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1 Patient Management > Lecture 5 > Flashcards

Lecture 5 Flashcards

1
Q

PTs must document

A

what you did with a pt
how much assistance you provided

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2
Q

Level of assistance provided

A

Based on the amount of the activity that the patient is able to do on their own

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3
Q

I

A

Independent, 100% of activity done by pt
safely, without verbal or physical assistance, does in acceptable amount of ime

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4
Q

S

A

supervision, 100% of activity without physical assistance
require the physical presence of another person. Verbal cues, safety, provide confidence

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5
Q

Close S

A

close supervision, within personal space

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6
Q

Distant S

A

Distant supervision, in patient room

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7
Q

SBA

A

standby assist

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8
Q

Close SBA

A

close standby assist

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9
Q

CGA

A

contact guard assist
patient is able to do 100% of the activity, but requires a person to be in physical contact. Gait belt would be an example

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10
Q

MIN A

A

Minimal Assist
Patient performs 75-99% of task/activity

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11
Q

MOD A

A

Moderate Assist
patient performs 50-74% of task/activity

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12
Q

MAX A

A

Maximal Assist
patient performs 25%-49% of task/activity

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13
Q

D

A

Dependent
Patient performs <25% of task/activity

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14
Q

Communication as a PT

A

Provide info at a level they can understand
avoid medical terms
be concise
Non-verbal cues
Listen!
Tactile cues and demonstration

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15
Q

Patient education

A

There should be an change occurring in what the pt knows, how the pt performs, the pt’s beliefs/attitudes
Just telling them what to do won’t necessarily get you the desired outcome

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16
Q

Health literacy

A

degree to which individuals have the capacity to obtain, process, and understand basic health info and services needed to make appropriate health decisions

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17
Q

Functional Mobility

A

general phrase for the movement used during daily life

includes bed mobility, transfers, gait, wheelchair mobility, stairs, dynamic balance

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18
Q

Stability

A

how well someone is able to stay put

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19
Q

Mobility

A

how well someone moves out of a position

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20
Q

AMAP

A

as much as possible

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21
Q

ANAP

A

as normal as possible

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22
Q

CC

A

control centrally, assisting physically

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23
Q

DD

A

direct distally, using verbal cues

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24
Q

How functional mobility progresses

A

Stability to mobility
maintain to attain
static to dynamic
Large BOS to narrow BOS
low COG to high COG

