Study Guide PTA 205
Acute Care Defined
What is the definition of acute care provided in the source?
Acute care refers to the treatment of patients who have short-term, severe medical conditions, such as injuries, illnesses, or urgent medical needs. It's a branch of healthcare focused on active but temporary interventions to stabilize and recover a patient from a sudden health problem.
Acute Care Setting
Where might a patient receive acute care according to the source?
Hospitals, Urgent care centers, trauma centers, acute medical Units (AMU), Psychiatric acute care centers, long-term acute care (LTAC)
What are some examples of sub-acute care settings mentioned?
Skilled nursing facilities (SNFs), rehabilitation hospitals, specialty hospitals, and at-home.
What level of medical and rehabilitation services might specialized subacute units in Skilled Nursing Facilities (SNFs) provide?
Specialized subacute units can provide a higher level of medical and rehabilitation services than typical nursing home care.
Acute Care Journey Emergency Room
What are the steps listed for the emergency room journey before a patient is admitted to the floor?
Admitting clerk → Admitting ED nurse → Emergency room assessment → Imaging and tests → Consult by specialist → pharmacist and nursing → admitted to the floor
Once they are admitted to the floor…
What are some initial steps that occur once a patient is admitted to the floor?
HUC paperwork → nursing intake → specialist/surgeon/exam/intake → nursing team
Who are some members of the Therapy TEAM mentioned?
PT, SLP, OT, rec ther
Who are some members of the Nursing TEAM mentioned?
Charge nurse, Nurse, CNA, Registered Nurses (RN), Licensed Practical Nurses (LPN)
Who are some members of the Support Staff mentioned?
Housekeeping, HUC, Techs for everyone
Who are some members of the Clinical Specialties mentioned?
Pharmacists, Respiratory therapists, technicians (EKG, ECO), Radiology, Dietitian, Discharge planner
Acute Care Team
List some of the roles included in the Acute Care Team according to the source.
Physicians: Including emergency medicine doctors, surgeons, specialists (e.g., cardiologists, pulmonologists), and hospitalists.
Licensed Practical Nurses (LPNs) and Certified Nursing Assistants (CNAs): Providing basic patient care and assisting RNs.
Physician Assistants (PAs) and Nurse Practitioners (NPs): Assisting physicians in providing patient care and managing certain medical conditions.
Technicians: Performing diagnostic tests, such as X-rays, ultrasounds, and electrocardiograms.
Support staff: Health Unit Coordinator, social workers, care coordinators, dietary staff, and housekeeping personnel.
What are the general responsibilities mentioned for Registered Nurses (RNs)?
Providing direct patient care, monitoring vital signs, and administering medications.
What are the general responsibilities mentioned for Respiratory Therapists?
Managing patients with respiratory issues, including those requiring mechanical ventilation.
What are the general responsibilities mentioned for Pharmacists?
Ensuring accurate medication dispensing and monitoring drug interactions.
Referral to Therapy Team
What is required to provide therapy services for each piece of the team?
A prescription! (RX)
What instruction is given regarding following the direction in the Rx or PT POC?
You must follow the directions exactly as given.
When is a PT Re-Eval needed?
When there is a downward shift in status (pt gets worse) or an increased level of care (pt goes from the “floor” to the ICU, pt requires a higher assistance level).
Hospital Emergency Codes
What does the source state about hospital codes?
Codes vary by facility.
Health Care-Associated Infections (HAIs)
What is stated about the frequency of HAIs?
Occurs in 1 out of every 31 patients.
What is stated about HAIs as a cause of death?
They are the fourth leading cause of death (yikes).
What basic measures of prevention are mentioned for HAIs?
Varied means of patient exposure, every patient treated as if they have a transmissible disease, using full PPE for any patient on contact/droplet precautions.
What approach was taken in 2020 regarding patient treatment and Personal Protective Equipment (PPE)?
2020: Every patient treated as if they have a transmittable disease; therefore, don personal protective equipment (isolation gown, gloves, face shield or goggles and N 95 filtering mask or higher respirator, head covering when necessary) when entering a patient’s room who is on contact/droplet precautions.
