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Flashcards in Exam 2 Deck (64):
1

postural support of a wheel chair

-back
-seat
-arm rests
-front rigging
-positional devices

2

mobility base of a wheel chair

-frame
-axle
-drive wheels (tires, locks, push rims)
-casters

3

axle forward makes the wheel chair more likely to...

tip backward

4

instance where axle would be farther back:

with an amputee

5

angle of standard back

90 degrees to the seat

6

armrests

-decrease weight on buttocks by 5-9%
-provide support to the upper body

7

bariatric wheel chair

-heavy duty frame
-350-850 lbs

8

effect of bringing the axle forward

makes the chair more agile but more tippy

9

optimal position for fitting measurements

90-90-90

10

seat depth

-beware of sacral sitting
-measure back of hips to popliteal fold
-subtract 2 in. to determine seat depth

11

seat width

measure trochanter to trochanter or the widest part of the body

12

armrest

-measure elbow by side flexed to 90 degrees
-add 1 in.

13

confirming fit

-2 fingers between hip and side of wheelchair
-2 fingers horizontally between popliteal fold and front edge of seat

14

effect of chair too wide

-difficult to propel
-hard to fit through small spaces
-poor postural control

15

effect of chair too narrow

-pressure against hips

16

effect of seat too shallow

-lack of support for thighs so increase risk of ischial pressure sores

17

effect of seat too deep

-pressure against back of knees
-encourages sacral sitting
-increase risk of pressure ulcers on back of legs and sacrum

18

effect of inadequate cushioning

-increased risk of pressure ulcer
-decreased postural control with improper cushioning

19

effect of seat too low

-difficulty rising from chair
-knees elevated

20

effect of seat too high

-difficulty fitting chair under desks or tables

21

effect of back to low

-poor trunk control

22

effect of back too high

-pressures against scapula impede arm movement
-pressure against axilla
-difficulty reaching to push handles

23

chair adjustment that can provide more stability

-having higher front than back

24

advantage of having seat level

-helps them transfer independently

25

long-term positioning checklist

1. clear airway
2. good spinal alignment
3. minimized pressure over bony prominences
4. minimized gravity creating shearing forces
5. cushioned support surfaces to minimize pressure
6. immobile extremities elevated
7. positioned to prevent joint and soft-tissue contractures
8. support and stability provided for trunk and extremities
9. positioned to allow patient maximum long-term functioning
10. positioned to optimize interaction with the environment
11. special needs accomodated

26

common contractures from supine

-shoulder flexion
-elbow flexion
-hip flexion
-hip adduction
-knee flexion
-ankle plantarflexion

27

common contractures from side lying

-shoulder flexion
-shoulder adduction
-scapular protraction
-elbow flexion
-hip flexion
-hip adduction
-knee flexion
-ankle plantarflexion

28

common contractures from sitting

-shoulder flexion
-elbow flexion
-hip flexion
-hip adduction
-knee flexion
-ankle plantarflexion

29

short-term positioning checklist

1. patient is safe
2. good spinal alignment
3. accessibility of necessary areas of the body
4. trunk and extremities supported for comfort
5. positioned to optimize interaction with the environment
6. special needs accommodated

30

pressure point risk areas in supine

-occiput
-scapulae
-spinous processes
-elbows
*sacrum/coccyx
-ishial tuberosities
-lateral malleoli (if hips are ER)
*heels

31

pressure point risk areas in prone

-ear/side of face
-chin
anterior surface of shoulders
-iliac crests and ASIS
-knees/patellae
-dorsal surfaces of feet

32

pressure point risk areas in side lying

-ear/side of face
-humeral head
*hip/greater trochanter
-medial aspects of knees
-medial aspects of ankles

33

pressure point risk areas in sitting

-occiput in a high-back chair
-scapulae
-spinous processes
-elbows (on arm rests)
-sacrum/coccyx
-ischial tuberosities
-heels

34

the longest a healthy person should be allowed to remain in one bed position is:

2 hours

35

time limit for repositioning in long term sitting

15 minutes

36

keys of bed mobility tasks:

-identify your objective (immediate task and larger context)
-explain to the patient what you are doing (ongoing communication
-use safety techniques
-consider environment

37

control the patient's movements by applying forces:

centrally

38

direct the patient's movements using:

distal body segments

39

short term positioning goals:

1. safety
2. comfort
3. access

40

long term positioning goals:

1. safety
2. prevention
3. comfort

41

effect of immobility on the integumentary system:

skin break down

42

effect of immobility on the musculoskeletal system:

-contracture
-calcium loss
-deconditioning
-balance

43

effect of immobility on the cardiopulmonary system:

-peripheral edema
-aerobic deconditioning
-decreased air exchange
-cardiopulmonary compromise

44

effect of immobility on the neurological system:

-vestibular impairment
-neuromuscular deconditioning

45

effects of immobility on other body systems:

-UTI
-depression

46

preventing edema/cardiopulmonary complications

-extremities at or above the heart
-vary demand on heart with upright positioning
-vary positions for lung drainage

47

symptoms of pulmonary embolism

-difficulty breathing
-chest pain
-fainting
-rapid heartbeat

48

control ____, direct ____

centrally,
distally

49

positioning after THA

-avoid hip flexion beyond 60-90 degrees
-avoid hip adduction past 0
-avoid hip internal rotation past 0

50

positioning after a CVA with hemiplegia

-prevent contractures
-prevent wrist and hand edema
-avoid distraction of the hemiplegic shoulder
-avoid shoulder retraction for prolonged periods

51

common contracture development after CVA with hemiplegia

-scapular retraction
-shoulder add, flex, IR
-hip add, flex, IR
-elbow wrist, finger flex
-knee flex
-ankle plantar flexion

52

positioning after a LE amputation DON'T:

-let residual limb hang off the edge of the bed
-place a pillow under the hip or knee while the patient is supine
-allow the patient to lie with the knees flexed
-allow patient to cross legs

53

risk of adduction will be less when L THA patient gets out of bed:

on the right side
-but gets back into bed on the left side

54

with hemiplegia it is easier to roll to _____

the weak side

55

with hemiplegia it is easier to come to a sit from______

the strong side

56

spinal level that is the transitional level between dependence/independence in bed mobility:

C6

57

tilt table:

-provides controlled progression from supine to standing
-requires security straps
-involves weight bearing on at least one LE

58

elevate tilt table in ___ increments:

15 degree
-take vitals at each level

59

take action if patient on a tilt table:

systolic BP falls 20 mmHg or diastolic falls 10 mmHg

60

standard wheel size:

24"

61

best on hand grip:

natural fit rim

62

proper sequence for a transfer:

1. lock wheels
2. remove arm rests; leg rests
3. scoot patient forward
4. position feet (in front for balance)
5. nose over toes

63

pivot transfer

-patient can use lower limbs to some degree

64

lateral transfer

-patient is non weight bearing or without limb control