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DPT PCM I > Exam 2 > Flashcards

Exam 2 Flashcards

(105 cards)

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1
Q

what does the term seating refer to?

A

the ability to be positioned in sitting against gravity with balance and optimal postural alignment

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2
Q

what does good seating correct and/or accommodate?

A

postural deviation that could lead to:
structural deformity
prevent skin breakdown
assists in spasticity management
allow users to participate in ADLs, functional tasks and recreation

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3
Q

what are the 6 types of wheelchairs?

A

manual wheelchairs
recliner wheelchairs
tilt-n-space wheelchairs
pediatric wheelchairs
powered wheelchairs
sports and recreation wheelchairs

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4
Q

who specifically uses a lightweight and ultra lightweight manual wheelchair?

A

those who cannot push a standard chair functionally or need different seat sizing

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5
Q

what are the components to a wheelchair? (5)

A

seat frame
seat-to-back angle
armrests
leg rests and footrests
wheels and wheel locks

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6
Q

what are the wheelchair accessories? (9)

A

lapboard
positioning belt
anti-tip devices
hill holder
hand rim projections
brake lever extender
controls
cushions
positioning

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7
Q

what is the optimal seat height for a wheelchair?

A

2” clearance of footrest from the floor to allow for footrest clearance over thresholds and thigh resting on cushion

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8
Q

what is the optimal seat depth for a wheelchair?

A

full thigh support to reduce pressure on buttocks and support lower extremities

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9
Q

what is the optimal seat width for a wheelchair?

A

space to accommodate width of hips without causing pressure to skin

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10
Q

what is the optimal back height for a wheelchair?

A

below inferior angle of scapula to not interfere with UE propulsion

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11
Q

what is the optimal armrest height for a wheelchair?

A

appropriate support of the UE

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12
Q

what is the proper breakdown for a folding frame wheelchair?

A

remove any cushions/supports, leg rests & armrests
pull up on seat upholstery to fold in the middle
lift the wheelchair by the frame to transport

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13
Q

what are 4 client and caregiver trainings for wheelchairs?

A

proper sitting posture
pressure relief
wheelchair propulsion
transfer training

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14
Q

what are safety considerations for wheelchairs? (5)

A

brakes and transfers
arm and leg rest
curbs and inclines
wheelchair maintenance
transfers <> wheelchair

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15
Q

what are transfers?

A

movement of a patient from one position or surface to another

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16
Q

what are 3 considerations to account for before transferring based off the patient’s experience ?

A

have they done this before?
if they have, how much help did they need?
does the pt regularly use any type of device or orthotics?

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17
Q

what are 7 considerations to account for before transferring based off the patient’s ability ?

A

strength
joint mobility
balance
pain level
cognition
endurance
motor control

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18
Q

although patient independence is the goal of transfers, what is the primary responsibility during transfers as a caregiver?

A

provide assist to protect the patient to avoid injury

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19
Q

what are 4 considerations you need to think about when planning a transfer?

A

purpose of transfer
equipment needed
departure and arrival points –> safe?
assistance needed?

  • have a plan A, B, C
  • A: realistic plan, B: better than expected plan, C: plan completely falls apart
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20
Q

what is the purpose of a gait belt?

A

improves safety of both the patient and caregiver

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21
Q

generally, where should you position a gait belt?

A

most often at the waist
can be higher –> patient comfort and facility dependent

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22
Q

what kind of grip do you have when using a gaitbelt? what muscles are you using?

A

strong underhand grip - using extrinsic muscles of wrist and hand

  • do not use over-hand grip - relies more on intrinsic hand muscles
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23
Q

what are special circumstances where you would place the gait belt in a spot other than at the waist?

A

colostomy/ileostomy
supra-pubic catheters
feeding tubes
chest, abdominal or spine surgeries
chest tube placement
nephrostomy placement
rib fractures
trauma
fragile skin
age related anatomical changes
patient preference

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24
Q

what are 4 benefits of good body mechanics?

A

uses less energy
reduces strain on body tissues
produces safe, efficient movement
promotes control and balance

