PE Exam 2

Standard Precautions

Treat ALL patients as potentially infectious; applies to blood, body fluids, secretions, non-intact skin, mucous membranes. Includes hand hygiene, gloves, PPE as needed, safe injection, respiratory etiquette.

Droplet Precautions

Used for illnesses spread through respiratory droplets (flu, strep, meningitis). PPE: surgical mask, gown, gloves, eye protection as needed; patient ideally in private room; maintain 3-6 ft distance if possible.

Contact Precautions

For pathogens spread by direct/indirect contact (MRSA, C. diff); PPE: gown + gloves; dedicated equipment required; C. diff: MUST wash hands with soap and water.

Airborne Precautions

For airborne pathogens (TB, measles, varicella, COVID); MUST wear N95 respirator; patient in negative-pressure isolation room; patient wears surgical mask during transport.

Handwashing - When Required

Hands visibly dirty; after contact with bodily fluids; after removing gloves; after C. diff patient contact; duration: 40-60 seconds; warm water + friction.

Alcohol-Based Hand Rub - When Appropriate

When hands not visibly soiled; faster, more accessible; duration: 20-30 seconds.

Medical Asepsis

Reduce number/spread of organisms.

Surgical Asepsis

Prevent ALL microorganisms from reaching the patient; requires sterile gloves, sterile field, sterile instruments.

Signs of Poor Infection Control

Missing hand hygiene; reusing equipment without disinfecting; incorrect PPE; failure to isolate infectious patient; poor environmental cleaning.

When PPE Must Be Removed Before Leaving Room

ALWAYS remove gown and gloves in patient room; perform hand hygiene immediately afterward.

Transmission-Based Precaution Room Assignments

Contact: private room; Droplet: private room (preferred); Airborne: private room with negative airflow.

MRSA Precautions

Contact precautions to prevent the spread of Methicillin-resistant Staphylococcus aureus.

TB Precautions

Precautions that include wearing an N95 respirator and using a negative-pressure room.

Respiratory Hygiene Education

Education for patients and visitors on covering coughs, performing hand hygiene, and wearing masks if symptomatic.

Positioning

The act of placing patients in specific positions to prevent complications.

Repositioning Frequency

Every 2 hours in bed and every 10-15 minutes in a wheelchair.

Most Common Pressure Sore Site

Sacrum.

Supine Common Contractures

Hip flexors, knee flexors, ankle plantar flexors, shoulder internal rotators/adductors.

Prone Common Contractures

Ankle plantar flexors, shoulder rotators, neck rotators.

Side-Lying Common Contractures

Hip/knee flexors, hip adductors/internal rotators, shoulder internal rotators.

Sitting Common Contractures

Hip/knee flexors, hip adductors/internal rotators, shoulder internal rotators/adductors.

Positioning General Rules

Maintain alignment, avoid wrinkles in linens, protect bony prominences, max position hold = 2 hours, encourage weight-bearing to prevent osteoporosis/atrophy.

Residual Limb (Transfemoral) Positioning

Avoid hip flexion, elevation of limb, abduction; maintain hip neutral extension; limit sitting to 40 min/hour.

Residual Limb (Transtibial) Positioning

Avoid knee flexion; maintain knee extension; encourage prone lying; avoid elevation > a few minutes.

Hemiplegia Positioning

Upper extremity: shoulder abduction + external rotation, elbow extension, wrist extension; lower extremity: hip extension/abduction/internal rotation, ankle dorsiflexion/eversion; avoid flexion synergies.

Burns Positioning

Avoid positions of comfort; frequent gentle range of motion; prevent tightening around graft sites.

TKA Positioning

Knee extended (no pillow under knee); neutral hip.

Posterior Hip Precautions

No hip flexion > 90°, no internal rotation, no adduction past midline.

Anterior Hip Precautions

Avoid extension, external rotation, and adduction past midline.

Bed Mobility Definition

Ability to reposition in bed: scooting, rolling, supine to sitting, bridging.

Why Bed Mobility Matters

Prevents pressure sores, improves pulmonary function, prepares for transfers, reduces risk of DVT, increases independence.

