Wichita Sate PT dougs Final
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| How often must you change a catheter | at least once a month
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| what are drain lines used for | reomove excess fluid from surgery/wound site
(compressed to create (-) pressure)/ w/ eception of some subdural drain w/ neurosurgery
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| with drain how often can blood volue be returned through IV | only once
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| when to use rectal drain | pt with chronic diarrhea that are at risk for skin brakdown
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| how are rectal drain held in place | inflattable cuff is filled with saline
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| what could cause dry mucous membranes and skin irritation | O2 lines
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| uses small perforations in pad combined with air pressure to raise pt off surface, much like air hockey table | Bariatric transfer pads
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| what is key when tx bariatric pt | early mobilization
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| how much strength can you lose in the 1 st wk of being bed bound | 25%
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| when bariatric pts are moving they use _______ to move thier body | momentum
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| with obese pt we must always check skin integrity | including under folds
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| protects the confidentiality of pt medical records as they are conveyed between health care providers and/or insurance providers | Helath insurance portability and Acccountability Act (HIPPA)
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| when are facilities required to provide this information to the pt about HIPPA | upon admission
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| Examination consist of | chart review
interview
test and measures
eval
diagnosis
prognosis
POC
documentation
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| iwhen should chart review occur | prior to interviewing the pt
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| what falls under chart review | demographics
current condition
PMH
general health status
social and family hx
social health habits
prior and present fxn status
midication
if pt is minor parental consent required
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| what falls under interview | pt safe and comfortablemaintain professional eye contact and body language
address pt by formal name (HIPPA requires names & DOB)
open/closed ended questions
summarize what the pt is telling you to clarify
Always conclude by is there anything else
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| Test & measures | ROM
MMT
sensation
fxn mobility (bed mobility, gait, transfers, balance)
safety
cognition
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| evaluation | analysis of everything observed or heard
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| diagnosis | fxn diagnosis(gait abnormalities gait dysfxn LE weakness impaired ROM, jt contracture, jt effusion or swellin)
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| Prognosis | what fxn or specific progess we expect to make based on the above info
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| Plan of care | include: frequency (#of visits)
duration(length of time you seept)
goal setting (always involve pt)
interventions planned (exercise, ROM, jt mobs, modalities, gait, transfer training, pt family staff education)
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| Documentation | SOAP noted
forms
computerized
only state facts, DO NOt include personal judgement
keppt notes concise
use only approved abbreviations
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| vital signs | used to monitor pt before, during and after tx
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| changes in vital signs indicate | physiolocal reponse to tx
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| vital signs consist of | HR BP respiration and temp
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| pulse | measure BPM
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| normal range for heart rate | adult 60-100 if in shape can be 40-60 moderate sedentary 60-85
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| a resting heart rate over 85 bpm is an indication of | deconditioning or medical condition
although infants and young children have a faster heart rate 80-100
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| Bradycardia | resting heart rate less than 60
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| tachycardia | resting heart rate greater than 100
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| max heart rate | highest one should achieve during exercise upon max exertion with respect to age and medical condition subtract one age from 220
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| target heart rate | heart rate one should achieve during exercise for cardio conditioning with respect to age and medical condtion
contraindication it should fall between 60 and 80 percent of max heart rate
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| basal heart rate | resting heart
indicator of cardiovascular fxn in the abscence of physical activity
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| heart rate measured during activity | indication of cardovascular system capacity to provide blood flow during physiological or physical stress
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| heart rate measure after activity | indication of the CV system ability to recover
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| what can be used to determine patency | heart rate
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| patency | openness of the peripheral portion of the CV bydeterming the presence or absensce of a pulse at a chosen site
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| absense of a pulse without underlying diagnosis this is a | red flag: report no tx should be given till looked at evaluated adn cleared
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| trophic changes | physiologic sequealae to decreased circulation such as loss of hair dry skin or muscle atrophy
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| makes assessing patency difficult | edema
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| loss of skin color resulting from decreased circulation | blanching
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| the worse the circulation the more | pronunce and rapid blanching becomes
