vitals, precautions, inpatient Flashcards
standard precautions purpose
prevent spread of infection
standard precautions include
- hand hygiene
- wearing gloves, gown, protective eyewear, PPE with body fluids
- bandage to minor cuts/skin lesions
- proper handling/disposing of sharp objects
- routine cleaning/disinfecting environmental surfaces/equipment before & after patient interaction
what is the purpose of infection control?
to minimize/prevent nosocomial infections & spread of health-related diseases
what does infection control include?
hand hygiene, isolation systems, sterilization
what is the purpose of hand hygiene?
infection control to prevent spread of germs & infection through washing hands when visibly dirty and using alcohol-based sanitizer when not visibly dirty
what is used in conjunction with standard precautions?
airborne and droplet precautions
what is the purpose of airborne precautions?
transmission-based infection control method to prevent transmission of disease/infection spread via particles
what do airborne precautions include?
N95 mask/respirator, intervention in isolation room, equipment only for single-patient use (or can be disinfected)
what is the purpose of droplet precautions?
transmission based infection control method to prevent spread of disease/infection via droplets
what is included with droplet precautions?
mask, intervention in patient’s room, single use patient equipment (or can be disinfected)
what are universal precautions?
assume everything is infectious
- also for emergent phase of burns
basic first aid for bleeding
- assess situation, wash hands/donn gloves
- clean/sterile dressing over wound
- apply direct pressure
- elevate wound surface above heart
- tell patient not to move wounded extremity
fire safety
RACE
Rescue
Alarm
Contain
Extinguish/Evacuate
total parenternal nutrition (TPN)
infusion of nutrients via catheter inserted into vein when oral feeding not possible
- avoid occluding/dislodging catheter
- ensure connections intact before/after tx
arterial monitoring line (A line)
catheter placed in artery to continuously measure blood pressure or draw blood
- follow patient-specific artery precautions
- avoid occluding/dislodging catheter
pulmonary artery catheter (PAC)
- long IV tube placed in central vein (jugular, subclavian, femoral)
- connected into R pulmonary artery to measure changes due to medication, stress, activity
- Avoid occluding/dislodging tubing
- Avoid ROM near tubing
feeding pump
Device that provides nutrients at constant flow to patients unable to ingest, chew, swallow food
- Avoid stress/tension at insertion site
- Respond to alarm, indicating system empty or turned off
intracranial pressure
measures pressure inside skull
- normal: below 20 mmHG (client specific)
mean arterial pressure
measured via centralized monitoring to determine avg arterial pressure during cardiac cycle
- normal: 70-110 mmHg
normal respiratory rate
12-20 breaths per min
normal O2 saturation
95-100%
- measured with pulse oximeter
normal BP
90-120mmHg/60-80mmHg (systolic over diastolic)
hypotension level
low BP
- systolic under 90
prehypertension
120-140/80-89
hypertension stage 1
- greater than normal
140-159/90-99
hypertension stage 2
> 160/>100mmHg
normal heart rate
60-100bpm
bradycardia
less than 60 bpm
tachycardia
more than 100bpm
sterile precautions
- wash hands
- keep all work surfaces clean & dry
- touch only outside wrappers with your bare hands when handling supplies
- mask over your nose and mouth
- supplies within reach so you do not drop or rub against them
where should a gait belt fit on a patient during a transfer?
fit snugly around the waist and not move up the trunk
steps for a safe transfer
- position the wheelchair
- lock wc brakes
- secure gait belt around waist (at all times! if don’t have one, use patient’s pants or belt)
- clinicians should follow proper body mechanics to maintain the integrity of their spine, in order to safely support and move the patient (both clinicians position the patient upright and centered, with the front clinician blocking the patient’s knees and feet)
if a client reports fatigue after completing a certain activity, what should be done in the next session?
reduce the intensity
if a client has a progressive disease and is preparing to be discharged home, what can be done to prepare the caregiver for the transition?
involve the caregiver in the patient’s sessions
maximum height a clinician should handle before using a lift
35 lbs
Levels of weight bearing
- NWB (non weight bearing): no weight on involved extremity
- TTWB (toe touch weight bearing): only toe placed on ground for balance while standing (90% on unaffected leg)
- PWB (partial weight bearing): 50% of person’s weight on affected leg
- WBAT (weight bearing as tolerated): patient judges how much weight to put on affected leg without causing too much pain
- FWB (full weight bearing): 100% of weight on affected leg without causing damage
When applying a hot pack, what is the method of application?
