Mobility in Context: CH 3,5,1

What must be considered at all times by Pt and Therapist ?

• Safety

Management of the environment ?

• You are responsible for cleaning and preparing. Don’t let aides take care of your mess.

What should you do with equipment not functioning ?

• should be tagged, removed from the treatment area, and reported immediately.

Annual inspection ?

• of all electrical, thermal and mechanical equipment by a biomedical engineer is required

Being Prepared ?

• Having supplies in area avoids leaving a patient unguarded or interrupting treatment.

Body Mechanics ? BOS VS COG ?

• Proper posture.

• BOS: part of the body in contact with the supporting surface

• COG: the point at which the three cardinal planes intersect.

Cardinal rules 5 L’s ?

• 1.) Load: only carry what is appropriate for you and your strength.

• 2.) Lever: keep load as close to you as possible.

• 3.) Lordosis: use isometric contractions of back extensor and abdominal muscles

  • Do not twist

    • Move feet to change direction

    • Place feet in stride and slightly apart (stronger leg in the back infront of another)

• 4.) Legs: lift with legs

  • Avoid trunk flexion or extension

  • Use appropriate base of support (wide)

• 5.) Lungs: avoid holding breath

  • Exhale during contraction

Valsalva Maneuver ?

• is closing the glottis during heavy exertion resulting in increased intrathoracic and intra-abdominal pressure, which can cause increased BP.

Body Mechanics during transfers ?

• Transfers require movements that move the COG away from the center of BOS

  • Can cause loss of balance

• Increasing the size of the BOS by setting the feet in stride and slightly apart provides a larger BOS

• Proper arrangement of the chair/bed can reduce the distance during a transfer

• Avoid crossing the legs, because it will decrease the BOS

Body Mechanics during guarding ?

• you should be positioned with feet in stride and the body at a 45-degree angle, slightly to the side and behind the patient.

• If a pt starts to fall, this position allows the pt’s COG to be pulled toward the PTA.

Instructions and verbal commands ?

• Make sure the patients understand before the activity is performed by asking “Do you understand the instruction?

  • Have patients repeat instructions

• Before treatment, inform your patient the general sequence of events that will occur during that treatment session.

• Sharp, loud tone receives quick responses

• Soft or low tones elicit slower responses.

What is draping ?

• Draping is covering a patient at a modest and comfortable level.

• Purposes: (good to know ****)

  • Protect pt’s modesty

  • Provide warmth

  • Protect wounds, scars, residual limbs

  • Expose area for treatment.

Gait Belts

• You have control of patient movements

• Apply correctly

• Make sure it does not interfere with other equipment: IV, oxygen lines, GI tubing, etc.

• Do not pull too hard on gait belt because it can interfere with the activity.

IV’s /Catheters

• Catheters should be below the level of bladder

• IV bags must remain above the heart level

• Take care not to disrupt lines during movement

Transporting

• Lock wheels before transfers.

• Adjust IVs before moving patients

• Put up siderails on cart if leaving pt unattended and when pushing the cart.

Transporting via Gurney

• Gurneys have 4 swivel wheels. Push Gurney from the end at which a pateint head is place so patients can see where they are going.

3 Positions in which a lock can be set ?

• When the lock lever is in the horizontal, both swivel and rolling movements can occur

• When lock levers are tilted in one direction, swivel movements are not possible and rolling movements are permitted

• Tilting lock levers in the other direction locks wheels completely.

Transporting via Wheelchair

• Leg rest and foot rest in place

• Arms in lap

• Descending Curb- Backward

• Ascending Curb- Forward.

Door ways opening away

• position pt facing away from door

• PTA walks backwards thru the doorway pulling the WC backward thru the doorway using back to hold the door.

Doorways opening toward

• Positon pt/WC parallel to door

• PTA opens door with 1 hand block door with foot and guide WC.

Intensive care unit

• Overall goal for pt in the ICU will be to minimize or prevent inactivity and assist each person to become functionally independent.

• Treatment aspects: contracture mobilized for too long.

