Patient Care
Help!
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| 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!
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| 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!
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| 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!
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| what two things do you ALWAYS always do? | smooth sheets and drape!
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| 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!
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| common soft tissue contracture sites for SUPINE | hip + knee flexors, hip ERs, shoulder extensors/adductors, IRs.
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| common soft tissue contracture sites for PRONE | ankle PFs, shoulder EXT, ADD, IR/ERs, neck rotators.
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| common soft tissue contracture sites for SIDE LYING | hip + knee FLEXors, hip ADD + IRs, shoulder ADD +IRs.
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| common soft tissue contracture sites for SITTING | hip+ knee FLEXors, hip ADD +IRs, shoulder ADD + IR + EXTs.
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| use additional caution when positioning pts who are.... | mentally incompetenet/confused, comatose, very young/old, paralyzed or lacking normal circulation/sensation.
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| avoid prolonged _____ of ankles for an extended period of time | PF
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| anti gravity vs gravity eliminated | anti-gravity: go against gravity (normal workout), gravity eliminated (make it easier- generally in position of sidelying or prone).
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| 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.
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| 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.
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| 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,
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| 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.
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| 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.
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| 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.
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| 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.
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| 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.
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| 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
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| 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.
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| 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.
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| primary reasons 4 draping | expose free area to be treated, modesty concerns, body temp maintenance, protect skin from soiling.
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| 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)
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| what do you list first in T+M | address functional activities and deficits b4 listing impairments.
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| long term vs short term positioning | short term <30 mins. 30mins>long term<2hrs
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| Recommend Partial posit changes every? | hour
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| indep pts should change posit every? | 15 mins
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| 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
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| what is the max time for restraints for adults, older kids, younger kids? | 4 hrs=adults
2 hrs 9-17
1 hr age<9
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| 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.
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| 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.
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| 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)
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