide
- OR flexion abduction of hips, flexion extension of knees, PF and DF of ankles
What strength testing do you conduct prior to mobilizing
- SLR x5 seconds - compare left and right
- Grade 3 quad in sitting-compare sides
- Bridge 5 second hold
What can you do to make balance testing more difficult
reach outside of BOS
give perturbation
What are post-operative considerations for cardiac patients
- Sternal precautions
- hemodynamic stability
What are post-operative considerations for thoracic considerations
- Shoulder ROM
- Positioning considerations
What are two major medication considerations
Do any medications change their BP, HR, cognitive status
Do any medications pose a falls risk to the patient
What are 3 activities for therapeutic bed mobility
- Bridging
- ROM and Strength exercises in bed
- Rolling right to left and up and down in bed
How would you support an incision
Pillow/blankets/ abdominal binder
What therapeutic movement do you do at the edge of the bed
forward and backward movement in sitting
how do you move someone towards edge of bed once they are already sitting
Hand under arms on lower borders of rib cage
Collapse one side, extend other side, move the hip on the collapsed side forward
Why is sitting up in a chair a therapy for most patients
- Allows them to have better gas exchange as gravity takes effect
- Allows them to take a better breath because of positioning
- Decreases the risk of immobility and skin breakdown
For who do you use dangle protocols
acute post-operative clients who have a graft or flap procedure
What is a flap surgery
a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site with an intact blood supply
What is a graft surgery
a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site without an intact blood supply - relied on the growth of new blood vessels
What is a graft surgery
a technique in plastic and reconstructive surgery where any type of tissue is lifted from a donor site and moved to a recipient site without an intact blood supply - relied on the growth of new blood vessels
What is the dangle protocol
- Observe flap - colour, temperature, turgor
- apply dressing and tensor bandage
- dangle leg for 1 minute
- Remove dressing and observe flap for changes
- Dangle twice per day, progressing duration by 1 minute each time
- When 5 minutes reached, patient can progress to ambulation
- Flap must have a dressing and compression any time the limb is dependent
