OT 501 wk 3 pre classs readiness

Purpose of assessing vital signs in acute care

To determine physiological status, ensure patient safety during evaluation/intervention, and decide whether to proceed, modify/grade, or stop activity.

Patient populations requiring baseline vital signs

Patients recovering from trauma, illness, or hospitalization; those with cardiovascular/cardiopulmonary conditions; individuals inactive for weeks/months; those with fatigue/debility; children under $2$; and adults over $65$.

Factors that influence vital signs

Activity level, emotional status, physiological status, environmental temperature, and age.

Blood pressure

The pressure exerted by circulating blood against blood-vessel walls.

Systolic blood pressure (BP)

The pressure exerted against blood-vessel walls during left ventricular contraction.

Diastolic blood pressure (BP)

The pressure exerted against blood-vessel walls during the heart's resting period.

Normal adult blood pressure criteria

Systolic $<120\,mmHg$ AND diastolic $<80\,mmHg$.

Elevated blood pressure criteria

Systolic $120\text{--}129\,mmHg$ AND diastolic $<80\,mmHg$.

Stage 1 hypertension criteria

Systolic $130\text{--}139\,mmHg$ OR diastolic $80\text{--}89\,mmHg$.

Stage 2 hypertension criteria

Systolic $\ge 140\,mmHg$ OR diastolic $\ge 90\,mmHg$.

Expected normal systolic BP response during vigorous exercise

An increase of approximately $40\text{--}60\,mmHg$.

Abnormal diastolic BP response during activity

An increase of more than $10\text{--}15\,mmHg$.

Abnormal systolic BP responses during activity

Rapid increase, failure to increase, continued rise/fall after activity plateaus, failure to decline appropriately post-activity, falling significantly below resting level, or declining while exercise intensity is maintained.

Normal adult resting respiratory rate

$12\text{--}18\,$respirations per minute.

Four qualities assessed during respiration observation

Rate, rhythm, depth, and character.

Thoracic (upper-chest) breathing pattern

The thorax rises and expands during inhalation while the abdomen remains relatively motionless.

Abdominal breathing pattern

The abdomen expands during inspiration with essentially no thoracic movement.

Breathing pattern indicative of respiratory distress

Simultaneous or combined thoracic and abdominal breathing efforts.

Factors affecting respiration

Age, emotional status, physical activity, air quality, altitude, and disease/illness.

Normal adult resting heart rate

$60\text{--}100\,bpm$.

Physiological process indirectly measured by heart rate/pulse

Contraction of the left ventricle.

Factors affecting heart rate/pulse

Medications, emotional status, age/gender, environmental temperature, and infection.

$SpO_2$ level indicating immediate cessation of activity

$<90\%$, unless a different physician or facility parameter is ordered.

$SpO_2$ level requiring caution

$$90\text{--}94\%

Normal $SpO_2$ level

$$\ge 95\%

Activity tolerance

The ability to sustain purposeful activity over time without undue fatigue, pain, or physiological compromise.

Common causes of reduced activity tolerance in acute care

Bed rest/immobility, cardiac or pulmonary compromise, anemia, malnutrition, pain, medication effects, postoperative status, and anesthesia recovery.

Methods for grading activity UP

Increasing duration, resistance, repetitions, or complexity.

Methods for grading activity DOWN

Shortening session length, adding rest breaks, simplifying tasks, or using energy-efficient positions (e.g., sitting instead of standing).

Key energy-conservation principles

Pacing, planning, prioritizing, positioning, and proper body mechanics.

Symptoms requiring immediate activity cessation and reassessment

New/worsening chest pain, disproportionate dyspnea, diaphoresis, pallor, dizziness, $SpO_2 < 90\%$, significant HR/BP changes, orthostatic symptoms, distress, or patient request to stop.

Essential items to review prior to acute care patient mobilization

Activity orders, weight-bearing status, isolation precautions, fall-risk status, and physician-specified parameters.

Diagnostic criteria for orthostatic hypotension

A decrease of $\ge 20\,mmHg$ systolic OR $\ge 10\,mmHg$ diastolic within $2\text{--}3\,$minutes of moving from supine/sitting to standing.

Clinical signs of orthostatic hypotension

Dizziness, lightheadedness, visual graying, pallor, diaphoresis, or syncope.

Patient populations at high risk for orthostatic hypotension

Patients following prolonged bed rest, postoperative patients, and individuals taking antihypertensives or diuretics.

Score range of the Borg RPE scale

$6\text{--}20$.

Borg RPE score corresponding to "somewhat hard"

Approximately $13$.

Score range of the modified CR-10 RPE scale

$0\text{--}10$ (from nothing at all to maximal effort).

Key transfer and mobility skills in acute care OT

Bed mobility, sit-to-stand, functional ambulation, toilet transfers, and bathtub/shower transfers.

Independent (level of assistance)

Patient performs the task completely safely without any assistance or cueing.

Modified Independent (level of assistance)

Patient performs the task independently, but requires an assistive device, safety equipment, or extra time.

Supervision / Standby Assist (SBA)

No physical contact is provided; the therapist is nearby for verbal cueing or safety oversight.