Fowlers Positon ?

• When the upper portion is raised slightly.

• 45 degree angle of semi-reclining position.

Types of bed - (Clinitron)

• Air fluidized support bed/ feel like a water bed

• Uses: pt who have several infected wounds/burns and spinal cord injury.

• Disadvantages: can be punctured easily

• Reduces the need for topical meds and dressings due to healing factors of the microclimate.

Roto Rest ?``

• Post trauma mobility beds. designed to maintain a seriously injured patient in a stable position/maintain proper postural alignment.

• Oscillates from side to side

• Uses: those with restrictive respiratory function/multpile ulcers

Low Air loss Therapy bed

• Air pressure in each bladder can be controlled

• indicated for ppl who require prolonged immobilization of risk of ulcers.

• patients weight can be inflated or deflated based on senors for the bed.

• Disadvantages- bladders can be punctured or torn.

NG Tube - Nasogastric tube

• flexible tube attached to a electric pump containing liquid nutrition inserted via nasal passages thru esophagus down into stomach.

• NPO

• Head and neck movements should be closley monitored

Colostomy Bag

• Collection of fecal matter

Urinary Catheter ?

• Tube inserted into bladder via urethra providing drainage of the bladder. Tube is taped to the thigh to prevent removal.

• keep bag below bladder level.

• Alternative types: Condom Catheter - males , Pure Wick - Women

Cardiac Leads ?

• 12 lead wires connecting electrodes to the torso to a central cardiac unit.

IV Line (intravenous)

• Thin line inserted with a needle for drug

• commonly found on back of the hand or forearm.

Pulse Oximeter

• Applied to clip of fingertip or earlobe

• Used to monitor 02 Saturation rates of blood.

• Normal: 90-100%

• Exercise: above 90%

Hickman Catheter

• Neck area

• inserted thru jugular vein under skin then to superior vena cava of the heart.

Arterial Line

• Connected to a artery/monitor

• Radial and Brachial most common

Sequential compression device

• Cuff placed on pt leg attached to a pump that inflates the sleeve.

• Purpose: to prevent blood clots.

Respiratory system device: Endotracheal Tube ?

• Large flexible breathing tube inserted thru mouth into trachea and connected to a ventilator.

Respiratory system device: Tracheostomy ?

• Flexible tubing inserted thru neck into trachea.

• Maintains an open airway

Respiratory system device: Nasal Cannula

• External tube for providing oxygen

• Delivers 1-2 L of O2/Min

Patient controlled analgesia (PCA)

• Pump that delivers medicine thru a pump w/Button.

NG suction tube (Nasogastrol)

• tube inserted thru nose attached to a suction device to remove stomach contents.

postoperative surgical Drain ( HemoVac)

• Postoperative device that drains pt”s own blood from surgical wounds.

Mechanical Ventilator ?

• Respirators that bring air into lungs.

Monitoring - Telemetry

• Vital sign monitor- measures everything

Halo

• Cervical spine external device

Hoffman”s device

• External fixation ( see from outside)

Internal Fixation

• Screws bone plates wires nails and rods inserted for proper alignment ( from the inside)

Laboratory values

• To screen for disease or system imbalance

• to monitor progress of a disease

Laboratory Values: Cardiac Enzymes, creatine Kinase (CK), Arterial Blood Gasses (ABG’s)

• Troponin (Tnl, TnT)

• Found in cardiac muscle/When found in vlood indicates acute MI has happened.

• Levels of oxygen transport/Measurement of diff gasses in blood.

Lab Values: Red Blood Cells (RBC)

• Transports oxygen to cells

• Polycythemia when count is high

Lab Values: White Blood Cells (WBC)

• Helps fight infection and other disease.

Lab Values: Hemoglobin ( Hgb)

• Protein found in RBC that transport oxygen

Lab Values: Hematocrit

• Measures volume percent of packed RBC’s in a sample of blood.

Platelet count ?

• clotting of blood.

Lipid profile ?

• Group of test to help determine coronary risk based on target levels.

