Acute Care Occupational Therapy and Clinical Precautions

Flashcards covering acute care settings, trauma center levels, daily OT interventions, medical lines and tubes, vital signs, lab values, weight-bearing precautions, and isolation guidelines.

Goal of Acute Care

To medically stabilize the patient and discharge to a setting that promotes the highest level of functioning with as little assistance as possible.

Average Length of Stay in Acute Care

Typically short-term, averaging $3\text{--}5$ days.

Level 1 Trauma Center

A comprehensive regional tertiary care facility that provides prevention through rehabilitation, specialized equipment and procedures, $24$-hour in-house general surgeon coverage, prompt specialty availability, and leads in public education, teaching, and research. Diagnoses treated include spinal cord injury, TBI, CVA, polytrauma, severe burns, and cardiac surgeries.

Level 3 Trauma Center

A trauma center providing assessment, stabilization, and emergency operations with prompt availability of general surgeons and anesthesiologists, featuring transfer agreements to Level 1 or Level 2 centers. Diagnoses treated include CVA, orthopedic surgeries, oncology, amputations, respiratory failure, general medical, and OB/GYN.

Acute Care Interdisciplinary Team

Respiratory Therapist (RT), Physicians, Nurses, Occupational Therapy (OT), Speech Pathology (SP), Social Worker, Dietician, Patient and Family/Caregiver, and Chaplain / Spiritual Care.

Typical Day in Acute Care (OT Focus)

Daily interventions addressing ADLs, functional mobility and transfers, caregiver training and education, sitting and standing balance, therapeutic exercise, and cognitive retraining.

Acute Care Treatment Variation Factors

Treatments in acute care are varied based on client factors, performance skills, and discharge location.

Just Right Challenge

An intervention approach where an activity is tailored so it is neither too easy nor too difficult for the patient.

Hospital Room Setup Rationale

Ensures patient safety by preventing falls and line dislodgement during mobility while enabling vital sign monitoring, clear communication, and client autonomy.

Normal Blood Pressure (BP)

$$120/80\,\text{systolic/diastolic}$$

Normal Heart Rate (HR)

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

Normal Oxygen Saturation ($\text{O}_2\,\text{sat}$)

$$>90\%$$

Normal Respiration Rate

$$12\text{--}20\,\text{per minute}$$

Pulse Oximeter

A device that measures hemoglobin saturation on red blood cells, which can be used continuously or as a portable unit (normal range: $>90\%$).

Nasogastric Tube (NG-Tube)

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

Foley Catheter

A urinary tract catheter held in place inside the bladder by an inflated balloon.

Swan-Ganz Catheter

A pulmonary artery catheter inserted directly into the right atrium of the heart.

Chest Tube

A device used to treat a collapsed lung and/or drain fluid from the lungs or pleural space.

Jackson-Pratt (JP) Drain

A closed suction surgical drain featuring a grenade-shaped bulb.

Hemovac Drain

A spring-loaded compression drain with a larger volume collection capacity than a JP drain.

Wound VAC

A negative pressure therapy system commonly used for large, chronic wounds or wounds that have failed to respond to other treatments.

Ileostomy

A surgical opening allowing the small intestine to remove stool, typically created following the removal of all or part of the colon and rectum.

Colostomy

A surgical diversion of the colon (large intestine) to an artificial opening (stoma) to bypass a diseased or damaged section of the colon.

Urostomy

A surgical diversion that reroutes urine directly from the kidneys through a stoma, bypassing the bladder.

Percutaneous Endoscopic Gastrostomy (PEG-Tube)

A flexible feeding tube inserted through the abdominal wall directly into the stomach, bypassing the mouth and esophagus for nutrition, fluids, and medications.

Jejunostomy Feeding Tube

A feeding tube surgically placed into an opening in the small intestine (jejunum) to deliver nutrition and medications.

Patient-Controlled Analgesia (PCA) Pump

A pain medication pump that allows the patient to control output by pressing a button within physician-set dosing parameters.

Mechanical Ventilator

A machine that assists or breathes for a patient recovering from surgery/illness, attached via an endotracheal (ET) tube or tracheostomy.

PTT / INR Guidelines

Normal range is $0.9\text{ to }1.1$; therapeutic range is $2\text{ to }3$. If INR is greater than $5$, do not perform therapy.

Platelet Count Activity Thresholds

Less than $20$: do not exercise; between $20\text{ to }30$: PROM is appropriate; $30\text{ to }50$: AROM is appropriate; greater than $50$: resistive exercise is appropriate.

Anterior Hip Precautions

Avoid hip flexion past $90^\circ$, internal rotation, and leg adduction.

Posterior Hip Precautions

Avoid hip extension, external rotation, and leg adduction.

Spinal Precautions

Avoid bending, lifting, and twisting (BLT).

Sternal Precautions

Avoid pushing, pulling, and lifting. Follow the 'Move in the Tube' principle and hug a heart pillow during transfers or coughing.

Pacemaker Precautions

Wear an upper extremity sling as directed, and avoid placing arms overhead or overlifting with the left upper extremity.

Weight Bearing as Tolerated (WBAT)

A weight-bearing restriction allowing the patient to bear as much weight on the affected limb as they can comfortably tolerate.

Partial Weight Bearing (PWB)

A restriction allowing only a specific portion of the patient's body weight to be placed through the affected limb.

Non-Weight Bearing (NWB)

Zero weight may be placed through the affected extremity; it must not touch the ground.

Toe-Touch Weight Bearing (TTWB)

Only the toes of the affected foot may touch the floor, strictly for balance assistance and not to bear substantial weight.

Full Weight Bearing (FWB)

The patient is cleared to bear $100\%$ of their body weight on the affected limb without restriction.

Heel Weight-Bearing (HWB)

Weight is placed only through the heel of the affected foot while keeping all weight completely off the forefoot and toes.

Heel-Touch Weight-Bearing (HTWB)

Only the heel touches the floor for balance and proprioception, without bearing any significant body weight.

Universal / Standard Precautions

Infection control practices applied to every patient encounter regardless of diagnosis.

Contact Isolation Precautions

Infection control measures requiring personal protective equipment consisting of gown and gloves.

Airborne Isolation Precautions

Infection prevention protocol requiring an N-95 respirator mask, placement in a negative-pressure patient room, and the use of a gown and gloves.

Neutropenic Precautions

Protective isolation precautions used when patients are immunocompromised, requiring healthcare workers to wear a gown and gloves.

Diagnosis-Related Groups (DRGs)

A reimbursement system used for Medicare patients based on client diagnosis, comorbidities, and illness complications, used to calculate expected payment and project length of stay (LOS).