Week 2 &3 Lectures Flashcards
Know the difference between short sitting, long sitting, hook lying, and bridging.
-Short sitting- legs flexed
-Long sitting- legs straight on bed
Hook lying- back on bed, knees at 90 degrees
-Bridging- raising hips
What does EOB stand for?
Edge of Bed
Know the difference between half-kneeling, kneeling, and quadruped
- Half-kneeling- one knee on ground
- Kneeling- both knees on ground (tall kneeling)
- Quadruped- on knees and hands
What are the 4 assistance levels? Give a definition of each.
- Independent- Patient able to perform skill safely with no one present
- Supervision- Patient requires someone within arms reach as a precaution
- Close guarding (stand-by assist)- Person assisting is ready with hands up, but not touching patient.
- Contact guard- Therapist is positioned as with close guarding, with hands on patient but not giving any assistance
Difference between assistance levels?
- Min assist- patient can perform 75% of the task
- Mod assist- patient can perform 25-75% of the task
- Max assist- patient can perform less than 25% of the task
- Dependent- patient does not attempt participation
Weight bearing status abbreviations
FWB- Full weight bearing
- WBAT- Weight bearing as tolerated
- No restrictions for FWB or WBAT, limited only by patient discomfort. WBAT is between PWB and FWB
- PWB- partial weight bearing
- Prescribed amount as a percentage of patients body weight.
- TTWB (TDWB)- toe touch (touch-down) weight bearing
- Toes may rest on ground in standing, but the extremity is non-weight bearing. Utilized for balance assist only
- NWB- non-weight bearing
- Foot may not contact the floor
5 bed mobility movements
SLIDE 10-18
- Scooting up and down
- Scooting sideways
- Rolling supine to side lying
- Supine to sit
- Scooting in sitting
Steps to providing assistance in bed mobility?
- Maintain good body mechanics
- Use bed height to your advantage
- Utilize the draw sheet
- Direct distally, control centrally
How many fingers should fit in a gait belt?
2
How to get from sitting to standing?
- Scooting in sitting to front of surface
- Place base of support under center of mass
- Shift center of mass anteriorly
AKA: Butt forward, feet back, nose over toes
TRANSFERS
TRANSFERS
Types of transfers?
- Lateral sheet transfer
- Vertical lift
- Squat pivot
- Stand pivot
- Transfer board
Does a vertical lift involve 2 people?
Yes
When would you use a squat pivot vs a stand pivot?
When the patient requires higher level of assistance
What does squat pivot not achieve that stand pivot does?
Full extension
Therapist position for a squat pivot transfer?
- Staggered stance
- Hips and knees flexed
- Utilize gait belt or ischial tuberosity’s
- Knee block
VITAL SIGNS
VITAL SIGNS
What are the 4 internationally recognized vital signs?
- HR
- BP
- RR
- Temp
Other measurements to take with vital signs?
- Pain
- Pulse Ox
- Perceived exertion rating
What is basal heart rate?
HR measured after an extended period of rest.
Can be an indication of CV function in the absence of physical stress
What is resting heart rate?
Without imposed stress
What is pericardial HR?
Measurement of the CV system’s capacity to provide blood flow during imposed physiological or physical stress
What is recovery pulse rate? When is it taken?
Measurement of the cardiovascular system’s recovery capability following the imposition of physiological oor physical stress.
Usually taken 1-3 minutes after intervention
HR>100=______.
HR<60=______.
Tachycardia
Bradycardia
Ask what normal is
Assessing Pulse/HR
\+3 = Bounding \+2 = Normal \+1 = Weak or Thready 0 = Absent
Difference between the HR values of +3,+2,+1, and 0
+3 (Bounding)- Readily palpable, not easily obliterated by finger pressure
+2 (Normal)- Easily palpable and obliterated only by strong finger pressure
+1 (Weak or Thready)- Hard to feel and easily obliterated by slight finger pressure
0 (Absent)- not discernible
What is patency?
The openness of the peripheral portion of the cardiovascular system
Presence or absence of pulse at a given site
Is a patient with a lack of patency a red flag?
Yes, immediate referral to MD
HR Zones
- Warm up/Cool down- 50% or less
- Fat burning zone- 50-65%
- Target HR Zone- 65-85%
Anaerobic/High Intensity Zone- 85-100%
Calculation for Max HR
220- age
Heart Rate Norms at different ages
- Newborn- 120-160
- Infants (1-12 months)- 100-120
- Children (1-8yo)- 80-100
- Adult- 60-100
What should you not do when taking HR?