Place a folded towel or two between body part to be treated & hot pack (hot packs are heated in hot water bath of 160 degrees F)
- good warm up for exercise prep, adjunct to functional activity
- increases muscle extensibility (helpful with ROM restriction)
If an OT is using a goniometer on a patient and is getting varying measurements after 4 times of measuring, they should
Verify correct goniometer placement
MMT Grading Scale
0: NONE (no contraction seen/felt)
1: TRACE (no movement but can contract muscle)
2-: POOR MINUS (incomplete ROM w/ GRAVITY ELIMINATED)
2: POOR (complete ROM with GRAVITY ELIMINATED)
2+: POOR PLUS (less than 50% ROM against gravity)
3-: FAIR MINUS (more than 50% ROM against gravity)
3: FAIR (complete ROM against gravity)
3+: FAIR PLUS (complete ROM against gravity & SLIGHT resistance)
4: GOOD (complete ROM against gravity & MOD resistance)
5: NORMAL (complete ROM against gravity & MAX resistance)
MMT Grading Scale interventions
0: NONE (no contraction seen/felt- maintain PROM to prevent contractions, adhesions, deformity)
1: TRACE (no movement but can contract muscle) - facilitate stronger contraction by tapping, rubbing, vibrating muscle; AAROM - patient contracts muscle & OT or mechanical device completes entire ROM (slings, pulleys, weights, springs, elastic bands- graded by reducing assistance until patient performs active exercises)
2-: POOR MINUS (incomplete ROM w/ GRAVITY ELIMINATED) - complete ROM for them passively when they stop actively moving extremity in gravity eliminated plane; incorporate a goal into exercise such as using a suspension mobile arm support with meaningful activity
2: POOR (complete ROM with GRAVITY ELIMINATED) - use powdered surface/skateboard to reduce resistance produced by friction on surface when in gravity-reduced plane (EX: place client’s arm on top of table covered with powder & have them do table top activity to slide arm on table surface through complete ROM in gravity eliminated plane. Board game with light pieces)
2+: POOR PLUS (less than 50% ROM against gravity) - complete ROM gravity eliminated slight resistance (EX: introduce weighted game pieces as resistance to a board game)
3-: FAIR MINUS (more than 50% ROM against gravity) - activity to encourage client to lift arm up in vertical plane against gravity with goal at highest level client can reach
3: FAIR (complete ROM against gravity) - can structure activities against gravity (E: balloon volleyball, throwing balloon at a target requiring patient to lift arm against gravity)
3+: FAIR PLUS (complete ROM against gravity & SLIGHT resistance) - resistive exercise is used to complete strength (EX: tossing a beach ball)
4: GOOD (complete ROM against gravity & MOD resistance) - resistance used to increase strength (EX: toss beach ball with weighted cuffs strapped to client’s wrists. Tossing a therapy ball)
5: NORMAL (complete ROM against gravity & MAX resistance)- resistive exercise to increase strength (EX: tossing a medicine ball while standing)
Shoulder ROM norms
Flexion: 0-180
Extension: 0-60
Abduction: 0-180
Horizontal Abduction: 0-45
Horizontal adduction: 0-135
IR: 0-90
ER: 0-100
Elbow & FA ROM norms
Elbow f/e: 0-150
Supination/Pronation: 0-80
Wrist ROM norms
Flexion: 0-80
Extension: 0-70
Ulnar deviation: 0-30
Radial deviation: 0-20
Thumb ROM norms
CM flexion: 0-15
CM extension: 0-20
MP f/e: 0-50
IP f/e:0-80
Abduction: 0-70
Opposition
The physician’s order, which was not signed by the physician, requests a splint for this patient’s wrist, with no specifications stated. How should the OTR proceed with this request?
DO NOT CONTACT OR APPROACH MD! THEY ARE RELYING ON OT TO GIVE THE CORRECT TYPE OF SPLINT
- issue a prefabricated wrist splint to give patient more flexibility
- do not ask patient to return to the physician for a signed order (violates beneficience)
