Wheelchairs, Transfers and Emergencies Flashcards
Fit confirmation for seat height/ leg length
feet on footrests, 2-3 fingers placed between user’s thigh and seat; bottom of footrests 2 inches from floor
Fit confirmation for seat depth
2-3 fingers between front edge of seat and popliteal fold (seated back in chair)
Fit confirmation for seat width
hands can vertically fit between user’s hips and chair’s clothing guards/armrests
Fit confirmation for back height
4 fingers (hands held vertically) can fit between top of back of seat and floor of axilla
Fit confirmation for armrest height
shoulders level, trunk erect; able to rest arms on armrests with no change in posture
seat height/leg length WC measurement
heel to popliteal fold + 2 inches (consider height of cushion)
seat depth WC measurement
posterior buttock along lateral thigh to popliteal fold -2 inches
seat width WC measurement
widest aspect of buttocks/hips +2 inches
back height WC measurement
seat of chair to floor of axilla with shoulder flexed 90 degrees -4 inches (height should be below inferior angles) (consider cushion)
armrest height WC measurement
shoulders level, trunk erect; able to rest arms on armrests without change in posture
transfer used for patients with relatively good strength and balance where patient stands fully upright, pivots, and sits on another surface
stand pivot
transfer used when patient lacks mobility or strength in one or both lower extremities or unable to stand; requires fair sitting balance
sliding board
transfer used when patient is unable to use lower extremities but has very strong upper extremities and good upper trunk balance
lateral scoot
transfer type for patients who are unable to participate in the transfer
dependent
How much effort does patient provide in a standing assisted pivot
25-75%
maximal assist
patient is able to perform 25-49% of task
moderate assist
patient is able to perform 50-74% of the task
minimal assist
patient is able to perform 75% or more of the task
independent
patient is able to perform task with no assistance (no cues or equipment)
contact guard assist
patient requires hands-on assist only; balance may be an issue
supervision/stand-by
patient is able to perform task with no hands-on assistance, but therapist feels need to be close to patient; patient may need cues to assist
dependent
patient is unable to perform the task in any way
modified independent
patient is able to perform the task with no assistance (cues) but requires use of an assistive device
weight limit of standard wheelchair
for patients weighing less than 300 pounds
wheelchair for patient over 300 pounds
bariatric wheelchair
wheelchair that is 2 inches lower to allow for lower extremities to propel wheelchair
hemiplegic wheelchair
wheelchair with drive wheels positioned 2 inches posterior to normal position
amputee wheelchair
air cushion, consisting of air bladders that can be filled or emptied according to spots where pressure builds up most
ROHO
main goal of wheelchair cushions
prevent pressure buildup
provides no support or cushion for bony places on patient’s rear end: promotes internal rotation of hips
typical sling seat
used for wheelchair propulsion
drive wheels
In which position should a patient be placed for measurement for a wheelchair
sitting on firm surface (not in wheelchair)
DO THIS BEFORE performing a transfer with a patient
lock wheelchair brakes
DO THIS when patient is learning to pop a wheelie
guard patient closely from behind wheelchair
objective information to include in SOAP note about wheelchair
WC measurements, fit checks, propulsion education, levels of assist, number of reps or time spent on task, any verbal or tactile cues required, barriers negotiated-with how much assist or education on
If a patient has a trough on the WC for their arm, it is important to
ensure patient can remove their arm before leaving the patient unattended (can become a restraint)
wheelchair positioning begins where?