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| to reproduce blanching | raise the extremity above the level of the heart or apply pressure to the skin occlude circulaiton in that area
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| regularity | refers to the eveness of the heart rate
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| 0 | absent
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| 1+ | thready weak
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| 2= | normal
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| 3= | strong
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| 4= | full bounding
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| methods of measuring heart rate | auscultation
doppler
pulse
oximeter
manual palpaation
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| doppler | measure frequency changes during blood flow to examine patency (check for DVT
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| ausculation | stethoscope
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| pulse oximeter | does pulse and o2 and is digital
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| manual | pads of fingers
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| most common site to palpate pule | radial a
carotid artery
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| common site to palpate patency | brachial a
femoral a
popliteal a
pos tib a
dorsal pedis a
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| measure of cascular resistance to blood flow and the effectiveness of cardiac mm in pumping blood to overcome reistance | blood pressure
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| measures pressure exerted when heart is contracting | systolic pressure
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| measures pressure exerted when heart is relaxed | diastolic
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| blood pressure sounds to recorded are called | korotkoof sounds
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| normal blood pressure values | 120mmHg/80mmHg
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| what arm is bp usually take in | left
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| to determine if a person has orthostatic hypotension you would | take bp in supine sitting then standing
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| red flags | a faulure of systolic pressure to rise in proportion with increased activity
a decrease in systolic pressure > 10mmHG w/ activity
a systolic pressue > 240
increase of diastolic pressure > 29 during activity
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| respiration cycle | one inhalation and one exhalation
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| resting respiration rate | 12 breathes per minute for adults 20 for children (anything below 10 or above 20 is considered abnormal)
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| following exercise the rate of respiration can increase to | 40-45 breathes per minute and gradually go down
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| body temp | provides info concerning bmr, potential presence of infection and metabolic response to exercise
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| skin temp provides information concerning | circulatory status potential peripheral neve injury and local inflammation responses
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| normal temp | 98.6 degrees F 37 degress C
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| Afebrile | those with temp below 100 degress F
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| febrile | temp exceeds 100 F
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| hypothermia | rectal temp below 94 degress F
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| hyperthermia | rectal temp greater than 106 degrees F
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| pain | subjective desciption descibed by pt
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| pain is rated on a visual analog scale | (0-10)0 being no pain 5 tolerable 10 take me to the emergency room
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| body machanics | the application of kinesiology to the use of the body in activites and to the prevention and correction of problems related to posture
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| correct lifting | maintina spine as erect as possible
flex your knees into a squat close to the pt
grasp gait belt firmly
bring pt in COG close to your body into your COG
lift with you leg not your back
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| general principles of lifting | avoid twisting
turn with short steps, turn with your whole body as a unit use leverage whenever possible
avoid reaching provide the minimal amount of resistance to allo pt to gain independent transfer
get help with transfer
don't hold on neck
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| stability | maintain COG and base of support
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| cneter of gravity | low center of gravity is more stable
pt with LE atrophy have higher COG
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| Base of support | wider BOS is more stable
feet in stride position in the direction of the desired movement
can plave ft at 90 degree agle to increase BOS
applies to all mobility not just trasfers
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| mobility | momentum can be you friend and enemy
always instruct pt clearly to improve desired outcome
pvot vs twisting
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| efficiency | use the shortest lever arm possible with lifting
use the longest lever arm possible when resisting
pulling is easier than pushing
never lift when you can pull
ensure you and pt are brething ( use abdominal bracing not diaphragm)
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| two person tranfer | stongest and or most skilled should control COG unless training
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| never use a pt arms to lift | gh is one of the least stable jt lifting can stretch the capsule, impinge or tear the RC, or sublux or dislocate the jt
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| during a tranfer do NOT allow | pt to reach around neck or grab it they will over power your COG
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| expect pt to fall or lose their balnce during a transfer | being prepared you have control over the movement
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| what are the exceptions for not using a gait belt during | draw sheet
bed to bed trasfer
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| Bed postioning |
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