Toolbox 1 midterm Flashcards
Average blood pressure
90/60- 120/80mm/Hg
Average heart rate
60-100
Average o2 saturation
95-100%
– amount of oxygen in the blood
(COPD between 88-90%)
Average respiratory rate
12-18 breaths per min
What are the 6 levels of dependence
independent, standby, minimal, moderate, maximal, dependent
Percentage of assistance for minimal level
patient requires up to 25% assistance
percentage of assistance for moderate level
patient requires between 25-50% assistance
percentage of assistance for maximal level
between 51-75%
Percentage of assistance for dependent level
more than 75% assistance required from OT
What does the COPM stand for
Canadian Occupational Performance Measure
What categories are part of the self care section on the COPM
personal care, functional mobility, and community management
What categories are part of the productivity section on the COPM
paid or unpaid work, household management and school/play
what categories are part of the leisure section on the COPM
quiet recreation, active recreation and socialization
What are the main topics on the COPM
Self care, productivity, and leisure
How is the COPM scored
1- not important/ not satisfied/ not able to do it
10- most important/ most satisfied/able to do it no problem
Name 7 key ADLS
dressing, eating, feeding, bathing/showering, functional mobility, toileting, sexual activity
Name 4 key IADLS
driving, safety, care of others/perts, communication/financial management
definition of occupation
activities that are meaningful to an individual
What is the role of an OTA
primary role is to implement treatment, conduct standardized assessment and required to be supervised by an OT
What does OTPF stand for
Occupational Therapy Performance Framework
What is grading
is used to increase or decrease the activity demands on a person while he or she is performing an activity
- make it more or less challenging
EX. increasing/decreasing repetitions, or add/remove weights
what is adaptation
Changing ot modifying an aspect of the activity to allow for successful participation in an occupation
EX. using equipment, or other people to help
Adaptation is similar to grading, but adaptation is not done “with the intent to reduce or increase the demands on the client
What is the difference between performance and satisfaction on the COPM (back sheet of form)
performance is being able to do something not at all or do it very well
satisfaction is how okay are you with your current performance level
What is the COPM used for?
identify problem areas in occupational performance
provide a rating of the clients priorities
evaluate performance and satisfaction relative to those problem areas
provide the basis for goal setting
measure changes in a client’s perception of their occupational performance
What manual transfer do you NOT scoot the client forward
sliding board because the board should be under their thigh but still on the surface they are sitting on
When do you need to block a client knee’s
if there is lower body weakness, or for a dependent transfer (put your knees on the outside of their legs)
What is the definition of Evidence Based practice?
combo of clinical expertise, research evidence, and patient characteristics or preferences
What are the parts of a PICO question
Population
intervention
comparison
outcome
What databases search medline
PubMed, Ovid, CINAHL
When is an item considered a constraint
restricts normal movement
typically goes over a joint
if they cannot cognitively/physically remove it themselves
Who can order a restraint?
doctors
documented every 24 hours, nurses usually check the status of the restraint
Can we remove a restraint to work with someone?
Yes, but remove one at a time and put it back on at the end of the session back how you found it
How do you put on a wrap around belt restraint?
Wrap around the client and the surface they are sitting on
the no slip part goes against their body
What is the key point to remember about using a soft limb restraint?
clip it onto the surface they are actually on, not on a surface next to them, or a handrail (these can be removed)
What direction does the d ring face for a freedom arm split?
Away from patient so it does not rub against the skin
What should you do after you put a mitten on a client to make sure it is not too tight
check fingers to see if they still react to pressure, if they stay white for too long, then it is too tight
When should vital signs be taken during an OT session and why?
when you change positions, or after an activity (sitting to standing)
What is a normal blood pressure response to activity?
progressive increase in SBP my 7-10 mmHg
What is a troponin and what are normal ranges?
0-0.4ng-mm
muscular protein, and if above that range would be an indication of a heart attack or heart damage
If hemoglobin is low, what precautions would you take during your OT session?
lower intensity of exercise (hemoglobin measures blood capacity to carry oxygen)
What is the purpose of an IV line and precautions
to administer fluid or medicine
if pulled out put pressure on it and call the nurse
What is the purpose of a NG tube and precautions
feeding/medication and pulling gastric fluid out
more temporary than a G tube
make sure bed is at 30 degrees or more
What is the purpose of a chest tube and precautions
remove fluid/air from pleural space (between ribs)
keep box below incision
What is the purpose of a JP Drain and precaution
remove fluid from wounds/incisions
hook to patient with a safety pin, don’t hook to pants
what is the purpose of a G tube and precaution
feeding and nutrition
make sure gait belt is above or below
What is the purpose of a foley catheter and precautions
empties bladder automatically
make sure it stays below insertion so it drains and don’t have it under their leg
What is the trendelenburg position?
Knees raised and sitting up
What are the 4 spinal precautions
no twisting of head/trunk
don’t lift more than 5-10 lbs
log roll
wear brace as directed
What are the 7 cervical precautions
no twisting/rotating of neck don't lift more than 5-10 lbs log roll wear brace as directed no pulling with arms no nodding can lift arms to where it is comfortable, but stop if pain occurs
What is the order according to the CDC for putting on materials to go into a contaminated room
wash hands
Put on gown (then mask)
put on gloves
What does BADL and PADL stand for?
Basic ADLS and Personal ADLs
both other terms for ADLS
What is the definition of an ADL?
activities oriented toward taking care of one’s own body
What is the definition of an IADL?