Elements of the Infection Cycle
What are the elements of the infection cycle listed?
Infectious Agent
Reservoir
Exit
Transmission
Infection
Susceptible Host
What are the common means of transmission mentioned?
Contact
Droplet
Airborne
What are some aseptic techniques listed?
Protecting the caregiver and others
Barriers: skin and cilia in the lungs
Cleanliness of equipment, floors, and restrooms
Proper control of heat, light, and air
PPE use and disposal
Hand hygiene activities
Medical Asepsis
What is the purpose of medical asepsis?
Designed to keep pathogens confined to a specific area, object, or person
What may medical asepsis involve?
May involve isolation in a private room of a patient having a communicable or transmissible disease
What approach is used in medical asepsis?
Use of the “clean approach”
Standard Precautions
What are Standard Precautions?
Standard precautions are a group of infection prevention practices used to prevent the transmission of infectious agents that apply to all patients. Applies to blood, all body fluids, secretions, and excretions except sweat.
What do Standard Precautions apply to?
All patients
Who are Standard Precautions designed to protect?
Health care workers and patients
What is the purpose of using Standard Precautions?
They are used to decrease the risk of transmission of pathogens.
Transmission-Based Precautions
Who are Transmission-Based Precautions designed to protect?
Protects caregivers from specialized patients with highly transmissible pathogens
What techniques might be used in Transmission-Based Precautions?
Hand hygiene, using gloves and/or gown, mask or respirator, eye protection or shield PRN, proper care of the patient’s skin, linens, and personal items.
When to perform Hand Hygiene?
List situations when hand hygiene should be performed according to the source.
Hand hygiene should be performed before and after patient contact, before and after contact with wounds, dressings, specimens, bed linen, and PPE, after contact with secretions, before and after toileting, after sneezing, coughing, or nose blowing, after removing gloves, and before and after eating.
Hand Rubbing: Basic Steps
Outline the basic steps for hand rubbing.
Remove jewelry from wrists and hands. Apply a small amount of product to the palm of one hand. Rub the product briskly over hands, covering all surfaces. Rub hands until dry. Perform hand wash after a specific number of hand rubs.
How long should hands be rubbed until dry?
15-30 Seconds
Handwashing
When is handwashing the preferred method according to the source?
Handwashing is preferred when hands are visibly dirty or soiled, or considered contaminated.
How long should you wash using ordinary soap?
40-60 seconds
What happens when an antimicrobial or germicidal agent is added?
Adding an antimicrobial or germicidal agent leads to antiseptic cleansing.
What type of soap should be avoided?
A bar of soap.
What are some potential contaminants mentioned in the context of handwashing?
Bar of soap, sink rims and basin, water splashes, towel dispenser, faucet handles, and operating lever of soap dispenser.
What are some best practices mentioned for handwashing facilities?
Knee- or foot-operated controls
Automatic soap and water dispensers
Soap-contained one-time-use brush
Basic Principles of Handwashing
List basic principles for handwashing according to the source.
Remove jewelry.
Avoid artificial fingernails or chipped nail polish.
Trim nails to less than ¼ inch.
Use proper care for irritations, lesions, or breaks in skin.
Use warm water.
Process:
Wet hands.
Apply soap.
Rub briskly, covering all surfaces and creating friction.
Isolation Precautions: Transmission-Based Precautions (TBP)
On what concepts and principles are TBPs based?
The cycle of infection
medical and surgical asepsis
What are the routes of transmission mentioned in relation to precautions?
Contact: direct (person) or indirect (object)
Respiratory droplets: sneezing, coughing, talking
Airborne: small infectious particles in the respirable size range
Environmental: contaminated water or food
What items are typically found on a cart outside the room for Isolation Precautions?
PPE, biohazard bag, and other necessary materials/supplies
What should the caregiver be aware of regarding the patient's condition and transmission?
The mode of transmission for the specific disease or infection.
When providing care outside the patient's room, what should be done?