Use your thumb as a palpation finger
Methods of taking HR?
- Manual palpation
- Auscultation- monitoring of the heart using a stethoscope
- Doppler Measurements
- Pulse Ox
- ECG or Electronic Monitors
Muscle mass and depth make which palpation sites harder?
Brachial, popliteal, and femoral
What is BP?
Measure of force exerted by blood against the aorta
Difference between systole and diastole?
During systole the ventricles of the heart are contracting, this is when maximum pressure is exerted.
Diastole is when the ventricles are relaxed, minimum pressure is exerted.
BP is a key indicator for what?
Health of the cardiovascular system
A low BP results in _____ high BP results in __________.
Fainting
Stroke/ Myocardial Infarction
Purpose of taking BP?
- To determine vascular resistance to blood flow
- To determine the effectiveness of cardiac muscle in pumping blood to overcome vascular resistance
BP measurement considerations.
- Size of cuff
- Placement of bladder
- Support of patient’s arm
- Patient Position
You should always take BP on the ____ side unless?
Left
IV, breast cancer, post-surgery
Patient should be sittin with the arm in a horizontal supported at ___________.
Heart level
Normal resting BP’s in different ages
Systolic Neonates- >60 Infants- 70-95 Children- 80-110 Adults- 90-120
Diastolic
Neonates through Children- highly variable
Adults- 60-80
Blood Pressure Phases
Phase I- first clear tapping sound heard
SYSTOLIC BP
Phase II- Softer sound, may be a swishing or murmur
Phase III- Louder and more crisp sound
Phase IV- Sound changes from crisp and distinct to muffled
Phase V- Cessation of sound
(Diastolic BP)
Blood Pressure Categories
Normal- Less than 120/80
Elevated- 120-129/Less than 80
High BP (Hypertension Stage 1) - 130-139/80-89
High BP- (Hypertension Stage 2) - 140 or higher/ 90 or higher
Hypertensive Crisis- 180 or higher/ 120 or higher
High BP reading signs and symptoms?
Headache
- Dizziness
- Flushed face
- Spontaneous epistaxis
- Vision Changes
- Nocturnal urinary frequency
How long do you have to wait between BP readings?
1 minute
BP red flags for termination of exercise?
BP changes in presence of angina (chest pain), dizziness, nausea, pallor, or extreme diaphoresis at rest or during exercise
Other abnormal BP responses to physical activity?
- Diastolic increases more than 10mmHg with activity
- Systolic BP does not rise or it falls with increasing workload
What is orthostatic hypotension?
A sudden drop in BP with changes in position
Drop of 20 Systolic
Drop of 10 Diastolic
Or Both
Changes within 3 minutes of standing/sitting up
ANKLE BRACHIAL INDEX
VITAL LECTURE S32
Subjective measures of respiration
- Depth of respiration
- Regularity
- Ease
- Use of accessory muscles
Accessory Muscles of Inspiration
- SCM
- Pec Major/minor
- Serratus Anterior
- Lats
- Trapezius
- Serratus posterior
Accessory muscles of Expiration
- Transverse Abdominis
- Internal/External Obliques
- Rectus Abdominis
- Intercostals
- Quadratus Lumborum
Respiration Norms
- Newborn- 40-60 breaths/min
- Infants- 25-50/min
- Adults- 12-25/min
- Elderly- may increase secondary to decreased elasticity/effeciency of gas exchange
Borg Breathlessness Scale
0- none at all
5- severe
10- maximum
Purpose of Temperature
- Baasa, metabolic states
- Infection, inflammation
- Response to exercise
Methods to take Temperature
-Thermometer
-Mercury glass
-Electronic
-Heat sensitive
strips
Sites to take temperature
- Oral
- Rectal
- Auditory canal/tympanic
- Forehead
- Axillary
Average temperature of the body?
98.6
Varying Factors
- Time of Day
- Menstrual Cycle
- Pregnancy
- Aging
- Season (controversial)
- Physical Fitness
- Shift work
- Meals
- Alcohol
Hypothermia vs Hyperthermia
Hypo- decreased core temp
Hyper- increased core temp
What does pulse ox measure?
Oxygenation of the blood
What is a normal O2 sat?
90% and above
Under 85% is severe hypoxia
Pain is _______.
Subjective
Purpose of measuring pain?
- Diagnosis
- Prognosis
- Appropriate interventions
- Response to interventions
