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Patient Care

Describe the appropriate position for body in supine pillow under head, not shoulders. small pillow/towel roll-under popl.space 2 relieve Lumb. Lord/promote comfort. under ankles2relieve pressure off calcaneus. (AVOID hyperext.of knee), 2 prevent ER. UEs based on comfort-@ side/chest.UE/LE on table.cover!
Describe position for prone towel-under head 4 O2!or posit head to L or R. or forehead of folded towel or cutout 4 face. pillow under chest (females) pillow under ASIS, towel roll under ankles (pillow may be2 much). UEs based on comfort. towel under distal thigh4 patella)drape!
describe posit for side LEs flexed, upper slightly fwd, pillow inbtwn, towel roll under lower lat. malleolus. 1-2 pillows 4 head. folded pill. 4 chest (hold UE). pil behind post trunk2 prevent roll. towel/pil proximal 2 greater troc. cover!
what two things do you ALWAYS always do? smooth sheets and drape!
describe sitting position pillow for back and under bottom. LEs on footrests of w/c or floor. (if leaning fwd- pillow for ant trunk). UEs on armrest/pillow. drape!
common soft tissue contracture sites for SUPINE hip + knee flexors, hip ERs, shoulder extensors/adductors, IRs.
common soft tissue contracture sites for PRONE ankle PFs, shoulder EXT, ADD, IR/ERs, neck rotators.
common soft tissue contracture sites for SIDE LYING hip + knee FLEXors, hip ADD + IRs, shoulder ADD +IRs.
common soft tissue contracture sites for SITTING hip+ knee FLEXors, hip ADD +IRs, shoulder ADD + IR + EXTs.
use additional caution when positioning pts who are.... mentally incompetenet/confused, comatose, very young/old, paralyzed or lacking normal circulation/sensation.
avoid prolonged _____ of ankles for an extended period of time PF
anti gravity vs gravity eliminated anti-gravity: go against gravity (normal workout), gravity eliminated (make it easier- generally in position of sidelying or prone).
key rationale for proper positioning 1-RELIEF OF PRESSURE (bony promiences,soft tissue) 2-prevents CONTRACTURE, provides comfort. acess/exposure to treatment area, promotes efficient function of body systems, stability for trunk + extremities.
list the bony promiences that may cause injury when lying SUPINE occip. protuberance, spine+inf angle scap, spinous proceses, Post. Illiac Crest, Sacrum, great troc, head of fib, calcaneous, lat malleo w/ER, olecranon + medial epicondyle.
list the bony promiences that may cause injury when lying PRONE forhead, lat ear, tip acromion, strenum, ant head humerus, clavicle, ASIS, patella, ridge tibia, dorsum foot,
list the bony promiences that may cause injury when lying SIDELYING head- lat head, lat ear, LE- greater troc, lateral condyles, malleous, fith MT. UE- lat acrom process, lat head hum, lat epicondlye hum, lat ribs.
list the bony promiences that may cause injury when lying SITTING back head, spine/inf scap, spinous processes, LEs-ischial tub, sacrum (if slouched), greater troc, poplit. fossa, post calcaneus. UE- med epicondlye + olecranon of humerus.
Preventative Postioning- avoid during transfemoral amputation avoid RL Hip Flex + AB, Knee FLex. Make sure hips/pelvis in alignment. limit sitting to 40 mins. Lying in prone is periodically recommended.
Preventative Postioning- avoid during transtibial Amp. avoid RL knee flex, hip flex ER. do not sit more than 40 mins. Lying in prone is periodically recommended.
Preventative Postioning- avoid during hemiplegia LE- Hip ER + fLEX, knee FLEX, ankle PF+inv., UE- elbow + wrist + finger Flex, shoulder ADD, IR, supination/pronation, finger ADD.
Preventative Postioning- general notes when positioning pts w/ Rheumatoid Arthritis avoid FLEX and protect bony prominences- elbows and greater troc @ highest risk. gentle active/passive movmt is recommended several x day, unless inflamed. watch out for tendency to go into ULNAR DEVIATION
Preventative Postioning- general notes when positioning pts w/Split thickness Burns + Grafted Burn Areas do the oposite of what's comfortable. extend, ABD, frequent movmts.
Preventative Postioning- general notes when positioning pts w/ Ortho Surgical Conditions TNR- keep in extension, no pillow! neutral posit for hips. THR- avoid ADD, ER, FLEX.
primary reasons 4 draping expose free area to be treated, modesty concerns, body temp maintenance, protect skin from soiling.
what do you include when documenting tests and measures? tests/observations performed by PT!Should be repeatable, valid +reliable. Type 1: types of Tests (Amb, txrs, Balance, ROM, Strength, Sensation). OR Type 2: Body+Functional Skills (Amb, ADL, IADL (indep. activities of daily living), UEs, LEs, trunk)
what do you list first in T+M address functional activities and deficits b4 listing impairments.
long term vs short term positioning short term <30 mins. 30mins>long term<2hrs
Recommend Partial posit changes every? hour
indep pts should change posit every? 15 mins
what are some warnings to look for when inspecting a pts skin (re: positionging) o RED- areas of pressure o Paleness or blanching- severe, dangerous areas of pressure. Circulatory compromise o Numbness/tingling- excessive pressure o Localized edema- excessive pressure
what is the max time for restraints for adults, older kids, younger kids?  4 hrs=adults  2 hrs 9-17  1 hr age<9
what are the 2 types of restraints?  Chemical- drug- reduced anxiety/agitiation  Physical- writs/ankle strags, tight bed sheets, cloth garment (posey/straight, bed rails, seclusion.
what are some common mistakes seen in T+M portion of notes? o Failure to state body part o Measureable info (ex. “pt is weak” no! say “pt is 3/5”) o Failure to state type of T+M being measures/observed o Make sure ENTIRE clinical pic is clear- so someone else could work from ur notes if necessary.
when writing a progress note, what info do you list in the T+M? Don’t need to address every category, only what ur updating/relevant changes/LACK of change. Always address what you wrote in your goals. Need 2measure status of goals here!Consider 3rd party payers- wants2see progress improving functional limitations)
Created by: tpostrel