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25
what are some out of bed transfers?
sit to stand stand pivot seated transfers --> squat pivot & slideboard
26
what are situational transfers?
bed to WC WC to toilet WC to car Bed to bed/stretcher
27
what are some considerations you need to be thinking about when doing a transfer?
patient starting position wheelchair/target surface position patient ending position -- stable, safe, comfortable, environmental access
28
what does a patient need to be able to do to perform a sit to stand transfer?
prepping the position weight shift rise (pt pushes down through feet & hands maintaining forward trunk flexion. pt bears weight through BLE to unweight rear end) stand
29
what is a stand pivot transfer?
stand with/without assistive device and pivot to target
30
what is a squat pivot transfer?
modified stand/half squat with physical assist from caregiver and pivot to target patient & PT have opposite head and hip relationship --> like a seesaw
31
what are the rules to a squat pivot transfer?
pt can bear weight safely through at least one LE pt does not come to full stand however can lift and clear bottom from surface --> quick lift over short distance no devices are used for squat pivot make sure you remove the arm rest of WC often more than one person assisting
32
what are rules for a seated "popover" transfer?
pt is unable to stand due to weakness pt can lift and clear bottom from surface with or without caregiver assist pt must possess significant UE strength and trunk control
33
what are tips for the caregiver in regards to transfers? - observe? - problem solve? - encourage? - prepare?
observe the transfer and practice providing assistance problem solve to determine the most effective way to use the patient/family members' abilities encourage gradual independence and decreased assistance prepare home environment to match the level of the ability of the patient/family member prior to discharge
34
GG level 06:
independent no assistance is required to complete tasks in normal time
35
GG level 05:
setup/cleanup modified independent pt may require verbal cues, uses assistive device, or requires additional time to complete task
36
GG level 04:
supervision/touching assistance supervision, stand by assist, contact guard assist verbal or tactile cues, directions, instructions positioned close to but not touching pt. therapist has hands on pt and/or gait belt to provide safety as needed
37
GG level 03:
partial/moderate assistance min assist: pt performs > 75% of activity mod assist: pt performs 50-74% of activity
38
GG level 02:
substantial/max assist patient performs 25-49% of activity
39
GG level 01:
dependent pt requires total physical assistance one or more persons to accomplish the task safely
40
what are 3 types of supine transfers?
rolling supine to supine drawsheet dependent
41
what are 3 things you should do to ensure a successful transfer?
set up the environment before the transfer determine the transfer style and level of assist based off patients condition and mobility/balance ensure safety -- gaitbelt, knee & foot placement
42
what are special populations you could encounter that may need special considerations?
spinal, hip, sternal precautions hemiplegia paraplegia bariatric cognitive impairment WB status
43
true or false. someone with a spinal cord injury will have spinal precautions
false - not necessarily
44
what are spinal precautions?
BLT: no bending past 90 no lifting > 8-10 lbs no twisting--> log roll instead
45
what movements may be affected by spinal precautions?
bed mobility hip transfers sit to stand
46
what are special equipment used with spinal precautions?
TLSO or LSO
47
what are posterior hip precautions?
hip should not: flex past 90 add past midline IR past neutral
48
what are anterior hip precautions?
hip should not: extend past non-surgical LE ADD past midline ER past neutral
49
what movements may hip precautions affect?
bed mobility sit to stand transfers
50
what special equipment may be involved with hip precautions?
hip abduction pillow elevated toilet seat
51
considerations when transferring a pt with hip precautions:
- unaffected limb should be closest to target to allow for pivot and transfer to stronger side - stand with physical assist from caregiver w/ assistive device and step or pivot to target - the patient should be able to provide 25-75% physical effort during transfer
52
what kind of surgeries have sternal precautions?
cardiac
53
what are sternal precautions?
do not use UE to push or pull during transfer no arm motions that could open up or stretch front of chest
54
what are special equipment used for pts with sternal precautions?
cardiac pillow elevated toilet seat
55
what kind of injuries would have hemiplegia?
CVA, TBI, neurodegenerative
56
what are hemiplegia precautions?
hemi-side weakness possible inattention (unaware that side exists) possible hemi-side sensation loss
57
what movements might hemiplegia affect?
bed mobility transfers
58
what special equipment may be used with hemiplegia pts?
assistive device considerations ankle foot orthotics (AFO) UE sling --> only use for safety when transferring. don't leave on.
59
How should you transfer a hemiplegia patient?
- unaffected side should be closest to target - may practice affected side first if using for therapy intervention - affected LE should be blocked to prevent knee buckling in standing - stand with physical assist from caregiver with/w/o AD and step or pivot to target --> first, weight shift to affected limb w/ knee blocked to test stability and WB tolerance - allow patient to step toward target w/ unaffected limb while stabilizing affected side --> use your foot to push theirs along
60
what kind of injury would a paraplegia pt have?
SCI - traumatic and non-traumatic
61
what are paraplegia precautions?
lower body weakness, flaccidity usually accompanied by sensation loss
62
what special equipment may you use with a paraplegic pt?
transfer board/slideboard custom WC
63
How do you conduct a slide board transfer?
- assist pt to EOB - position yourself in front of pt, blocking knees - position slide board under patient's R or L hip. ensure stable placement before transferring - instruct pt to put one hand on slide board, the other can assist w/ pushing off from bed - hold onto gait belt, rock pt forward 3x to lift bottom from bed. Pt can help push up from bed as able. move approx. halfway across board. assist with guiding pt's legs as needed - repeat until pt is seated on intended transfer surface. remove board. assist pt to scoot back as needed
