Intervention Exam #1

clean

minimizing contatmination to prevent or control the spread of infection, remove pathogens/invading organisms, and minimize capacity to create infection

body's defense mechanisms

mechanical barrier, biological, chemical

infection signs (local)

induration, fever, erythema, edema

infection signs (systemic)

fever, chills, tachycardia

healthcare associated infections

(HAIs) infections that patients acquire within healthcare settings that result from treatment for other conditions.

MDROs

Multi-Drug Resistant microOrganisms - MDROs are very serious because drugs do not kill them.

isolation precautions

attempts to prevent the spread of infection from one person to another by separating susceptible hosts from potential sources of pathogens

standard precautions

A strict form of infection control that is based on the assumption that all blood and other body fluids are infectious.

hand hygiene

washing hands with either plain or antiseptic soap and water and using alcohol-based hand rubs

when can you not use alcohol based handrubs

c-diff patients, hands visibly soiled, or after the use of bathroom

mistakes with handwashing

cleansing for to little, overlooking areas, turning faucet off with bare hands, not allowing hands to dry thoroughly when using sanitizer

when hand hygiene

patient contact, device, personal activities, eating, collection of specimens, soiled, on/off duty

respiratory hygiene/cough etiquette

infection control guideline that includes teaching the patient to cover their mouth/nose when coughing and dispose of tissues in the proper receptacle - upper arm - hand hygine after - separation - wear face mask

PPE

Personal Protective Equipment i.e. gloves, mask, safety glasses and clinical attire (use when anticipating contact with any blood and/or bodily fluids)

OSHA

Occupational Safety and Health Administration, a government agency in the Department of Labor to maintain a safe and healthy work environment

PPE in healthcare

gloves, gowns, masks, respiration, goggles, face shields

when to where gloves

anticipate contact with body fluids (except sweat) regardless of infection

when to where gowns

to protect clinician's skin/clothing from contact with pathogens in body fluids

when to where face mask/goggles

protect clinician from spray or secretion of body fluids

center of mass

CoM/CoG - anterior to S2 (usually the middle) can change depending on if a boot (on that side) or amputation (on other side)

base of support

the area on which an object rests (BOS) - all the parts touching the ground - contact area of an object with its supporting surface

moment arm

distance from linear force to the axis

friction

objects resistance to moving relative to another object

force

push or pull that creates an action of one object upon another

load

amount of force that is applied to an object or structure

correct positioning places

CoM of the clinical close to patient

importance of good body mechanics

reduce risk of injury, balance, reduce energy required, reduce fatigue, avoid injury to patient and those assisting

preparation of lifting

- move close to the object you are lifting

- place feet wide and staggered

- prepare your spine in neutral position with active core

when lifting

-maintain proper posture with spine in neutral postion

- turn with feet, avoid twisting in the back

- lift/load from a squat position straight up

what not to do when lifting

bend at waist

principles of body mechanics

push rather than pull, exhale when lifting, stabilize core, arm position close to body, limit friction, know your capabilities

what to always do before starting

- hand hygine

- introduce self

- ask for consent

- don gait belt

positioning goals

safety, comfort, prevention of secondary impairments due to immobility, position appropriate for the goal, and patient need

when to reposition

supine: every 2 hours

seated: every 10 minutes

pressure areas on the body

bony prominences, skin folds, feet, braces or orthotics

how to test for pressure areas

skin blanching test and red areas usually indicate areas of pressure

contractures

limitations in joint motion caused by adaptive shortening in the ligaments, tendons, and muscles (can be restored but usually permanent)

common contractures

supine/prone: ankles pointed (plantarflexion muscle tighten)

seated: hip and knee bent (flexion muscles tighten

intervention for contractures

muscle release, tendon lengthening, splinting, or stretching

what to avoid when positioning a patient

compromsing the airway, poor spinal alignment, clothing/linen wrinkles, pressure on bony prominence, friction, minimizes interaction with environment

equipment to releive pressure

pillows, rolled blankets, towels, prevalon boots, waffle cushion/pressure relieving cushions, foam pads, mattress types

dependent

requires complete assistance

bariatric

extremely obese

hemiplegia

paralysis of one side of the body

plinth

padded table

vertigo

dizziness

paresis

weakness

paralysis

loss of voluntary movement

blocking

restricting movement to one extremity or part of the body

guarding

maintain close contact and using the gait belt

verbal cues

cues spoken to the patient during the course of the transfer

before meeting the patient

review the chart and determine if patient is medically stable to transfer, cognitively/physically able to help, precautions, weight bearing limitation,

always choose the transfer that is

allows/encourages the patient to participate as much as possible and is safe for all

prepare for transfer

non-skid footwear, assistance-extra person needed?, gait belt in reach, device, chair or wheelchair ready

manual transfers

sit to stand, stand pivot w/o device, stand pivot w/ device, squat pivot, slide board transfer, dependent 1 person, or dependent 2 person