Use additional precautions and cleansing
Protective Isolation: Precautions
What are some precautions listed for protective isolation?
Apply protective garments carefully
Avoid causing excessive air currents
Do not wear protective garments from one patient room to another
Perform proper hand washing before applying and after removing protective garments
Donning PPE for Isolation Precautions
What is the sequence listed for donning PPE?
Hand hygiene
Gown (Neck + Back or side tie)
Mask or respirator (Adjust nose piece)
Goggles or Face Shield
Gloves
Removal of Contaminated Protective Garments
What specific instructions are given for removing contaminated garments regarding touching areas with hands (gloved or ungloved)?
Do not touch any area of your body with gloved hands.
Do not touch the sleeves or the front of the gown with ungloved hands
Do not touch the outer surface of the glove with the ungloved hand.
Removal of PPE
What is the sequence listed for removing PPE?
Gloves
Gown
Exit the room
Perform hand hygiene
Remove face shield or goggles
Remove and discard the face mask or respirator
Perform hand hygiene
Disposal of Instruments and Clothing
How should contaminated instruments and clothing be handled according to the source?
Clean instruments & equipment according to policies and procedures
Place contaminated instruments & clothing in appropriate containers
Wear gloves during labeling and disposal
Glove Techniques for Asepsis
What glove techniques are mentioned?
Open glove technique and closed glove technique
Which technique is stated to have more risk of contamination?
Open glove technique
Which technique is used to reduce the risk of glove contamination?
The closed-glove technique is used to reduce the risk of contamination
OSHA Guidelines
What are some OSHA guidelines listed in the source?
Use protective equipment and clothing
Dispose of wastes in proper containers
Dispose of sharps in proper containers
Keep work and patient care areas clean
Wash hands before and immediately following the removal of gloves
Intensive Care Unit (ICU) - Orientation
Describe the patients typically found in the ICU according to the source.
Acutely ill and requiring extensive nursing care
May need life support equipment
Therapy Progression of ICU Patient
What steps are listed for therapy progression with an ICU patient before starting treatment?
Check vital signs and medical stability
Assess the level of alertness and ability to follow commands
Therapeutic exercises in all planes
Assess bed mobility and supine to sit transfer
Sitting on the edge of the bed
Establish measurable and attainable goals
Establish a treatment plan
EOB (Edge of Bed) activities
Transfer training
Gait training
What are some suggested treatment plan items mentioned for an ICU patient?
Therapeutic exercises in all planes
Assess bed mobility and supine to sit transfer
Sitting on the edge of the bed
Establish measurable and attainable goals
Establish a treatment plan
EOB (Edge of Bed) activities
Transfer training
Gait training
Before providing treatment…
What should be done before providing treatment according to the source?
Chart review
Talk to nursing or physician to confirm pt status/orders
Confirm you have the right patient
Introduce yourself, your role, and your goals/expectations for the session
How do you confirm you have the correct patient?
Pt identifiers x3: Full name, DOB, pt identifier wrist band
What should you do upon introducing yourself to the patient?
Introduce your name, role, and your goals/expectations for the session
Chart Review 101 - General Guidelines
What general information should be sought during a chart review, according to the source?
When did they come into the hospital/ for what, diagnosis, medical hx, pain, anticipated length of stay and discharge location, family support, prior level of function, change in status, is there an order for PT, what does the the physician prescription (order) ask you to do, treatment goals, past Pt daily notes, patients response to treatment, POC
Chart Review 101 - Specifics
What specific information is highlighted as important to know from the chart for an Orthopedic diagnosis?
precautions, surgical protocol
What specific information is highlighted as important to know from the chart for a Neuro diagnosis?
Dx and severity, symptoms, orientation, alertness, able to follow commands, motor impairments, discharge plans
What specific information is highlighted as important to know from the chart for a Med Surg diagnosis?
type of surgery, assistive device needs, follow-up, anticipated length of stay
Oxygen Therapy Systems
What are some modes of oxygen delivery listed?
nasal cannula, oronasal mask, nasal catheter, tent, tracheostomy mask, or catheter
What are some types of oxygen used in inpatient settings?