• Total Cholestrol: <200

• High density lipoprotein : >60

• Low density lipoprotein: >190 high risk

• Triglycerides: <165

Arthrography ?

• Joint

Myelography ?

• Spinal cord

Angiography ?

• Dye is injected either intra arterially or intravenously.

• Blood vessels

CT/SCAT scan - Computed Tomography

• X-ray combines many x-ray images with the aid of computer to generate cross sectional views.

CT Myelogram ?

• Diagnostic tool uses radio-graphic dye injected into subarachnoid space (cerebrospinal fluid)

• To check for : Inflammation of the membrane that covers the brain/spinal cord

• Problems with the blood vessels to the spine.

Electromyogram

• test used to record electrical activity of muscles.

Lumbar Puncture

• Looking specially CSF

• Needle into L3-L4

Heart Catheterization/Coronary angiogram ?

• Insert of a catheter thru major artery femoral or radial thru aorta till reaches left ventricle to examine function of heart (usually Femoral)

Doppler ultrasound

• Beneficial to reveal DVT

• Uses sound waves to measure blood flow thru major arteries and veins.

• Reveal blood clots in leg veins(deep vein thrombosis or DVT that could break loose and block blood flow to the lungs (pulmonary embolism) (Blood clot to travel called Pulmonary Embolism).

Vital Sign: Abbrev. oxygen saturation

• Sp02

• Normal is 90-100%

When to take Pulse ?

• At rest

• during exercise

• after treatment

• Basal Heart rate (First thing in the AM)

Whats is Patency ?

• Absence of a pulse

• Doppler measurement are used to examine Patency.

Method for Pulse ?

• Oximeter

• Manual Palpation: Don’t use thumb,don’t press hard/count 60 seconds. (True accurate HR)

Sites for HR

• 2 main sites radial and carotid.

Best sites to monitor Patency ?

• Brachial, popliteal, posterior tibial and dorsal pedal arteries.

• Report it as absent or present.

Range for Pulse BPM: Athletes? , infants and children? Adults ?

• Athletes:40-60 BPM

• Infants and children: 80-100 BPM

• Adults: 60-100 BPM

Tachycardia? Bradycardia?

• Tachy - Over 100 BPM

• Brady: Less then 60 BPM

Abnormal HR response

• Rapid rate of rise

• very slow rate of rise in untrained.

Maximal Heart Rate ? Target heart rate ?

220 - age =MHR

.60 x (220-age)+.80 x (220-age) = THR

Blood Pressure Systolic vs Diastolic

• Systolic: When the heart is contracting

• Diastolic: Not contracting

Blood Pressure 1 cuff size

• 80% of circumference of upper arm and width is 40%

• Left arm most accurate

• Normal: slightly below 120/80 mm Hg

BP Levels to know pre hyper,stage 1 and stage 2

• Pre hypertension: 120-139/80-89

• Stage 1: 140-159/90-99

• Stage 2: >160/>100

Normal response to BP

• Diastolic BP remains unchanged or decreases during aerobic activity.

• Pt’s response to exercise: diastolic remains stable (10 mm of mercury)

Rubor dependency Test ?

• Test to asses if there is an interruption of capillary circulation.

• Method 1: Have pt supine. raise 1 LE at a 45 degree angle. Maintain position for 1 min. Pallor will occur when decrease Patency is present.

Respiration

• each cycle is 1 inspiration and one expiration

• Method: Visual, Auditory and palpation

Respiration 1 Norms ?

Adults: 12 RR

Children: 20 RR

Temp ? sites ?

• Site: Oral, rectal and Axillary

• Norms: 98.6 F or 37C

• Most accurate is rectal

• Hyperthermia: above 106

• Hypothermia: below 94

What is Malingering ?

• Pain is expressed when an injury or disease does not truly present pain. ******

Purpose of measuring pain ?

• Diagnosis

• prognosis

• Appropriate interventions

• responses to treatment

site for pain ?

• Body diagrams can be used to document the site of pain *****

What is Anthropometrics ?

• Monitoring patients height and weight