pelvis
direction to lean when ascending a ramp in a wheelchair
forward
direction to lean when descending a ramp in a wheelchair
backward
types of propulsion for motorized wheelchairs
joystick, head array, chin joystick, sip-n-puff, tongue switch, eye movement controls
treatment for mild allergic reaction
remove allergen, assist patient in administering antihistamine (Benadryl) or anti-itch cream (Calamine lotion); observe ofr worsening symptoms
treatment for anaphylaxis
call 911; rescue breathing if needed, EpiPen if available
pale, moist cool skin; shallow and irregular breathing; rapid pulse; dilated pupils; sweating; nausea and dizziness/syncope in person who has suffered a traumatic event or injury
shock
treatment for patient in shock
remove cause, monitor vitals, place in supine with legs elevated slightly, cover with blanket, no eating or drinking, keep patient still
a cut in a person’s tissue
laceration
most commonly used method to remove an object blocking airway
Heimlich maneuver
sudden drop in blood pressure as a result of postural changes
orthostatic hypotension
causes of orthostatic hypotension
dehydration, prolonged periods of supine or sitting, heart problems, endocrine problems
management ot orthostatic hypotension
sit up or stand for a few minutes before changing position again; abdominal binder; compression stockings; tilt table
HYPOglycemia S/S
fatigue, anxiety, sweating, hunger, irritability, shakiness
worsening: confusion, visual changes, loss of consciousness
HYPERglycemia S/S
frequent urination, blurred vision, fatigue, headache
worsening: nausea and vomiting, shortness of breath (SOB), weakness, coma
brain attack: results from lack of blood flow to brain
stroke
acronym to recall S/S of stroke
FAST (face, arms, speech, time)
hypersensitivity of immune system to something in environment
allergy
signs and symptoms of heat stroke
body temp over 104 degrees, altered mental state or behavior, nausea, vomiting, flushed skin, rapid breathing, racing pulse, headache, changes in sweating
signs and symptoms of heat exhaustion
heavy sweating, faintness, dizziness, rapid pulse, nausea, muscle cramps
treatment for heat exhaustion
place in shady area, loosen clothing, monitor vitals, apply cold compress to head/neck, offer water or electrolyte solution, observe for signs of shock or heat stroke, contact 911 if patient does not improve, have patient rest remainder of day
An acronym that personnel use to remember their duties
for discharging a fire extinguisher
PASS (pull, aim, squeeze, sweep)
This acronym is used as a reminder of the duties of
personnel in the case of a fire
RACE (rescue, alarm, confine, extinguish)
a patient safety event that results in death, permanent harm, or severe temporary harm
sentinel event
adverse effect of seat height too high
insufficient trunk support, difficulty positioning knees under table, difficulty propelling WC, poor posture with forearms on armrests
adverse effect of seat height too low
difficulty with transfers due to lower center of gravity, footrests may contact items on floor and decrease mobility
adverse effect of seat depth too deep
increased pressure on popliteal space (causing increased pressure and decreased circulation
adverse effect of seat depth too shallow
decreased trunk stability due to less support under thighs, increased weight bearing on ischial tuberosities, poor balance due to decreased base of support
adverse effect of seat width too wide
difficulty propelling WC due to inability to reach drive wheels, difficulty performing transfers, difficulty navigating through doorways, postural deviations from leaning to one side
adverse effect of seat width too narrow
difficulty changing positions, too much pressure on greater trochanters, difficulty wearing braces (orthoses) due to narrow space
adverse effect of back height too high
difficulty propelling WC due to difficulty using arms, increased pressure/friction on scapulae, decreased balance due to inclined trunk
adverse effect of back height too low
decreased trunk stability or postural deviations due to less support
adverse effect of armrest being too high
difficulty propelling WC due to inability to reach drive wheels, difficulty performing transfers, postural deviations due to raised shoulders, decreased trunk stability due to not using armrests
adverse effect of armrest being too low
postural deviations due to depressed shoulders, decreased balance from leaning forward, difficulty with transfers
Items to include in documentation of a transfer
type of transfer, level of assist required, how many people were needed to assist, transfer surfaces (bed, WC, floor), verbal or tactile cues provided
benefits of proper seating and positioning
promote function, prevent deformity, improve body alignment, improve trunk stability, prevent tissue damage, reduce discomfort/overuse syndromes, prevent additional complications, minimize energy expenditure