Nasal pillows, pulse oximeter, BiPAP
According to the source, is placing or removing oxygen within the PTA's scope of practice?
We, as PTA’s may not remove or place oxygen without consent; decreasing or increasing is not within our scope of practice.
Oximetry
How does a pulse oximeter measure SpO2?
Infrared light reads the amount of hemoglobin bound to oxygen through the fingernail.
What is stated as a normal SpO2 value?
90% and above
What are some factors that could cause bad readings on a pulse oximeter?
fingernail polish and poor placement
Blood Pressure in Acute Care
What is considered normal blood pressure according to the source?
120/80
What is considered hypertensive?
>130/>80
What are some hypertension risk factors mentioned?
obesity, inactivity, nicotine, alcohol, salt, DMH, contraceptives (for women)
What are some comorbid correlates mentioned in relation to hypertension?
CAD (coronary artery disease), CVA (cerebrovascular accident/stroke), PVD (peripheral Vascular Disease), CHF (congestive heart failure)
What are the cutoff values for starting therapy based on initial blood pressure?
Initial values over 180/100 mmHg
What blood pressure value indicates a therapy session should stop?
200/110 mmHg
What are the heart rate cutoffs mentioned?
>120 or <60 bpm
Hypotension
How is hypotension defined in the source?
Systolic pressure < 100 mmHg
What are some symptoms of hypotension?
Dizziness, syncope (passing out/fainting)
Describe the steps of the Postural Hypotension Test as outlined in the source.
Supine x 1-3 min > then take BP
Take Pt from supine to sitting and immediately take BP after transition. Then wait 1-3 min.
Take pt from sitting to standing and immediately take BP and wait 1-3 min.
Positive if drop in systolic > 20 mmHg or >10 mmHg diastolic
What indicates a positive test for postural hypotension?
Positive if drop in systolic > 20 mmHg or >10 mmHg diastolic, or if they are still dizzy or unstable
Respiratory Rate in Acute Care
What constitutes one respiration?
One respiration = cycle of inspiration + expiration
What characteristics are used to describe respiration?
Deviation with rest, quiet, activity
What are the normal respiratory rates given for adults and infants?
For adults, it is 12-18, and for infants, it is 30-50.
Assessing / Rating Pain
What scale is mentioned for rating pain?
0-10 scale
What are some objective signs of pain listed in the source?
Facial Grimace
Open wounds – impaled
Rub legs
Shaking/ringing hands
Trunk rocking back and forth
Changes in position
Symptoms do not change with distraction
Perseveration
What might you document if the subjective report of pain does not match objective findings?
“Subjective report does not match objective findings.”
Lines
What are some common lines mentioned in the source?
O2
IV
Foley Cather
Telemetry
SCD
NG tube
What are some other common types of lines listed?
PICC line
Central line
Swan line
Indwelling catheter
Arterial line
Intravenous Therapy – “IV”
What should you do immediately if an IV is pulled out by you or the patient?
Notify nursing immediately
What are some potential complications of IV therapy listed?
Infiltration
Phlebitis
Cellulitis
Thrombosis
Local hematoma
Sepsis
Pulmonary thromboembolus
Air bolus
Catheter fragment embolus
Urinary Catheters
What are the types of urinary catheters mentioned?
Indwelling (catheter through the urethra), for example, a Foley catheter, a suprapubic catheter
External (males only)
What are urinary catheters used for?
Used for loss of voluntary control or micturition (a process where urine is expelled from the body)
What are positioning guidelines for a Foley catheter?
Needs to be downhill from the body
Position on top of, not under, the leg
Will be biased to the R or L side
What should you do if a Foley catheter bag is too full?
Talk to nursing
Telemetry
What is an important instruction given regarding telemetry?
Never unplug. It's mobile!
It broadcasts info to pt room and the front desk
Sequential Compression Device – “SCD"
What is the purpose of SCDs?
Decrease the risk of blood clots.
How do SCDs work (sequential compression)?
