Acute Care Occupational Therapy Study Guide

Flashcards covering core principles, trauma center levels, telemetry vital norms, medical lines and equipment, critical lab thresholds, surgical movement precautions, weight-bearing statuses, isolation protocols, and reimbursement in acute care occupational therapy.

Acute Care Primary Goals

To medically stabilize the patient and discharge them to a setting that promotes the highest level of functional independence with the least required assistance.

Acute Care Average Length of Stay

Short-term inpatient stay averaging $3\text{ to }5\,\text{days}$, ranging from $1\,\text{day}$ to longer depending on medical stability.

Occupational Therapy Acute Care Productivity Expectations

Productivity expectation ranging from $80\%\text{ to }90\%$ with typical session durations of $15\text{ to }45\,\text{minutes}$ conducted primarily at the patient's bedside.

Level 1 Trauma Center

A facility providing comprehensive tertiary care covering total care from prevention through rehabilitation, featuring specialized equipment, $24\text{-hour}$ in-house general surgeons, teaching programs, and regional referral capabilities.

Level 2 Trauma Center

A hospital able to initiate care for all injured clients, treating complex trauma cases requiring specialized emergency surgical interventions in collaboration with Level 1 facilities.

Level 3 Trauma Center

A facility focused on assessment, stabilization, and emergency operations with prompt availability of general surgeons and anesthesiologists, utilizing formal transfer agreements to Level 1 or 2 centers for complex trauma.

Level 4 Trauma Center

A facility providing Advanced Trauma Life Support prior to transfer to a higher-level trauma center, offering basic evaluation, stabilization, and diagnostic capabilities.

Level 5 Trauma Center

A facility that provides initial evaluation, stabilization, and diagnostic capabilities for basic emergency presentations (such as wound stabilization, urinary tract infections, and falls without injury) prior to transfer.

Baseline Normal Blood Pressure

$120/80\,\text{mmHg}$ systolic over diastolic; measures arterial pressure and requires monitoring for orthostatic drops or hypertensive spikes during transfers.

Baseline Normal Heart Rate

$60\text{ to }100\,\text{beats per minute}$; measures cardiac rate to prevent overexertion, particularly in cardiac populations.

Baseline Normal Oxygen Saturation

Greater than $90\%$, measured via pulse oximeter calculating hemoglobin saturation on red blood cells.

Baseline Normal Respiratory Rate

$12\text{ to }20\,\text{breaths per minute}$; measures pulmonary ventilation efficiency per minute.

Intravenous (IV) Line

A peripheral line used for temporary administration of fluids, medications, or blood transfusions; blood pressure cuffs must not be applied directly over the insertion arm.

Peripherally Inserted Central Catheter (PICC)

A central venous catheter inserted into a peripheral vein that extends into a central vein for long-term intravenous therapy; requires maintaining a dry, intact dressing and avoiding tension during upper extremity range of motion.

Swan-Ganz Catheter

A deep venous line inserted directly into the right atrium and pulmonary artery to monitor cardiac pressures; requires extreme caution with head, neck, and shoulder movements.

Femoral Line

A vascular catheter inserted into the femoral artery or vein for access, medications, dialysis, or Continuous Renal Replacement Therapy; hip hyperflexion on the catheter side must be strictly avoided.

Nasogastric (NG) Tube

A tube inserted through the nose extending directly into the stomach to empty gas or liquids, or to administer medications and nutrition.

Percutaneous Endoscopic Gastrostomy (PEG) Tube

A flexible feeding tube inserted surgically through the abdominal wall directly into the stomach for long-term nutrition, bypassing the mouth and esophagus.

Jejunostomy (J) Tube

A direct surgical opening into the small intestine (jejunum) to deliver food and medicine, requiring protection from compression, twisting, or pulling.

Foley Catheter

An indwelling urinary tract catheter retained in the bladder by an inflated balloon; collection bag must be maintained below knee and bladder level to ensure continuous downward drainage.

Fecal Management System (Rectal Tube)

A balloon catheter inserted into the rectum attached to a collection bag used for chronic diarrhea, weak sphincter control, or skin integrity preservation; must not be dislodged during bed mobility.

Jackson-Pratt (JP) Drain

A closed suction drain utilizing a grenade-shaped suction bulb to collect wound exudate; must be pinned to the client's gown rather than bedsheets during mobility.

Hemovac Drain

A suction compression drain featuring a larger volume capacity than a Jackson-Pratt drain.

Wound Vac

A negative-pressure wound therapy device applied to large, chronic, or non-healing wounds to facilitate closure and drainage.

