Discharge Planning/WC Intro Part 1 Flashcards
(35 cards)
When does discharge planning start?
As soon as you perform the initial chart review, no matter what the setting!
Home Evaluation Procedure Options
W/ pt and family present to see them move within their environment
Take empty WC to home with family present
FT/Zoom with family and have them take measurements upon request
Give pt/family a worksheet to draw floorplan
What should you have the pt consider when renovating their home to make it more accessible?
Do they rent or own?
Checking w/ landlord to see their options (e.g., appropriate procedure to prevent loss of deposit, landlord preferring their own installers)
What are features of the home related to pt safety?
Being able to exit safely through at least 1 entrance (hopefully 2)
Steps (handrails - on which side?)
Smoke alarms
Peephole (usage in pt’s with the inability to stand)
Scald control at the sink (to prevent burns in pts with sensory impairments)
What are some things to consider related to the parking situation at a pt’s home?
Where?
Room to open door/transfer pt
Temp regulation problem (pt) if parking outside
Complex transfers in the rain/possibly unsafe neighborhoods
What are some things to consider related to a pt’s general mobility around their home?
Opening doors
Accessing items in the cabinets/at the stove top
Accessing light switches/telephones
Being able to call for help (Life Line services, smart watches with fall detection alerts)
What are some options to widen the doorway to the patient’s bathroom?
Remove innermost molding
Removing door and replacing with tension rod/shower curtain
Flush mount hinges - help door stick out less
Simply widening the doorway itself (less expensive if not requiring the movement of light switches)
What should you consider when advising a pt on installing a WC ramp?
1 foot at length for each inch of height
Include height of threshold at the door in your measurements
Inclusion of a landing (for pt and/or caregiver to rest)
For sure having a landing at the door (to allow pt to unlock their door w/o rolling backwards)
“Grade Aid” WC Attachment
Particularly beneficial for pts with tetraplegia
Allows pt to push up but “catches” to prevent WC from wheeling backwards as pt repositions their hands
A pt who propels the WC with their feet (e.g., post-stroke) may prefer to do what when navigating a ramp?
Go up backwards
Allows person to push up with quads rather than pull with HS
What is required of ALL WC prescriptions?
Recent face-to-face visit with MD/DO
Diagnosis
Reasons why WC is necessary to perform mobility-related ADL
What questions determine the K (Complexity) Level of WC that the patient will qualify for?
Does patient require WC to perform “mobility related ADL” in the home? (Ideal answer YES)
How long will person sit in WC/day? (~4 hours)
Can pt walk/how far? Have other devices been tried/ruled out?
Can they push a standard manual WC? (50 lbs, least expensive) - lightweight WC (~35 lbs)?: If no, scooter? motorized WC (most expensive)?
What type of pt would likely benefit from using a scooter?
Someone who can walk short distances, but needs power for community distances/doing housework
NOT ideal for pts that are full-time motorized device users
Scooter vs. Motorized WC
Scooter has narrower and longer wheelbase (less stable side to side)
More trunk/upper body control needed for scooter
Scooter may not have armrests/seatbelt, has fewer seating options, and is less expensive
Large pole holding seat = scooter
You can NOT drive an adaptive vehicle from a scooter, only a motorized WC
Power Assist Device
Can be added to manual WCs for loading/unloading into vehicle and then removed
Traditional motorized WCs require lift/ramp into vehicle
Automatic Hi-Lo Seats
Changes height of seat to ease sit to stand/transfers onto variable heights
Tilt vs. Reclining WCs
Tilt-in-Space and Reclining can both be on either a manual or power WC
Tilt in Space will not fold/harder to load + hip angle is fixed
Reclining can fold but is still heavy to load + hip angle changes with recline (possible skin &/or tone issues)
What does a WC with a rear axle and larger wheel base allow for?
Chair more stable from a back standpoint
Pts that throw themselves backward will then not flip the chair, great for amputees/pts imbalanced in terms of weight
A WC axle in a more anterior position allows for what?
More mobility/curb jumping
What does it mean for a WC wheel to have 0 Camber?
Wheels straight up and down
A large Camber (degree/angle) is preferred for sports
Projection Hand Rims
Great for tetraplegia pts
Provides lever for them to push chair forward
What is something to keep in mind about a Desk Length Armrest?
It may not have enough support for attachments
When measuring a pt for a WC, what should be taken into consideration?
Ensure that the measurements are taken with the pt in a seated position
Prosthetics / orthotics are taken into consideration
Seat Width / Seat Depth WC Measurements
Width: Less than 1 1/4” wider than person’s hips / thighs (at widest point)
Depth: 1-2” less than posterior buttocks to popliteal fossa
