OT2236 Activity Context Theory & Practice Final

intensive care & acute care

-unique treatment environment

-pace (accuracy, efficiency, communication)

-variety (diagnoses, severity of illness)

-clinical skill/specialty

standard precautions assumptions

-assume every patient is potentially infected or colonized with an organism that could be transmitted in the healthcare setting

-applied to all patients, regardless of their infection status

standard precautions

-hand hygiene

-personal protective equipment (PPE)

-safe-needle devices

-sharps disposal

-hepatitis B and other protective vaccines

transmission-based precautions

-comprised of extra step to follow for illnesses that are caused by certain germs

-followed in addition to standard precautions

-some infections require more than one type of transmission-based precaution (contact, droplet, airborne)

hand hygiene

still the most effective way to prevent infection

when can waterless hand sanitizers be used?

can be used UNLESS hands are visibly soiled

when should you use soap and water?

-when hands are visibly soiled

-with certain conditions (C-diff or Norovirus)

moments for hand hygiene

-before touching a patient

-before clean/aseptic procedure

-after body fluid exposure risk

-after touching a patient

-after touching patient surroundings

alcohol sanitizers

-apply product to palm of one hand

-follow manufacturer's recommendations on volume of product to use

-rub hands together

-cover all surfaces of hands and fingers

-pay special attention to nail bed and between fingers

-rub until hands are dry

hand hygiene steps

-wet hands with hot water

-apply soap and work up lather

-use friction on your hands between fingers for at least 15 seconds

-use friction on you hands around your nails for at least 15 seconds

-rinse each hand thoroughly under stream of water

-dry hands and wrists thoroughly with a. clean paper towel

-turn off faucet with paper towel before discarding

personal protective equipment

specialized equipment and clothing designed to prevent blood borne pathogen exposure

when should PPE be worn?

anytime there is potential contact with blood/body fluids

what is PPE?

-gloves

-gowns

-masks

-goggles

-face shield

where should you don PPE?

while out of potential contact area

where is disposal done?

-in patient's room to prevent exposure

-sometimes in doorway or outside patient's room depending on facility

order of donning PPE

1 - hand hygiene

2 - gown

3 - mask

4 - face shield

5 - gloves

order of doffing PPE

1 - gloves

2 - face shield

3 - gown

4 - mask

5 - hand hygiene

contaminated areas of PPE

-outside of gloves

-front of gown

-gown's sleeves

-front of face shield

-front of mask

clean areas of PPE

-inside of gloves

-back of gown

-gown's dies

-straps of face shield

-straps of mask

contact precautions

used to prevent transmission of agents by direct or indirect contact

droplet precautions

used to prevent transmission of agents through mucous membranes or close contact with respiratory secretions

airborne precautions

used to prevent transmission of agents that remain infectious over long distances when suspended in the air

level I trauma center

provide comprehensive care for a wide range of diagnoses that require sophisticated equipment and staff with specialized training

level II trauma center

capable of providing comprehensive care but not for all specific populations

level III trauma center

provide initial stabilization of critically ill patients but have limited ability to provide comprehensive care

CCU

-critical care unit

-coronary (cardiac) care unit

ER/ED

-emergency room

-emergency department

ICU

-intensive care unit

-intermediate care unit

MICU

-medical intensive care unit

-mobile intensive care unit

NICU

-neonatal intensive care unit

-neurologic intensive care unit

PACU

-post-anesthesia care unit

PICU

-pediatric intensive care unit

-psychiatric intensive care unit

SICU

-surgical intensive care unit

TICU

-trauma intensive care unit

monitors

-you must be aware of your patient's EXPECTED and TOLERATED ranges

-your own eyes and ears will provide better and faster information than the monitor will

temperature

37º celsius

heart rate

60-100 bpm

pulse

60-100 bpm

blood pressure

120/80 mmHg

respiratory rate

12-16 breaths per minute

oxygen saturation

95-100%

hematocrit

how much of your blood is made up of red blood cells

hemoglobin

protein contained in red blood cells that is responsible for delivery of oxygen

platelets

fragments in blood that form clots and stop/prevent bleeding

white blood cells

protect against illness and disease

international normalized ratio (INR)

how long it takes for your blood to clot

cardiac precautions: who?

patients with cardiac or pulmonary conditions

cardiac precautions: when?

immediately post-op up to several months post-op, depending on the procedure and condition

cardiac precautions: what setting?

ICU, hospital, inpatient rehabilitation, skilled nursing, OP

cardiac precautions: general considerations

-no maximal resistance to assess strength

-avoid resistive exercises for 6-8 weeks post cardiac event or surgery

-avoid overhead, simultaneous, bilateral shoulder activities for at least 6-8 weeks

-avoid activities that may produce the Valsalva maneuver

-consider logrolling to get in and out of bed

cardiac precautions: take note of...

-angina

-dyspea

-faintness

-lightheadedness

-nausea

-fever

cardiac precautions: abnormal exercise response

-vital sign responses that exceed acceptable patient parameters

-complaints of SOB, lightheadedness, pain, nausea, profound weakness, palpitations

sternal precautions: who?

all patients status post cardiac surgery with a sternotomy with a stable sternum for 6-8 weeks, or until surgeon approves

sternal precautions

-avoid simultaneous bilateral shoulder flexion, abduction > 90º

-avoid UE resistive strength testing and exercises

-avoid lifting, pushing, and pulling > 10 lbs for 3 months

-logrolling to avoid strong contraction of abdominal muscles

-avoid full weight bearing through UEs

-avoid activities that may cause Valsalva maneuver

-splint chest with pillow when coughing

-no driving and no sitting in passenger seat for 4 weeks

neurological precautions: who?

patients with a variety of neurological conditions

neurological precautions: when?