Activities to support daily life within the home and community that require more complex interactions
What are the 3 levels the OTPF defines clients of OT
Persons
organizations
populations
What does domain mean in regards to focus area in the OTPF
What we do
- focus on the whole being
- understanding of interrelationships
What are the 5 aspects of OT’s domain
occupations client factors performance skills performance patterns contexts/environments
What does Process mean in regards to focus area in the OTPF
How we do it
client centered process
evaluation, intervention, targeting of outcomes
What is the most important info to gather from someone’s medical chart before going in to see them?
5 things
Basic personal information diagnosis (dx) History of Present Illness (HPI) Past medical history (PMH) Physician orders
What type of interview is most often used clinically
semi-structured (COPM)
What are the 4 steps of the COPM
Problem definition
rating importance
scoring
reassessment
What are the 4 levels of occupation?
Roles– position in society with expected responsibilities (student
task– set of activities that are purposeful (study for exam)
activity– productive action required for development (review notes)
action – basic unit consisting of bx directed toward to performance of a task (memorization)
What are the three movement restrictions fo posterior hip precautions
No hip flexion beyond 90
No hip adduction past neutral/midline (don’t cross legs)
No internal rotation
What are the 2 precautions fo anterior hip precautions
no hip hyperextension (no stepping backwards)
No hip external rotation( turning knees or feet outwards)
What are the 6 standard movement restrictions for sternal precautions?
- -No lifting more than 10lbs for 4 weeks
- no driving 4 weeks
- -can move shoulders within full ROM
- -Can use wheel chair as long as there aren’t any weight bearing precautions
- can use UE to propel a W/C
- can transfer themselves as long as they are at minimal assistance or below (standby, independent)
What are the 5 main movement restrictions for cervical spine precautions?
–BLT (bending neck, Lifting more than 5-10 lbs, and twisting neck and back)
–no neck movements
–no pulling with arms
–avoid reaching above shoulder height
–log roll
(8-12 weeks, others are 6weeks)
What are the 6 main movement restrictions for thoracic spine precautions?
- -BLT
- -Keep bed flat
- -don’t lie on stomach
- do not arch back
- -do not pull with arms
- -log roll
What are the 5 movement restrictions for lumbar spine precautions
- -BLT
- -Avoid crossing legs for extended amounts of time
- no hip flexion >90
- -Do not pull with arms
- log roll
What are the 3 movement restrictions for abdominal precautions
(4-6 weeks)
- -no lifting more than 5-10lbs
- no bending or twisting trunk
- -log roll
What are the 4 movement restrictions for endocardial pacemaker precautions
(about 4 weeks)
- -limit shoulder flexion <90
- no excessive activity or stretching on affected side
- don’t lift more than 10-15 lbs on affected side
- no internal rotation (reaching behind
what are the 5 movement restrictions for shoulder precautions
(4-6 weeks)
- don’t reach behind back
- no lifting objects or supporting body weight on involved side
- no external rotation >30
- don’t sleep on operative shoulder
What does weight bearing as tolerated (WBAT) mean
Pt can put as much weight on their affected side as long as their isn’t pain
What does partial weight bearing (PWB) mean
pt can put up to 50% of their weight on the affected side
What does touchdown/toe-touch weight bearing (TDWB/TTWB) mean
can’t bear weight on their affected side but can put their foot to the floor for balance
What does non-weight bearing (NWB) mean
pt cannot bear any weight on affected side/extremity
– cannot use walker
What does the systolic number tell you in BP
top number
pressure in the artery when the heart contracts
What does the diastolic number in BP tell you
bottom number
pressure in the artery when the heart is at rest and filling with blood
What artery do you place the stethoscope over?
brachial artery
what number should you inflate the cuff for BP to?
180mm/Hg
What can the OT do to help with high BP
lay client down
What can the OT do to help with low BP
Low client down with feet up
encourage client to drink fluids
What can the OT do for either high or low BP
get client to lay down
Always modify nurse/MD with any concerns
What are some symptoms of cardiac distress?
- -complaint of chest pain
- -burning radiating to jaw, neck, arm
- nausea
- shortness of breath (SOB)
What are some symptoms of low O2 saturation?
Shortness of breath fatigue mental confusion tingling fingers dizziness
What can OT’s do to help with O2 saturation
encourage client in slow purse-lip breathing (PLB)
- sniff the flower, blow out the candle
What is an important tip for taking respiratory rate
do not let the client know you are taking it
What is the average temperature range for adults
- 8-99.1 F
36. 3-37.3 degrees Celsius
What is the normal range for blood glucose?
between 80-125 depending on when and what the client last ate
what can you do to help patient who has low blood glucose symptoms?
offer carbohydrates (whole milk, crackers, turkey)
What is the primary goal of acute care?
stabilize the patient’s medical status and address life threatening issues
What are some of the OT roles in Acute care?
- -educate patient and family
- - make recommendations for discharge
What are the universal precautions for infection prevention?
- -wear appropriate personal protective gear
- -hand hygiene before and after patient contact
- properly clean all equipment after patient use
What are we preventing in infection prevention?
- -Blood borne pathogens
- -TB and other airborne pathogens
- Multidrug resistant bacteria
What are the 3 main blood borne pathogens?
Hep B
Hep c
HIV
What specific PPE do you need to work with a client who has active TB
N95 mask, mask that is fitting specifically for you (along with gloves, and gown)
When do you use a mask when working with a patient
if they have a droplet pathogen such as the flu or diphtheria
– of they have neutropenic precautions (lowered immune system)
Name 5 moments for hand hygiene
- -before contact with patient
- before aseptic task (helping client brush teeth)
- after body fluid exposure risk
- after patient contact
- after contact with patient surroundings
What is the order of donning/doffing gloves and gown according to the CDC
first gown, then gloves
