Psych and mobility devices

Question 1

What is the accurate way to measure the length the crutches should be?

Answer 1

2-3 ginger widths between the pad and the anterior axillary fold (armpit)
Tip of crutch is a point lateral (6 inches) and slightly in front of foot (6 inches)
Handgrip - angle of elbow is 30 degree and wrist at the level of the handgrip

Question 2

What should you NOT use to measure crutches

Answer 2

ANY landmark on the foot or anything that says axilla

Question 3

What is a 2 point gait? Uses?

Answer 3

Move the crutch and opposite foot together

Example: right crutch and left leg

Used for mild bilateral leg weakness

Question 4

What is a 3-point gait?

Answer 4

Move 2 crutches and the bad leg together followed by the unaffected foot

Question 5

What is the 4-point gait?

Answer 5

Move crutch, then opposite foot, then other crutch, then opposite foot

VERY slow but VERY stable

Question 6

What is the swing through? Uses?

Answer 6

Unaffected foot passes the tip of both crutches

Amputees
Non-weight bearing

Question 7

What is the rule for which gait of crutches should be used?

Answer 7

Use even point gait for even and odd-point gait for odd

Use even numbered gait when the weakness is bilateral - 2 point for mild and 4 point for severe

Use odd numbered gait when one leg is affected

Question 8

How do you go up the stair with crutches? How do you go down?

Answer 8

Up with the good, down with the bad

Lead with good foot and crutches follow when going up

Lead with bad foot and crutches then follow with good when going down

Question 9

Which side should a cane be held? Where should the handgrip be?

Answer 9

Hold cane on the unaffected side and handgrip should be at the level of the wrist

Question 10

What is the correct way to use a walker? Can you tie things to it? Can you have things on the feet?

Answer 10

Picks it up, sets it down, walks to it

Holds onto chair, stands up, then grabs walker

If things MUST be tied to it, tie to the side so doesn’t fall over

NOTHING on feet of walker including wheels and tennis balls

Question 11

What is the first question you should ask when a psych question comes up?

Answer 11

Is the patient a non-psychotic patient or a psychotic patient?

Question 12

How do you respond to you patient if they are non-psychotic?

Answer 12

Therapeutic communication

How are you feeling, that must be overwhelming, that must be difficult, I can see you are sad, tell me more

Reflection, amplification, restatement

Question 13

What is a psychotic patient?

Answer 13

A patient that has no insight and is not reality based
They do not think they are sick and everyone else is the problem
Has delusions, hallucinations, illusions

Question 14

What is a delusion?

Answer 14

A false, fixed belief or idea or thought that is all in their head

Question 15

What are the 3 types of delusions?

Answer 15

Paranoid
Grandiose - false belief that you are superior (I am the president, I am the smartest person ever)
Somatic - false belief about your body (I have x-ray vision, there are worms in my arm)

Question 16

What is a hallucination?

Answer 16

Sensory experience without external stimuli
Nothing there

Auditory, visual, tactile, gustatory, olfactory

Question 17

What is an illusion?

Answer 17

A misinterpretation of reality

There is a referent (something that both the pt and clinician can refer to) such as a cord, or people talking

Question 18

What is function psychosis? Examples?

Answer 18

Can function in everyday life. D/t chemical imbalance in brain

Skeezo, Skeezo, major, manic

Schizophrenia, schizoaffective disorder, major depression, mania

Question 19

What is psychosis of dementia? Examples?

Answer 19

Actual brain damage/destruction

Alzheimers, stroke, organic brain syndrome, anything that says senile/dementia

Question 20

What is psychotic delirium?

Answer 20

Temporary, sudden, dramatic, episodic, secondary to something else

UTI, thyroid imbalance, adrenal crisis, thyroid store, electrolytes, medications/drugs, overdose, withdrawal, DT, ICU for a long time, infection

Question 21

How do you approach a function psychotic patient?

Answer 21

There have the ability to learn

Acknowledge feelings (you seem sad, you seem angry)
Present reality (I know you see that demon but I don’t)
Set limits (We are not going to address that, stop talking about that)
Enforce limits (I see you’re too ill to stay in reality so our conversation is over)

Question 22

How do you approach psychosis of dementia?

Answer 22

They cannot learn reality d/t brain damage so don’t present it!

Acknowledge feelings
Redirect them - give them something that they can do

Question 23

How do you approach psychosis of delirium?

Answer 23

Acknowledge feelings
Reassume them of safety and temporariness of their condition

Question 24

What are ideas of flight?

Answer 24

Going from thought to thought to thought rapidly. Each thought is coherent but they are not coherent together

Question 25

What is neologism?

Answer 25

Make up words

Question 26

What is narrowed self concept? What do you not want to do with these patients?

Answer 26

Patient refuses to change their clothes or leave their room - this is because there two things define who they are and they are scared to change them b/c they wouldn’t know who they are without it

Never make them change their clothes, tell them you see they feel uncomfortable and only to change when they feel comfortable doing so

Question 27

What is idea of reference?

Answer 27

Thinking everyone is talking about you