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25
Part-task training
breaking down task into parts repetition of specific part (promotes kinesthetic learning) always finish with whole-task practice (makes it meaningful)
26
Bed mobility specific skills
Rolling Scooting Hook-lying Bridging Sitting up Lying down
27
Objectives of bed mobility
to engage patient in early form of mobility safe-energy efficient movement teach and increase level of independence
28
Assess bed mobility
pt ability to participate/follow directions any contraindications any environmental constraints
29
Principles of bed mobility
Communication Consent Explain Encourage pt to assist
30
Key points of control
Placing hands where majority of person's body mass lies Scapula and pelvis Possible head don't pull on limbs
31
Objectives of short-term positioning
allow access to area being treated while maintaining safety, modesty, comfort
32
Objectives of long-term positioning
Prevents contractures and skin breakdown individuals with decreased sensation, mobility, soft tissue protection over bone, circulation ability to express discomfort. Also muscle paralysis, shear forces & incontinence, poor nutrition
33
Shear Force
skin remains stationary as the body moves or shifts due to gravity. the bone creates torsion on tissue occurs commonly w/HOB elevated above 45°
34
Role of PTs in long-term positioning
consultation education implementation
35
Principles of positioning
support alignment weight distribution Time frame Skin Body mechanics
36
Support
Trunk, head, and extremeities need to be supported and stabilized
37
Alignment
trunk, head, extremities need to be in proper alignment close to neutral spine as possible
38
Weight distribution
evenly distrbuted as possible
39
Time frame of positioning
Healthy person should be in a bed position is 2 hours Sitting = 15 min Turning schedule for those that can't turn on their own
40
Goals of turning schedule
allows blood flow to return to areas of previous pressure allow for drainage of different areas of the lungs via gravity to ensure better ventilation/perfusion ratio
41
Outside normal alignment
should not be maintained in positioning for more than 30 minutes Think about a particular joint, what is it at resting position? What is it at non-resting position?
42
Skin Inspection
before and after positioning know baseline and make sure you do not position the person on an area that already has signs of pressure injury after: make sure there is no pressure injury
43
Body mechanics
monitor your own and that of the person you are teaching to position the patient
44
Known contraindications/precautions positioning
THA--you can't have hip adduction across midline, hip flexion has to be >90, hip IR
45
Considerations when positioning
Skin integrity Contractures Sensation Pulmonary/cardiac status Circulation Medical equipment attached to pt pt level of awareness
46
Contracture
permanent shortening of muscles, tendons, or other tissues, leading to deformity of joints muscle and fascia tighten, joint capsule tightens Named for position that muscle is stuck in hip flexion, knee flexion, and ankle plantarflexion common
47
Orthopnea
can't breathe lying down
48
Prone
belly
49
Supine
back
50
Sidelying
on side, named for side that is down
51
3/4 prone or 1/4 turn from prone
75% prone, but pillows keep you supine 3/4 on your stomach
52
3/4 supine, or 1/4 turn from supine
75% supine, but pillows keep you prone
53
Semi-fowler's
HOB angle = 30° is goal, 15-45° most common patient position in hospital bed
54
Fowler's
HOB angle = 45-60° can cause shear forces on sacrum
55
Trendelenburg
supine, with feet above head
56
Negative consequences of inappropriate positioning
Pressure injuries: pressure ulcer, decubitis, ulcer, bed sore Contractures Dependent Edema
57
Pressure injuries
can occur on any area where there is prolonged pressure and/or shear forces. Frequently occur over boney prominences
58
Progression of pressure injury
Hyperemia Ischemia Necrosis Ulceration
59
Hyperemia
develops in 30 min to 2hr, appears red, blanches out (turns white & comes back red), returns to normal within an hour
60
Ischemia
develops in 2-6 hour, appears as a deep red area, does not blanch, takes several days (after pressure removed) to return to normal decreased blood flow
61
Necrosis
occurs after 6 hours, appears discolored, heard, can take months to heal death of the tissue
62
Ulceration
open wound
63
Dependent Edema
Collection of body fluids in distal extremities due to dependent positioning (distal end is lower than level or heart) fluids pool in gravity dependent areas
64
Devices that help optimize long-term positioning
Multi podus, heel floating, neutral position boots prevent plantarflexion contractures specialized mattresses for pressure injuries
65
Draping for bed mobility/positioning
Communicate effectively Provide privacy allow for minimal exposure of body parts allow for maximal exposure of treatment area
66
Transfers steps
Identify the INTENT of the transfer Assess Determine transfer options for given situation
67
Identify the INTENT of transfer
Moving the patient Teach the patient Teach a caregiver
68
Assess a transfer
Assess the pt ability to physically participate pt ability to follow directions contraindications/precautions environment
69
Determine transfer options for given situation
intent precautions/contraindications patient's ability level your ability level equipment or second person assistance
70
Environmental poisitoning
move area close to you move person close to you move footrests/equipment Lock w/c or equipment assistive devices Medical equipment/lines/tubes
71
Wheelchair positioning
90° to the stationary chair (without wheels)
72
Steps for successful chair transfer, pt positioning
Transfer belt pt scoots forward on chair pt feet are placed under and slightly bent & under knees pt puts hands where they can push up THEY DO NOT GRAB ONTO YOU
73
Transfer belts
increases safety by allowing PT stable site for proximal control (decreases risk of fall by 3.65x) placed around pt's natural waist or lower
74
Considerations for transfer belts
infection control proper placement of belt contraindicated for some use after discharge?
75
Steps for successful chair transfer, pt communication
instruct and gain consent demonstrate encourage pt to assist
76
Patient handling in a transfer
majority of pt mass, pelvis and scapulae transfer belt sheet keep COG within BOS perform test lift
77
Total body lifts
patient is doing none of the transfer task. Dependent transfers not the same as transfer aids which allows and intends for pt to do some of the work
78
Zero lift rules
manual lifting of pts be minimized and/or eliminated when possible helps to reduce the # and severity of injuries among hospital staff
79
Patient handling devices
these devices allow pt to do some of the work transfer boards friction reducing sheets supine transfer board pivot disc transfer/pivot pole handybar

1 Patient Management (8 decks)

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