Levels of Assistance (Independent)

no assistance

Level of Assistance (Modified Independent)

Uses device or extra time

Level of Assistance (Supervision)

Verbal cues, PT out of arm's reach;

Level of Assistance (Stand-By Assist)

PT within arm's reach

Level of Assistance (Contact Guard Assistance)

Hands on patient but no lifting

Level of Assistance (Min Assist)

Patient does >75%

Level of Assistance (Mod Assist)

Patient does 50-74%

Level of Assistance (Max Assist)

Patient does 25-49%

Level of Assistance (Dependent)

Patient does <25%.

When to BLOCK Knees in Bed Mobility/Transfers

Generalized weakness < 3/5

Hemiplegia (block affected leg)

Bilateral lower extremity weakness (block both)

When NOT to Block a Limb

Fresh amputation, surgical incision near hip/knee, non-weight bearing status.

Types of Transfers

Stand pivot, squat pivot, sliding board, dependent lift, Hoyer lift, lateral transfer.

Transfer Toward Strong Side Rule

Whenever possible, transfer toward patient's strongest side to reduce fall risk and improve success.

Preparatory Steps Before Transfer

Hand hygiene, informed consent, demonstrate transfer, apply gait belt, lock wheelchair + bed, remove footrests, position wheelchair at 45°-60° angle.

Environmental Preparation

Remove clutter, clear pathway, adjust bed height, prepare assistive devices (walker/crutches).

Gait Belt Rules

Always used unless contraindicated; keep low around pelvis; never hold patient's limbs or clothes.

Signs Transfer Should Stop Immediately

Dizziness, orthostatic hypotension, extreme pain, shortness of breath or cyanosis, patient becomes unsafe/fatigued.

When to Use a Sliding Board

Upper extremity strength adequate, lower extremity strength ≤ 3/5, unable to pivot safely.

When NOT to Use a Sliding Board

Burns (risk of shearing), open wounds, ulcers, fresh amputation with incomplete healing.

SCI Considerations During Transfers

Weak trunk control, high fracture risk (osteopenia), assume lower extremity paralysis, guard trunk closely.

Burn Patient Transfer Rule

Absolutely avoid shearing; dependent lift preferred.

Hemiplegia Transfer Rules

Never pull on hemiplegic arm, block affected knee, transfer toward strong side.

Posterior Hip Replacement Transfer Rules

Avoid flexion >90°, avoid internal rotation, avoid adduction, use elevated surfaces to avoid bending.

Pressure Sore Risk Factors

Limited mobility, incontinence, poor nutrition, decreased sensation, excessive pressure over bony areas.

Pressure Sore Prevention

Reposition frequently, keep linens smooth, maintain skin hygiene, offload heels, use cushions/supports.

Contracture Prevention

Frequent range of motion, avoid static positions, positioning in extension, encourage mobility, avoid pillows behind knees.

Documentation

to/from surfaces

Level of assistance

Assistive device

Verbal cues

Safety

Time to complete

Tolerance

Comparison to previous session(s)

What is a type of transfer in patient care?

To/From surfaces

What is meant by 'level of assistance' in transfers?

The amount of help a patient requires during a transfer.

What are assistive devices used for in transfers?

Tools that help patients move safely during transfers.

What are verbal cues required for in transfers?

Instructions given to guide the patient during the transfer.

What is a key consideration for patient safety during transfers?

Ensuring the patient is secure and stable throughout the transfer.

What does 'time to complete' refer to in patient transfers?

The duration it takes to perform the transfer.

What does 'tolerance' refer to in the context of transfers?

The patient's ability to handle fatigue, vital signs, and dizziness during the transfer.

Why is it important to compare to prior sessions in transfers?

To assess progress and adjust care as needed.

Peripheral IV Line

Delivers fluids and medications into a peripheral vein.

Arterial Line (A-Line)

Provides continuous blood pressure monitoring and frequent blood sampling.

Foley Catheter

Drains urine from bladder into collection bag.

NG (Nasogastric) / PEG (Gastrostomy) Tubes

Provide nutrition and/or medications directly to GI tract.

Chest Tube

Removes air, blood, or fluid from pleural space to improve lung expansion.

Telemetry (Cardiac Monitor)

Continuously monitors heart rhythm and rate.

Pulse Oximeter

Monitors blood oxygen saturation (SpO₂) and often pulse rate.

Level 1 Intensive Care

Basic care, limited monitoring needs.

Level 2 Intensive Care

Intermediate care, higher monitoring than a general floor.

