ADL Exam 2 Review Flashcards by Linda Mercer

Complications from prolonged immobility

blood clots
orthostatic hypotension
increased insulin requirements
risk of aspiration
constipation
pressure injuries
decreased muscle mass and strength
loss of joint ROM, difficulty breathing
pneumonia
calcium loss in bones
general inability to perform daily activities

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requires therapist to move patient’s joints through full or available range

range of motion (ROM)

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AROM

patient performs movement independently

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PROM

movement of a body segment through the full motino possible by an external force (therapist) or uninvolved extremity

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striping pattern in which sensory neurons are arranged

dermatomes

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sensory neurons

nerves that detect pressure, pain and touch

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How people with normal sensation avoid too much pressure on certain bony places

lean forward
shift from one hip to another
scoot bottom back in chair
roll from right side to left

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Agency for Health Care Policy and Research statement on re-positioning patients

every 2 hours for bed, 15-30 minutes for seated

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Another name for pressure injury

decubitus ulcer

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pressure injury arises from

pressure applied to an area of skin over a long period of time

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Factors that can cause or exacerbate pressure injuries

friction force
shearing force
comorbidities

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Soft tissue contracture sites in supine

hip and knee flexors
ankle plantar flexors
shoulder extensors, adductors, internal rotators

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Soft tissue contracture sites in prone

ankle plantar flexors
shoulder extensors, adductors, internal rotator and external rotators
neck rotators

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Soft tissue contracture sites in sidelying

hip and knee flexors
hip adductors and internal rotators
shoulder adductors and internal rotators

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Soft tissue contracture sites in sitting

hip and knee flexors
hip adductors and internal rotators
shoulder extensors, adductors, internal rotators

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Generally desired position to avoid contractures

neutral

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Reasons for positioning

avoid contractures
decrease likelihood of pressure injury
comfort
access for therapist to body part
to maximize patient function

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areas where 25% of all pressure injuries are found

sacrum
heel
ischium
patella

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supine common areas of pressure

scapulae (spine and inferior angle)
spinous processes
posterior iliac crests
ischium
*heels (posterior calcanei)
*sacrum
elbows (medial epicondyle)
back of head (occipital tuberosity)

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sidelying common areas of pressure

ear
later ribs
*lateral acromion process
lateral head of humerus
medial/lateral epicondyles
*greater trochanter
medial/lateral condyles
*malleoli
5th metatarsal of foot

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prone common areas of pressure

forehead
lateral ear
anterior acromion process
clavicles/sternum
anterior head of humerus
anterior superior iliac spine (ASIS)
tips of toes
patella

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sitting common areas of pressure

*ischial tuberosities
scapular and vertbral processes
sacrum
coccyx
medial epicondyle of humerus
calcanei (heels)

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restraint

anything that would prevent a patient from being able to move or change position on his/her own

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things that might be considered restraints

medications, tying patient to bed or WC, WC cushions, WC toughs, , lap trays, bed rails, seat belt, pillows, towel rolls, bolsters, other positioning devices

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A restraint can be ordered by

physician or other licensed healthcare personnel authorized by state and facility

positioning for transtibial amputation

keep hip and knee fully extended, avoid prolonged sitting

positioning for transfemoral or transtibial amputation for some time each day

prone

contracture risk for transfemoral amputation

hip flexion also external rotation and abduction of hip

positioning for burn patient

discomfort

general goal of positioning limb after stroke

position patient in opposite of position of tone, support for flaccid extremity

contraindicated movements for THA, posterior approach

hip flexion past 90, hip adduction, hip internal rotation

contraindicated movements for THA, anterior approach

hip hyperextension, hip external rotation

general rule for limb edema

position patient's limb in elevation (higher than the heart)

position to make breathing easier for patients with pulmonary issues

HOB elevated

HOB raised upright to 90 degrees

Fowler's position

HOB raised between supine and 90 degrees

semi-Fowler's

reasons for draping

modesty warmth access protects clothing

action to take upon seeing a patient in bed whose skin is red and does not blanch

re-position patient, notify nursing staff and supervising PT; document

patient positioned in supine with towel roll under bilateral knees, pillow under head, and heels elevated with towel rolls to prevent pressure and maximize comfort is an example of which part of a SOAP note?