-depends on the condition

-some cases upon admission

-other cases = immediately post-op to several months post-op

neurological precautions: what setting?

ICU, hospital, inpatient rehabilitation, skilled nursing, OP

craniectomy precautions

-be aware of location of craniectomy

-do not apply direct pressure to area

-helmet required for all OOB activity

-keep HOB greater than or equal to 30º after surgery

orthostatic hypotension

-raise HOB slowly

-recline patient if complaints of the following: lightheaded, dizzy, blurry vision, weakness, fainting, confusion, nausea, headache

spinal precautions: who?

patients following spine surgery

spinal precautions: when?

immediately post-op up to several moths post-op, depending upon procedure and condition

spinal precaution: what setting?

ICU, hospital, inpatient rehabilitation, skilled nursing, OP

spinal precautions

-no bending

-no twisting

-no lifting greater than 10 lbs for 2-6 weeks

-follow brace use

seizure precautions: who?

-for patients with history of seizure

-establish seizure history, including prodrome or aura

-this may be done by chart review or interview

if a patient has a seizure...

-alert nursing staff

-stay with patient and observe seizure activity, note time

-place patient on side with soft object under head

-loosen clothing

-do not move patient

-move objects/furniture

-do not restrain patient

-do not put anything in mouth

orthopedic precautions: who?

patients with orthopedic conditions

orthopedic precautions: when?

immediately post-op up to several months post-op, depending upon the procedure and condition

orthopedic precautions: what setting?

ICU, hospital, inpatient rehabilitation, skilled nursing, OP

hip replacement - depending upon surgical approach

-no hip flexion beyond 90º

-no hip internal/external rotation

-no hip adduction

hip precautions: weight bearing

as indicated by surgeon

trauma precautions: who?

patients with multiple or single trauma

trauma precautions: when?

immediately post-op up to several months post-op, depending upon procedure and condition

trauma precautions: what setting?

ICU, hospital, inpatient rehabilitation

trauma precautions: weight bearing

-non-weight bearing

-partial weight bearing

trauma precautions: spinal clearance

spine is unstable and cannot be moved

trauma precautions: strict sinus precautions

-damage to facial bones/sinuses

-cannot lean forward

-sneeze with mouth open

-no Valsalva

draping

covering the client

why would you use draping?

-respect for client

-protects other parts of the body

-maintain body temperature

transfer

-safe movement of a person

-one surface or location other another

-one position to another

transfer: purpose

to permit patients to function in different environments

independent transfer

client completes all aspects of the transfer without any assistance from a caregiver

assisted transfer

client participates actively and requires assistance from a caregiver

dependent transfer

client performs less than 25% of the transfer and two or more caregivers are needed to provide assistance

levels of assistance

-standby assistance (SBA)

-contact guard assistance (CGA)

-minimal assistance (min A)

-moderate assistance (mod A)

-maximal assistance (max A)

body mechanics: why?

-stress and strain during transfers can cause injury

-proper body mechanics can prevent injury

-improper body mechanics can cause injury to both you and your client

body mechanics: common violations

-lifting while bending the back and keeping legs straight

-moving fast or jerking movements

-bending and twisting at the same time

-handling the load too far away

-poor planning

-poor communication

-insufficient strength

body mechanics: rules

-test the load

-plan the move

-use a wide, balanced stance

-keep the lower back in normal arched position

-bring the load as close to body as possible

-keep head and shoulder up while lifting

-tighten the stomach muscles as lift begins

-lift with legs and stand in smooth, even motion

-move feet (pivot) if direction change is necessary

-communicate if 2 or more individuals involved

client transfers

-assess client's transfer needs: amount and type of assistance, equipment needed

-plan your transfer: clear the way, manage equipment, people

-provide client/caregiver with adequate verbal directions and cues during transfer

-once transfer is complete, ensure that client is safe before moving away

assess client

interview client/caregiver for information to assist you in planning the transfer

planning the transfer

-get all necessary equipment

-move all unnecessary equipment out of the way

-consider which direction the client will move

-plan management of lines, drains, tubes

-adjust bed height

-move wheelchair footrests and armrests out of the way

verbal directions and cues for transfer

-client/caregiver should always be informed about the transfer and what they are expected to do

-use non-technical language

-if 2 or more people, one person takes the lead

completing the transfer

-transfer is not completed until the client is SAFE and SECURE in the new position

-only then can you move away from client

manual wheelchair with transfer

-move footrests out of way

-client should never stand on footrests

-make sure brakes are locked

-move wheelchair as close to the transfer surface as possible

power wheelchairs with transfer

-tilt-in-space

-recline

-footrests cannot be moved

-armrests may flip back

-switch off wheelchair before starting

scooter with transfer

-armrests may flip back

-seat will generally pivot 90º to the left or right

-switch off the scooter before starting transfer

transfer/sliding board

-use when client has good upper body strength

-use when client has good dynamic sitting balance

-match wheelchair and transfer surface height

-make sure fingers do not get pinched

-LOCK WHEELCHAIR

hoyer/mechanical lift

-dependent transfers

-highly recommended to prevent back injury

-maintain proper body mechanics

-do NOT leave pad under client

CARE SET - 6

-independent

-patient completes the activity by him/herself with no assistance from helper

CARE SET - 5

-setup or cleanup assistance

-helper SETS UP or CLEANS UP

-patient completes the activity

-helper only assists PRIOR to or FOLLOWING the activity

-helper can walk away and leave the patient to complete the task

CARE SET - 4

-supervision or touching assistance

-helper provides VERBAL CUES and/or TOUCHING/ASSISTANCE as patient completes activity

-assistance may be provided throughout the activity intermittently