Chest Tube

A catheter inserted into the pleural space to drain air or fluid; collection canister must remain upright and below chest level at all times.

Patient-Controlled Analgesia (PCA) Pump

A push-button delivery system allowing self-administration of intravenous pain medication within pre-programmed physician parameters.

International Normalized Ratio (INR) Critical Threshold

Normal baseline is $0.9\text{ to }1.1$ and therapeutic target is $2.0\text{ to }3.0$; all therapy must be held if the value exceeds $5.0$ due to high risk of hemorrhage.

Platelet Count Activity Guidelines

Hold exercise if count is below $20{,}000/\mu\text{L}$; passive range of motion only between $20{,}000\text{ and }30{,}000/\mu\text{L}$; active range of motion only between $30{,}000\text{ and }50{,}000/\mu\text{L}$; resistive exercise permitted above $50{,}000/\mu\text{L}$.

Potassium Critical Safety Thresholds

Normal serum range is $3.5\text{ to }5.0\,\text{mEq/L}$; therapy must be held if levels fall below $2.5\,\text{mEq/L}$ or rise above $6.6\,\text{mEq/L}$ due to the risk of lethal cardiac dysrhythmias.

Sodium Critical Safety Thresholds

Normal homeostatic range is $130\text{ to }160\,\text{mEq/L}$; therapy must be held or modified if levels drop below $130\,\text{mEq/L}$ or exceed $160\,\text{mEq/L}$ due to fluid imbalance and neuromuscular risks.

Troponins

Protein markers released into the bloodstream during cardiac muscle damage; values exceeding $0.03\,\text{ng/mL}$ indicate cardiac event risk and myocardial tissue injury.

Anterior Hip Precautions

Surgical precautions restricting hip extension past neutral, external rotation, and leg adduction across the midline.

Posterior Hip Precautions

Surgical precautions restricting hip flexion past $90^\circ$, internal rotation, and leg adduction across the midline.

Spinal Precautions

Movement restrictions designed to protect spinal alignment: no bending at the waist, no lifting objects over $5\text{ to }10\,\text{pounds}$, and no twisting of the trunk (requiring log-rolling).

Sternal Precautions

Movement restrictions following median sternotomy: no pushing, no pulling, and no lifting greater than $5\text{ to }10\,\text{pounds}$, along with using a heart pillow for splinting.

Move in the Tube Protocol

A sternal precaution technique where the patient keeps upper arms and elbows close to the torso during movement as if inside a narrow cylinder to minimize sternal sheer forces.

Pacemaker Precautions

Post-surgical movement restrictions avoiding overhead elevation of the left upper extremity above head height and avoiding heavy lifting or excessive strain on the involved left side.

Full Weight-Bearing (FWB)

A weight-bearing status permitting $100\%$ of body weight on the affected extremity without restriction.

Weight-Bearing As Tolerated (WBAT)

A weight-bearing status allowing the client to load as much weight as tolerable ($0\%\text{ to }100\%$) on the extremity based on comfort.

Partial Weight-Bearing (PWB)

A weight-bearing status where a specific percentage of body weight, typically $30\%\text{ to }50\%$, is permitted through the extremity.

Toe-Touch Weight-Bearing (TTWB)

A weight-bearing status allowing only the toes of the affected extremity to touch the ground for balance support without transferring body weight.

No Weight-Bearing (NWB)

A weight-bearing status permitting $0\%$ body weight; the affected extremity must remain off the ground completely during all mobility.

Heel Weight-Bearing (HWB)

A status where body weight is actively loaded through the heel surface while keeping the forefoot and toes completely off the ground.

Heel-Touch Weight-Bearing (HTWB)

A status where only the heel makes light contact with the floor for balance and proprioception without bearing any significant body weight load.

Contact Isolation

Infection control protocol requiring a gown and gloves for pathogens transmissible via physical contact, such as MRSA or C. difficile.

Droplet Isolation

Infection control protocol requiring a standard surgical mask, gown, and gloves to protect against large respiratory droplets from coughing or sneezing.

Airborne Isolation

Infection control protocol requiring an N-95 respirator mask, gown, gloves, and placement in a negative-pressure room for airborne pathogens like Tuberculosis.

Neutropenic Precautions

Protective isolation protocol requiring gown and gloves to protect severely immunocompromised patients from external healthcare-associated pathogens.

Diagnosis-Related Groups (DRGs)

A Medicare prospective payment reimbursement system calculated from primary diagnosis, comorbidities, and complications to project Length of Stay and determine bundled hospital payment.