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PHTH 524 > Therapeutic mobilization in acute care > Flashcards

Therapeutic mobilization in acute care Flashcards

1
Q

Peripheral vascular disease includes what two condition

A
  • Peripheral artery disease

- Chronic venous insufficiency

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2
Q

What is peripheral artery disease

A

Blocked circulation to the legs and/or feet

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3
Q

What % of elderly population have PAD

A

12-29%

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4
Q

Is PAD under or over diagnosed

A

under

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5
Q

What are the risk factors to PAD

A

Smoking, hypertension, diabetes, high cholesterol, aging, heredity

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6
Q

What is the pathophysiology of PAD

A
  • Arteriosclerosis (hardening of the arteries)
  • Atherosclerosis (a plaque in the artery that cuases narrowing); thisis a type of arteriosclerosis
  • Acute thrombus
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7
Q

What are signs and symptoms of PAD

A
  • 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
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8
Q

What are the diagnostic tests for PAD

A
  • Palpable pulses/pulse volume scale
  • Doppler US
  • CT angiogram
  • Ankle brachial Index (0.4-0.9 = moderate, <0.4 = severe)
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9
Q

What is the medical treatment of PAD

A
  • Management of risk factors, lifestyle changes diabetes management, medication
  • Surgery (thrombectomy, angioplasty, arterial bypass)
  • Wound care
  • Amputation
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10
Q

What is the role of PT pre-op for PAD

A

Walking program

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11
Q

What is the post-op role of PT in PAD

A
  • 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
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12
Q

What is chronic venous insufficiency

A

Pooling of blood in the legs from inadequate venous return

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13
Q

is Chronic venous insufficiency (CVI) more common in men or women

A

women

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14
Q

What are the risk factors for CVI

A

Age, genetics, females, obesity, smoking, inactivity

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15
Q

what is the pathophysiology of CVI

A

Weak and ineffective valves; blood builds up and puts pressure on valves and vein walls

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16
Q

What are signs and symptoms of CVI

A
  • 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
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17
Q

What are the diagnostic tests for CVI

A

Vascular/doppler ultrasound

18
Q

What is the medical treatment for CVI

A

Risk factor modification
Compression
Wound care
Surgery

19
Q

Acute PT treatment for CVI

A
  • Exercise
  • Ankle pumping to assist/encourage venous return
  • Compression therapy
  • Education to minimize LE dependency
20
Q

What are characteristics of surgical patients

A
  • 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!!
21
Q

What are the characteristics of medical patients

A
  • Admitted for further assessment
  • Failure to thrive
  • May transfer to a surgical ward
  • Includes ER
22
Q

What position does the bed need to be in if patient has an NG tube

A

head of bed needs to be above >30 degrees

23
Q

What is the general sequence of events for mobilizing a client

A
  • Preparation
  • Subjective
  • Preparation of environment, equipment, space, setting, support
  • Objective (ippa + functional mobility)
  • Treatment & re-assessment
  • Charting
24
Q

What are some general considerations when performing an objective assessesment on the patient

A
  • Medical lines
  • Affects of anaesthetic and surgery
  • post-operative medications (pain medication)
  • Surgical incisions
25
Q

Urinary catheter needs to be kept at what level? Chest tubes

A

below site of bladder

Below site of incision

26
Q

What AROM do you conduct before mobilizing

A
  • 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
27
Q

What strength testing do you conduct prior to mobilizing

A
  • SLR x5 seconds - compare left and right
  • Grade 3 quad in sitting-compare sides
  • Bridge 5 second hold
28
Q

What can you do to make balance testing more difficult

A

reach outside of BOS

give perturbation

29
Q

What are post-operative considerations for cardiac patients

A
  • Sternal precautions

- hemodynamic stability

30
Q

What are post-operative considerations for thoracic considerations

A
  • Shoulder ROM

- Positioning considerations

31
Q

What are two major medication considerations

A

Do any medications change their BP, HR, cognitive status

Do any medications pose a falls risk to the patient

32
Q

What are 3 activities for therapeutic bed mobility

A
  • Bridging
  • ROM and Strength exercises in bed
  • Rolling right to left and up and down in bed
33
Q

How would you support an incision

A

Pillow/blankets/ abdominal binder

34
Q

What therapeutic movement do you do at the edge of the bed

A

forward and backward movement in sitting

35
Q

how do you move someone towards edge of bed once they are already sitting

A

Hand under arms on lower borders of rib cage

Collapse one side, extend other side, move the hip on the collapsed side forward

36
Q

Why is sitting up in a chair a therapy for most patients

A
  • 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
37
Q

For who do you use dangle protocols

A

acute post-operative clients who have a graft or flap procedure

38
Q

What is a flap surgery

A

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

39
Q

What is a graft surgery

A

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

40
Q

What is a graft surgery

A

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

41
Q

What is the dangle protocol

A
  • 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

PHTH 524 (15 decks)

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