Objective

device used for proper positioning following a total hip replacement

hip abduction pillow (or abductor wedge) to prevent hip adduction

dependent (FIM 1)

patient is unable to assist in any way with bed mobility

maximal assist (FIM 2)

patient is able to preform 25-49% of the task

Moderate assist (FIM 3)

patient is able to perform 50-74% of the task

Minimal assist (FIM 4)

patient is able to perform 75% or more of activity

Contact Guard assist--No associated FIM-not used for FIM

requires hands-on only assist

Supervision/Stand by Assist (FIM 5)

No assist, no hands-on guarding, but therapist feels that he/she must be close to patient

Modified independent (FIM 6)

patient is able to perform task without assistance, including verbal or tactile cues, but patient requires use of an assistive device or equipment

Independent (FIM 7)

able to perform task with no assistance (no cues, no hands-on, no device/equipment)

Which technique is utilized to assist a patient with low back pain or SCI to get in, out of bed?

log roll

bed mobility includes:

any movement in the bed for repositioning or to prepare to get into or out of bed

FIM

Functional Independence Measure

a measure of disability, or what the patient can actually do, records progress on 18 items

FIM

What to avoid when moving patient with CVA

avoid pulling on involved limbs

ADA doorway or hallway width

minimum: 32inches recommended: 36 inches

ADA door handles

operable with one hand, no greater than 48 inches and no less than 34 inches from floor

ADA ramps

1:12 ratio (~8%); 36 inches wide

ADA Wheelchair turning radius

60 inches

undue burden

any action necessary to provide a reasonable accommodation that would cause an employer significant difficulty or expense

major life activities

communicating, working, walking, standing, lifting, bending, caring for oneself, breathing, learning, seeing, hearing, speaking, reading, thinking, sleeping, concentration, eating, performing manual tasks

disability

Physical or mental impairment that substantially limits a major life activity

qualified individual with a disability

Must have knowledge, skill, mental and physical capabilities to perform essential elements of job

reasonable accommodations

Modifications that will enable persons with disability to perform specific job – Physical accessibility of workplace – Adjusting work schedule – Assistive devices such (teletypewriter, large print manuals)

Americans with Disabilities Act

serves as a law recognizing persons with disabilities as minority groups who deserve equal opportunity

true leg length

ASIS to base of medial malleolus

apparent leg length

umbilicus to base of medial malleolus

landmarks used to measure length of upper extremity

anterior tip of acromion tip of middle finger

landmarks used to measure girth of upper extremity

tip of ulnar styloid olecranon process

landmarks used to measure girth of lower extremity

inferior pole of patella base of lateral malleolus

uses artificial kidney to remove waste and extra fluid from the blood; small amount of blood is taken out and filtered through a machine-then blood is returned to body; takes 4 hours; done 3x/week

hemodialysis

cleanses blood inside body by having plastic catheter surgically inserted into abdomen; abdomen is filled with dailysate; waster and extra fluid is drawn out into the dialysate

peritoneal dialysis

head down position of bed

Trendelenberg

head up/feet down position of bed

reverse Trendelenberg

measures pressure in right side of heart; allows for blood samples to measure blood oxygen flow

pulmonary artery catheter (Swan Ganz)

normal intracranial pressure

5-15 mmHg

abnormal intracranial pressure

anything greater than 20mmHg

HOB elevation for ICP

above 30 degrees

allows medications, blood, nutrients, fluids to be entered directly into blood; allows for extracting blood samples; used often for chemotherapy to prevent repetitive sticks

central venous catheter (CVC)

indwelling right atrial catheter placed in vein under collar bone; used for drawing blood, administering meds, providing nutrition and fluids

Hickman catheter

measures blood pressure continuously; inserted into radial artery

arterial line

DVT prevention

TED stockings intermittent compression medications such as Coumadin

S/S of deep vein thrombosis

erythema edema heat pain

has 2 tips that rest just below nose and blow oxygen up into nasal passageways; for patients requiring little to moderate oxygen concentration and temporary need for O2

nasal cannula

mask that covers nose and mouth; delivers higher concentration of oxygen

oronasal mask

measurement of oxygen delivery

Liters (L)

Usually utilized when long term catheter use is required; is immediately removed

straight catheter

Inserted surgically just above pubic symphysis

suprapubic catheter

Applied externally, only for males

condom catheter

Inserted through the urethra into the bladder, held in place by a small balloon; urine drains into bag

Foley catheter

bed designed for spinal cord injured patients or surgical patients that cannot move on their own; can remain in spinal traction because bed turns patient

Turning frame (Stryker)

has silicone-coated beads in mattress, suspended by heated air; for patients with wounds or at risk of wounds

Air fluidized support bed (Clinitron)

segmented mattress with individually filled air bladders; for patients with pressure injuries or at risk for pressure injuries

Low air loss bed

wider and longer beds; heavy duty-can hold up to 1200 pounds

bariatric bed

ADL Exam 2 Review Flashcards

(93 cards)