Non-systems B

What initial gait patterns is the MOST APPROPRIATE for this patient during her first attempt to begin standing and ambulating?

Front wheeled walker and 3-point gait pattern

Three-one point:

Bilateral ADs or a walker, and restricted weight-bearing:

Partial-weight-bearing, ADs and partial-weight-bearing LE, weight-bearing LE.

Dorsiflexion assist AFO’s: DF weaknes

Posterior leaf spring – It recoils during swing phase to produce dorsiflexion

Klenzak joint – Dorsiflexion spring assist incorporated into stirrup

Plantarflexion stop/resistance AFO: PF tightness

Plastic hinged AFO with a posterior stop

Longitudinal Arch (Scaphoid pad)

Pes Planus

Controls hindfoot valgus ̶Reduces subtalar motion. Three-point counterforces – control calcaneal eversion, forefoot abduction

Used to transfer a patient from a stretcher to a bed or treatment plinth.

Three-person lift/carry

Used to transfer patients of different heights or surfaces or transferring to the floor

Two-person lift:

Used to transfer a patient who cannot stand independently but can bear some weight through the trunk and lower extremities

Dependent squat pivot transfer

Used for dependent transfers when the patient is obese, there is only one therapist available to assist with the transfer or patient is totally dependent.

Hydraulic lift

Loss of balance forward

Pull back on belt, and pull trunk upright with other hand

Loss of balance backward

Push forward on pelvis

Controlling a fall

Instruct patient to release ADs and reach for the floor

Pull back gently to decrease momentum

Step forward with foot outside of patient and slow descent to the ground

If able instruct patient to bend elbows on contact and turn head to one side

Assess for injuries

Axilla space of approx. 2”

Standard Crutches (Axillary Crutches)

Top of forearm cuff is just distal to elbow, approx. 1-1.5” below olecranon process

Forearm Crutches (Lofstrand Crutches)

Always held on the unaffected side Ascending = Good foot goes up first, followed by bad foot and cane Descending = Bad foot and cane first, followed by good foot

Cane

Measure with tip of AD on ground 2 inches lateral and 4-6 inches anterior to the toe of shoe Always with 20-25 degrees elbow flexion, hand piece at level of wrist crease, ulnar styloid process, or greater trochanter

Handpiece height

FIRST thing to do when doing a w/c transfer?

safety lock on

Ascending curb

Lift the front casters onto the curb by performing a small wheelie

Push forward on the push rims to lift the rear wheels onto the curb

Descending curb

Perform a wheelie and descend with rear wheels off the curb followed by castor wheels OR

Descend backwards: Allow the rear wheels to slowly roll off the curb, followed by the castor wheels

Turn Right WC

Push the left wheel forward while pulling back on the right wheel.

Wheelie

Patient places hands back on hand rims, then push them forward abruptly and forcefully.

Propulsion phase

Apply a smooth, continuous push on the push rims, extending your arms forward. This motion propels the wheelchair.

Recovery phase:

After the push, release the push rims and bring your hands back to the starting position, ready for the next push.

Normal axle positioning

in line with the shoulder or slightly posterior

Wheelchair axle positioning bariatric patients

move the rear wheel axle forward

Wheelchair axle positioning of Bilateral Transfemoral Amputation

move the rear wheel axle behind the patient's shoulders

Seat height

Heel to popliteal fold + 2 inches

remove pop pressure, for leg rest

Seat depth

Posterior buttock along lateral thigh to popliteal fold - 2 inches

Seat width

Widest aspect of buttocks or thighs + 1.5 to 2 inches

Back height

Chair seat to axilla - 4 inches (consider any seat cushions and add thickness to final value)

with shoulder at90 deg, -4 to clear scap, add cushion

Armrest height

Seat of chair to olecranon + 1 inch (consider cushions)

Armrest height average

9 inches

Back height average

16 inches

Seat width average

18 inches

Seat depth average

16 inches

Seat height average

19.5 to 20.5 inches

If dislodged, have the patient exhale, place gauze or a gloved hand over the area and call nursing staff, keep collection bottle below tube

Chest tubes

Arm should not be held above head for extended periods, alert staff if fluid is low due to air bubbles

IV lines

If dislodged, apply firm pressure and alert nursing immediately

Arterial line

Avoid repetitive hip flexion and hip flexion >45 degrees

Femoral line

Hang below level of bladder, do not empty bag if output is being monitored, empty or alert staff if overfilled

Catheters

Measures blood pressure directly from right atrium and superior vena cava

Central Venous Pressure Catheter

Monitor arterial blood gases

Arterial Line

Inserted through an incision in the chest and may be connected to a mechanical or gravity-based suction system

Used to remove air, blood, purulent matter from the patient’s chest or pleural cavity

Chest Drainage Tube

Exits the colon to the abdomen (stoma) when a part of the colon or large intestine has been removed

Focus on early mobility

Colostomy Bag

Balloon flotation device inserted through the internal jugular vein or femoral vein into the pulmonary artery

Monitors blood flow and the function of the heart

Swanz Ganz Catheter

Central line tunneled under the skin.

Provides antibiotics, nutritional solutions, and blood samples

Hickman Catheter

Chest compressions rate

100-120/min

Compress chest at least

2 inches/5 cm

Lifting Guidelines:

Always attempt to increase your base of support

Maintain a proper lumbar curve while you lift

Pivot your feet while lifting; do not twist your back

Maintain a slow and consistent speed while lifting

Workstation Recommendations

Monitor should be 18-28 inches away (arms length from screen)

Monitor screen top slightly below eye level

Elbows bent 90 degrees, wrist in neutral and free while typing

Use a mouse that contours the hand

Thighs horizontal and feet resting flat on floor

Space under the desk should be at least 30 inches wide, 19 inches deep, 25- 34 inches in height, should be 2-3 inches between the top of the thighs and desk

Joint commission on Accreditation of Healthcare Organization (JCAHO)

accredits hospitals, SNF, home health agencies, PPO, HMO, mental health institutions

Commissions of Accreditation Rehabilitation Facilities (CARF)

accredits free standing rehabilitative programs/facilities

Center for Medicare & Medicaid Services (CMS)

determines what and how much will be reimbursed by Medicare for patient care

Occupational Safety and Health Administration (OSHA)

responsible for determining the safety of the work environment

Donning

1) Gown (Sparkling gown) 2) Mask (Make-up) 3) Goggles (Glasses or contacts) 4) Gloves (to keep her hands clean when going out)

Doffing

1) GLoves 2) GOGgles 3) GOWn 4) Mask

Contact conditions

MRSA, VISA, VRE, Clostridium difficile, Lice, Scabies, Impetigo, Gram Negative Bacteria, Uncontrolled Diarrhea, Aminoglycoside resistant, Hep-A, Hep-B, Dermatitis, Rota Virus.

Droplet Conditions

Mumps (Rubella), Streptococcus A, Neisseria Meningitis, Pneumonia, Influenza, Pertussis.

Airborne Conditions

Measles, Tuberculosis, Varicella, SARS, Disseminated Herpes Zoster, Chickenpox, Smallpox

PPE Contact

Gloves and Gown only when in direct contact with patient or items in patient room. (Remove before leaving the room)

PPE Droplet

Mask when working within 3 feet of patient. Contact precautions only when skin lesions present.

Airborne PPE

N-95 Mask (Fit Tested). Gown and Gloves if severe contamination. Discard mask upon leaving the room.

Minimize transport. Patient wears a surgical mask when leaves the room. Patient follows cough etiquettes.

Droplet and airborne