64
why should you make sure you lift the pt across the slideboard instead of sliding?
potential skin shearing
65
what are 2 things to make sure of to have a successful slideboard transfer?
double check position of WC and armrest before transferring reset pt's feet each time you move across board
66
what qualifies pt as bariatric?
BMI > 30
67
what are bariatric precautions?
generalized weakness learned helplessness - may not help move
68
what are special equipment that could be used with bariatric pts?
mechanical lift transfer board custom WC barton convertible bed
69
what are examples of cognitive/comprehensive deficits?
dementia, neurologic injury, hard of hearing
70
what are precautions for cognitively impaired pts?
pt/therapist safety compliance one step commands
71
what are special equipment that may be used with cognitively impaired pts?
restraints limit new, unfamiliar equipment
72
what would consider a pt NWB status?
traumatic injuries stay off limb to allow for healing
73
what would consider a pt PWB status?
must have adequate sensation and proprioceptive awareness in LEs usually a percentage
74
what would consider a pt TTWB status? (toe-touch WB)
"touch-down" WB balance only on toes, not distributing weight through limb by pressure in heel
75
what would consider a pt WBAT status? (WB as tolerated)
routine elective ortho surgeries full WB as tolerated by pt
76
what things must you make sure to document after completing a transfer with a patient?
type of transfer amount and type of assistance required amount of time required to complete - extra time or attempts? level of safety and quality of movement demonstrated precautions level of consistency of performance (if performed multiple times) equipment/devices used
77
what equipment is used in a recumbent, dependent lift? (aka lateral or horizontal transfer - supine to supine)
draw sheet plastic transfer board - much larger than slide board slide sheets (reduced friction) transfer stretcher mechanical lifts
78
what is a hovermatt and who is it most often used with?
air mattress that inflates to off-weight pt for lateral slide used in ICU and with bariatric pts
79
what is a sitting, dependent lift?
chair to bed/mat or chair to chair used when pt is unable to assist
80
what equipment is used in a sitting, dependent lift?
multiple individuals (two or more are required if no equipment used) mechanical lift (i.e., hoyer lift) slide board
81
what are the 3 different types of mechanical lifts?
hydraulic lift electrical lift - uses slings stander lifts
82
what is a hydraulic lift?
manually operated lift uses a valve to control increase and release of pressure base can widen or narrow pts supported by sling
83
what does an electrical lift use that a hydraulic lift does not?
rechargeable batteries/AC adapter to power the lift
84
what 3 things help you determine which transfer to use?
patient's ability patient's experience goal of the transfer -- functional independence or just going surface to surface?
85
if patient presents with notable weakness, which side are you most often transferring the pt to?
stronger side
86
what are you blocking when transferring a pt?
block involved and/or weaker side block one or both LEs -- stops forward progression of tibia -- can prevent legs from abducting blocking can help stabilize block tibia to tibia (not knee to knee) PT can use foot to assist pt's foot
87
what are some guidelines for treating in the ICU?
observe equipment/monitoring devices --> type and location observe & maintain tubes & lines evaluate pt's physical & mental state observe pt & monitor devices frequently, determine response to treatment & identify significant changes notify nursing of significant changes & document
88
what are the following lines for? - IV line - arterial line - PICC line - central venous catheter - hickman infusion site
- fluids, meds - blood draws, BP - nutrition - looking at heart function - fluid balance
89
what does mechanical ventilation do?
sends controlled flow of O2 into patient's lungs - rate, pattern, duration of gas exchange - volume control or pressure control
90
what are the 3 types of mechanical ventilation?
assist-control synchronized intermittent mandatory ventilation pressure support ventilation
91
what are examples of noninvasive mechanical ventilation?
NC, face mask, CPAP
92
what are examples of invasive mechanical ventilation?
endotracheal tube, nasotracheal, or tracheostomy
93
when is supplemental oxygen needed?
when concentrations of inspired oxygen are insufficient for respiration and patients are at risk for hypoxia and hypoxemia
94
what are modes of delivery for supplemental oxygen? (6)
nasal cannula face mask nonrebreather tracheostomy - can be mobile w/ this CPAP BiPAP
95
what are some precautions and considerations when working with someone on a mechanical vent?
mental status - pulls at lines location of vent length of lines explain to pt what is going on levels of O2, meds, etc.
96
what are ostomy devices and what are the 3 types?
opening in abdomen to allow elimination colostomy, ileostomy, urostomy
97
what are chest drainage systems used for?
use to remove air, blood, or other undesirable matter from the patient's chest or pleural cavity
98
where are chest drainage tubes placed to remove air?
anterior or lateral chest wall
99
where are chest drainage tubes placed to remove fluids and blood?
posterior and inferior chest wall
100
what are urinary catheters used for?
to alleviate urinary retention rebuild bladder muscle tone collect urine output and cultures manage bladder conditions
101
what are the two types of catheters for males?
indwelling (foley): catheter through the urethra condom catheter\
102
what are 3 feeding devices?
nasogastric tube (NG tube) gastrostomy tube (G tube) total parenteral nutrition (TPN)
103
where is an intracranial pressure monitor placed? normal ICP?
screwed into skull between arachnoid membrane and cerebral cortex to measure ICP normal: 5-10-15 mm Hg
104
what does an external ventricular drain relieve? what must you make sure to do with this before therapy session?
ICP, hydrocephalus or CSF after a hemorrhage always clamp before mobility
105
where is a swan-ganz catheter placed?
into pulmonary artery for cardiac function monitoring - pulmonary artery pressure, R atrium pressure, pulmonary wedge pressure, etc

DPT PCM I (1 decks)

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