mechanical transfers

sit to stand lift or total body/hoyer lift

total/dependent assistance

>75% of the work

maximal assistance

about 75%

moderate assistance

about 50%

minimal assistance

about 25%

contant guard assitance

hands on assist

stand by assistance

not touching the patient but stands within arms reach

supervision

watching patient from a distance

modified independent

independent with the use of an assistive device

independent

fully independent, no verbal cues

transfer prep

determine purpose/goal, patient education/consent, ensure appropriate footwear, remove obstacles, equalize surface heights, and secure both surface lock breaks

sit to stand lift

bearing 50% of weight on LEs, flex at hips, knees, and ankles, maintain sitting balance without support, participate in transfer (cognitive)

total body/hoyer lift

patient is unable to physically or cognitively assist effectively, precatious or is unable to weight bear through both legs, clinician is unable to assist manually -> need 2 people

parallel bars

Adjustable or nonadjustable wooden or metal bars that are horizontal and parallel to each other and attached to vertical uprights to provide a stable, nonmobile support for a person who requires an assistive device

walkers

Indications: poor balance, modifying weight bearing to lower extremities

disadvantge: size, maneuverability, space, safety on stairs, eliminates normal arm swing, poor posturer

standard walker

no wheels

benefits: greatest stability of walkers, lighter

disadvatanges: greater energy use - have to pick it up with every step, reduce gait speed, discontinous gait

front wheeled walker

benefits: less energy and allow for more normal gaint

disadvantage: less stable than standard

4-wheeled walker

benefits: seats for rest, basket, maneubers on uneven surfaces, less energy

disadvantages: heaviers, brakes, do not use as a wheelchair

platform walkers

benefits: useful for greater upper extremity support when unable to grip with hand, facilitate upright stance

disadvantage: heavy and difficult to maneuver/transport

hemiwalker

benefits: one involved side but adequate UE strength and balance, help in uninvolved side, required only one side support

disadvantages: limits normal gait and involved is unsupported

crutches

indications: assist with balance and partially or fully unload a single lower limb

benefits: increased gait speed, greater selection for gait pattern, easier to use on stairs, can use single or bilaterally

disadvantages: less stable than walker, greater UE/trunk strength, requires more coordination

axillary crutches

benefits: more stable than forearm crutches and inexpensive

disadvantages: requires good standing balance, functional UE and trunk strength, risk for axillary damage, safety maybe compromised in small spaces

forearm/lofstrand crutches

benefits: greater functional use of hands when standing still, greater stability than a cane, eliminates danger of axillary damage

disadvantage: less stable than axillary crutches due to more distal contacts

canes

indications: assistance with mild balance impairments, widening BOS, slightly decreased the load on LE joints, and held in opposite hand of injury of LE

Benefits: inexpensive, light, single or bilaterally, allows reciprocal arm swing

single point canes

can be a standard wood or an adjustable cane

tripod canes

stands on its own when user needs to stop and use hands

wide base quad cane or small base quad cane

benefits: more stable than a single point cane and stands on its own

disadvantages: due to wider BOS of cane, affects the gait mechanics

fitting parallel bars

- width of bars should be 2 inches of space between hips (greater trochanters) and rails

- adjust height to ulnar styloid process

- elbow flexion around 20-30°

fitting a walker

1st estimate walker height based on documented/reported patient height

2nd patient stands in walker with arms by sisde (stand tall) adjust height to ulnar styloid process (elbow flexion 20-30 degress when holding and consider change in height with shoes on)

fitting axillary crutches

Patient is standing straight and tall with relaxed shoulders and shoes on:

1. crutch tips are positioned 6 anterior and 2 lateral to little toe in away from feet at 45' angle

2. use 2-3 fingers placed between pt's axilla and top of crutch pad

3. ulnar styloid process should be even with hand grip, should result in elbows bending at 20'-30' angle (slight flexion)

fitting forearm/lofstrand crutches

same as axillary crutches but make sure the cuff is 1-2" below the elbow and tight enough to stay on arm but not restrictive

fitting a cane

same as axillary crutches, when folding cane elbow flexion should be 20-30 degress with writst in neutral

cane is placed in opposite side of impairment

common fitting errors

patient hunches or depressors shoulder, not standing erect, flexion/extension of writs, no shoes on, axillary crutches - not enough education of crutch paralysis, using device in wrong hand, only assess in standing still position

ambulation

the act of walking

gait

manner of walking

Antalgic gait

painful gait, presents as a limp

ataxic gait

uncoordinated gait

reciprocal

same

immobilizer

any device that is used to limit or prevent movement of a patient that might cause injury to self or others (brace)

weight bearing status

Patient's ability to bear weight on limbs.

gait - need to assess

safety, step ability, weight bearing and balance ability of the LE and UE, and ability to hold body erect

non-WB

no weight can be placed on the involved extremity

toe touch-WB

toes can rest on the ground for balance, but not for weight bearing

partial-WB

prescribed amount as a percentage of the patients body weight (usually 20-50%)

WB-as tolerated

limited only by the patient's tolerance/pain: usually 50% to 100%