Level 3 Intensive Care

Highest acuity, advanced life support (ventilators, multiple infusions, organ support).

Ventilator

Can be invasive or noninvasive.

Central Venous Lines

Includes internal jugular, subclavian, and femoral lines.

Sequential Compression Devices (SCDs)

Used for DVT prevention.

Primary PT Roles in the ICU

Initiate and progress early mobility to reduce complications of bed rest.

ICU Safety Principles for PT

Always confirm activity/mobility orders in the chart or with the nurse.

Monitor Vital Signs

Monitor vital signs and patient responses throughout activity.

Trace All Lines/Tubes

Trace all lines/tubes before moving the patient to avoid pulling them.

Respect Hemodynamic Stability

Stop if unsafe changes occur in HR, BP, SpO₂, or RR.

Never Ignore Alarms

Coordinate with nursing when alarms occur during mobility.

Foam Wheelchair Cushion

Basic pressure distribution, low-cost option; appropriate for patients with lower risk for skin breakdown; less effective for patients with absent or decreased sensation.

Gel Wheelchair Cushion

Provides improved pressure redistribution versus standard foam; helpful for patients with moderate risk of pressure injury or bariatric patients; heavier than foam and may require regular maintenance/adjustment.

Air/ROHO Wheelchair Cushion

High-level pressure redistribution using air cells; ideal for patients with high risk of pressure injury or impaired sensation; requires correct inflation level to maintain effectiveness.

Wheelchair Seat Width - Proper Fit

Generally 2 inches wider than the widest part of the hips; too narrow → increased risk of pressure at greater trochanters; too wide → difficult propulsion and poor posture/alignment.

Wheelchair Seat Depth - Proper Fit

Seat should allow 2-3 finger-widths between the seat edge and popliteal fossa; excessive depth → pressure in popliteal region, impaired circulation; too shallow → less thigh support and decreased stability.

Wheelchair Leg Rest Height - Impact

Too high → increased pressure on ischial tuberosities, risk of sacral/coccyx breakdown; too low → feet may drag, compromising safety and posture; goal: support thigh along the seat with feet flat on footplates.

Wheelchair Back Height - Considerations

Standard height: just below the inferior angles of the scapulae for active users; too high → impedes shoulder motion needed for propulsion; too low → insufficient trunk support for weaker patients.

Wheelchair Armrest Height - Considerations

Correct height supports forearms with shoulders in neutral; too high → shoulder elevation and neck/upper trapezius strain; too low → shoulder depression, poor postural support.

Spinal Precautions ("BLT")

No bending of the spine; no lifting (often >5-10 lb, or per surgeon orders); no twisting of the trunk; use log roll technique for bed mobility to maintain neutral spine.

Weight-Bearing Status - Clinical Meaning

Non-Weight Bearing (NWB): limb does not contact the ground

Toe-Touch/Touch-Down WB (TTWB/TDWB): minimal contact for balance only ("eggshells"); Partial WB (PWB): specific percentage of body weight allowed (ex, 25-50%)

Weight Bearing as Tolerated (WBAT): guided by patient's pain tolerance and stability

Full WB (FWB): no restrictions; normal WB allowed.

Burn Patient General Precautions (Beyond Transfers)

Avoid friction and shear forces on healing skin or grafts; prevent prolonged positioning in flexion at involved joints; integrate gentle ROM and functional movement within pain and medical tolerance.

Hemiplegia General Safety Precautions

Never pull or lift a patient by the hemiplegic arm; protect the affected shoulder from subluxation and traction; frequently support the UE in proper alignment with pillows, slings, or armrests.

Amputation General Positioning Precautions

Avoid prolonged limb elevation that encourages hip or knee flexion contracture; encourage prone lying (when appropriate) to promote hip extension; educate patient early on the importance of avoiding "comfy" flexed positions.

Axillary Crutch Fit Parameters

Axillary pad approximately 2 inches (2-3 finger widths) below axilla; handgrip at level of wrist crease/ulnar styloid when arm at side; slight elbow flexion (≈20-30°) when.

Forearm (Lofstrand) Crutch Fit

Cuff positioned about 1 inch below the olecranon so elbow can flex; Handgrip at wrist crease/ulnar styloid with arm relaxed; Allows controlled elbow flexion during gait.