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Foundations (final)

Goals of proper positioning (4) 1. make pt comfortable, 2. prevent pressure sores, 3. provide pt w/ access to environment, 4. position for treatment
3 general procedures for positioning + draping 1. body mechanics, 2. Lift (do not drag), 3. expose only area necessary
Procedures for relieving pressure (primary objective) disperse pressure over greatest area
Procedures for relieving pressure (6) 1. no direct contact w/ bony prominences, 2. eliminate sheet wrinkles, 3. minimize time w/ head elevated, 4. utilize linen/trapeze for transfers, 5. avoid position w/o support, 6. use "pressure dispersing medium" (pillow)
Bridging the gap support proximal and distal to sensitive area (like a bridge)
Effects of bedrest (7) 1. atrophy, 2. fatigue, 3. reduced cardiac funct., 4. loss of bone, 5. deep vein thrombosis (DVT), 6. orthostatic hypotension, 7. pressure ulcers
95% of pressure ulcers develop on... (5) 1. sacral/coccygeal, 2. greater troch., 3. ischial tuberosity, 4. heel, 5. lateral malleolus
Pressure ulcer prevention (6) 1. freq. repositioning, 2. relieve pressure on bony prominences, 3. physical activity, 4. monitor skin, 5. decrease moisture, 6. nutrition
Minimum time between checking patient positioned in supine/prone 2hrs
Documentation for pressure ulcers vital signs, stage + location of ulcer, positioning
ROM range of motion (full motion possible at the joint)
Passive Range of Motion (PROM) produced by external force ("relax I'm going to move you")
Active Range of Motion (AROM) produced by active contraction of muscles ("do this")
Active Assisted Range of Motion (AAROM) helped by external force ("So the parts you can. I will help you with the rest")
Reliability repeatability of measures
Validity degree to which your measure represents what you intend to measure
Improving reliability with a goniometer use a consistent position, landmark, device, and therapist
What type of ROM would you measure if the muscle is tight? PROM
What type of ROM would you measure if the muscle is weak? AROM
What type of ROM would you measure if the capsule is tight? PROM (for tightness)
What type of ROM would you measure if the patient has nerve damage? AROM
Active Insufficiency deficit of muscle shortening
Passive Insufficiency deficit of muscle lengthening
Contraindication for ROM intervention disrupt healing, life threatening condition
5 elements of pt management examination, eval, diagnosis, prognosis, intervention
end feel: boney abrupt end with no give
end feel: capsular/ligamentous bending plastic ruler
end feel: muscular stretching a large rubber band
end feel: springy bouncy end feel
end feel: empty unable to reach end feel (due to pain, etc)
During ROM measure, stabilize ____ the proximal segment
Steps of ROM measure 1. POSITION pt, 2. STABILIZE, 3. assess END FEEL, 4. PALPATE boney landmark, 5. ALIGN goni, 6. record START POSITION, 7. record END POSITION
Created by: cbaweiss