Contact Guard Assist (CGA)

Hands-on contact is maintained without active lifting; therapist is positioned to assist immediately if needed.

Patient effort percentage for Minimal Assistance (Min A)

Approximately $75\%$ or more.

Patient effort percentage for Moderate Assistance (Mod A)

Approximately $$50\text{--}74\%

Patient effort percentage for Maximal Assistance (Max A)

Approximately $$25\text{--}49\%

Dependent (level of assistance)

Patient performs less than $25\%$ of the task (or $0\%$), requiring total assistance from staff/therapist.

Non-Weight Bearing (NWB)

No weight is permitted through the involved limb.

Toe-Touch Weight Bearing (TTWB)

Toe may touch the floor for balance only, but no weight is placed through the limb.

Partial Weight Bearing (PWB)

Only a specified percentage of body weight is permitted through the limb.

Weight Bearing As Tolerated (WBAT)

Patient self-regulates weight bearing on the limb based on pain and tolerance.

Full Weight Bearing (FWB)

No weight-bearing restrictions; full body weight permitted.

Active Range of Motion (AROM)

Joint movement accomplished entirely by the individual's unassisted active muscle contraction.

Passive Range of Motion (PROM)

Joint movement produced entirely by an external force without active muscle contraction by the individual.

Four primary components of a goniometer

Protractor (body), axis (fulcrum), stationary arm, and movable arm.

Standard sequence for screening ROM

Stabilize proximally → screen less-involved side first → move proximal to distal → AROM scan → assess PROM if AROM is limited → goniometry as indicated → document.

Clinical considerations during ROM assessment

Monitor pain, maintain proper alignment, provide proximal stabilization, check scapular positioning, and select appropriate goniometer size.

Normal ROM for shoulder flexion

$0\text{--}180^\circ$.

Normal ROM for shoulder extension

$0\text{--}60^\circ$.

Normal ROM for shoulder abduction

$0\text{--}180^\circ$.

Normal ROM for shoulder internal rotation

$0\text{--}70^\circ$.

Normal ROM for shoulder external rotation

$0\text{--}90^\circ$.

Normal ROM for wrist flexion

$0\text{--}80^\circ$.

Normal ROM for wrist extension

$0\text{--}70^\circ$.

Normal ROM for radial deviation

$0\text{--}20^\circ$.

Normal ROM for ulnar deviation

$0\text{--}30^\circ$.

Normal ROM for elbow flexion/extension

$0\text{--}150^\circ$.

Normal ROM for forearm supination and pronation

$0\text{--}80^\circ$ each.

Manual Muscle Test (MMT) Grade 0

Zero: no palpable or visible muscle contraction.

MMT Grade 1

Trace: palpable or visible contraction present, but no joint motion occurs.

MMT Grade 2-

Incomplete range of motion in a gravity-eliminated position.

MMT Grade 2

Full available range of motion in a gravity-eliminated position.

MMT Grade 2+

Full available ROM in gravity-eliminated position with minimal resistance, or partial ROM against gravity.

MMT Grade 3-

Moves through greater than half range but less than full available ROM against gravity.

MMT Grade 3

Full available range of motion against gravity without added resistance.

MMT Grade 3%

Full available ROM against gravity with minimal resistance.

MMT Grade 4

Full available ROM against gravity with moderate resistance.

MMT Grade 5

Full available ROM against gravity with maximal (normal) resistance.

Clinical next step when AROM is normal during screening

Proceed directly to Manual Muscle Testing (MMT).

Clinical next step when AROM is limited

Assess PROM to determine total available joint range.

Clinical action when limited AROM equals available PROM

Perform MMT in the available range.

Clinical suspicion when PROM exceeds AROM

Suspect muscle weakness as the underlying factor limiting active motion.

Initial position for MMT when PROM exceeds AROM

Perform initial strength testing in a gravity-eliminated position.

Cognition

The capacity to acquire and use information to adapt to environmental demands.

Cognitive processes involved in acquiring new information

Taking in, organizing, assimilating, and integrating new information with prior experiences.

Generalization (cognitive concept)

The ability to apply learned information or skills to novel tasks or settings.

Three foundational cognitive functions in OT assessment

Orientation, attention, and memory.

Orientation (cognitive domain)

Awareness of oneself in relation to person, place, time, and circumstance.

Oriented x4

Fully oriented to person, place, time, and situation/circumstance.

Cognitive domain tested by asking "What is your full name?"

Orientation to person.

Cognitive domain tested by asking "Where are you right now?"

Orientation to place.

Cognitive domain tested by asking "What year is it?"

Orientation to time.

Cognitive domain tested by asking "Why are you in the hospital?"

Orientation to circumstance.

Four primary components of attention

Sustained, selective, divided, and alternating attention.

Sustained attention

The ability to maintain focused attention on a task over an extended period.

Selective attention

The ability to focus on relevant target information while filtering out competing distractions.

Divided attention

The ability to attend to two or more tasks or information streams simultaneously.

Alternating attention

The ability to fluidly shift focus back and forth between different tasks with distinct cognitive demands.

Memory

The cognitive capacity for information encoding, storage, and retrieval.

Four-stage sequence of memory processing

Attention → Encoding → Storage → Retrieval.