Compression from distal to proximal
Do SCDs typically require adjustment of compression values?
They are preset. NO adjustments
What area(s) can SCDs cover?
Calf and thigh
Nasal Gastric (NG) Tube
What angle should the Head of Bed (HOB) be inclined for a patient with an NG tube?
30 degrees inclined
What should be done if the tube is detached from suction?
The other end must be plugged
Checking for Orientation
What factors are typically assessed when checking for orientation?
PPST: person, place, situation, and time
Hospital Bed Orientation
What functions of a hospital bed are mentioned?
Movement (HOB, legs up, elevate, put down, CPR)
Breaks
Railings
Weighting
Alarms
What potential issues are mentioned regarding prolonged sitting in hospital beds?
Contractures
Hospital Bed - Types
What types of hospital beds are mentioned?
Bariatric
Air Bed with an air liner
Anti-trendelenburg
Orthopedic
Trendelenburg
Cardiac
Feet elevation
Semi-fowler
Help to stand up
Fowler
sitting
Positioning Pillows – Turning Schedule
What types of patients are listed as being at risk for developing pressure ulcers?
Low weight
Decreased sensation
Decreased alertness
Prolonged hospitalization
Decreased movement
How often should patients at risk for pressure ulcers be turned or have their position changed?
Every 2 hours
What details are suggested for charting related to turning schedules?
Chart about when you educate nurses and pt about the when, how, and why to turn the pt
Transfer Training
What methods are mentioned for transfer training (rolling, scooting/boosting, EOB, sit to stand)?
Rolling: 1-2 people, put pt in hip and knee flexion (4 shape) to roll more easily, option to use the sheet, use of pillows, note: consider BLT precautions here
Scooting/boosting: pull the sheet to scoot, use the Trendelenburg function to scoot pt up the bed, use reverse-Trendelenburg to scoot pt down the bed
EOB: Flatten the “bump slump” first, to assist pt, scoop under their shoulder and knees at the same time, and pivot to bring them to sitting
What does sitting on the edge of the bed (EOB) assess?
Assess pt’s core strength and fall risk (muscular strength and endurance), ability to progress, and toleration to change in position (ex: looking for a drop in BP)
Gait Training in Acute Care
What is the primary safety rule mentioned for gait training?
Use a gait belt
What should be done before starting gait training?
ask for pt consent and precautions, check vitals such as O2 levels, double check assistive device, lower or raise the bed to appropriate height, check pt footwear, appearance, and mental alertness, check for INCREASED FALL-RISK: 1. 5+ medications, 2. assistive devices, 3. weakness
What should be planned for regarding the session?
Check the chart for history, precautions, and gait pattern, plan what to work on, defensive walking (any hazards around to trip on), PPE, goals, tx plan, bed mobility,
What types of lines might need management during gait training?
IV, foley catheter, telemetry (heart monitor), sequential compression device, NG tube (feeding tube)
What kind of instructions should be used?
Simple instructions!
Supervision in the Hospital for PTA
What question is posed regarding the level of supervision needed for a PTA in the hospital?
General Supervision is common, however, it could be direct supervision depending upon the patient and their regulations.
Charting Transfers
What guidelines are provided for charting transfers under the "O" section?
Level of assistance, how many helpers, type of transfer, transfer surfaces, # and direction of transfers
What guidelines are provided for charting transfers under the "A" section?
Response, level of assist changes compared to previous attempts, education or instruction to improve performance, reference pt goals
Notes on Notes
What important point is mentioned regarding patient consent in the inpatient setting?
They still have a choice to be seen
What are the suggestions regarding documenting communication?
Communicate things such as checking c the surgeon to make sure precautions are still in place, doing a chart review and communicating with nurses before tx, and informing the nurse of things you noticed during tx so that they can notify the doctor. Document all of this communication!!
What details should be included regarding the patient's ending position at the conclusion of the session?
The position the patient was left in, with the call light in reach, and whether there was anyone in the room when you left the patient.
Common Medications / Medications – tips from past PTA student
What range is given for Hemoglobin, and what activity precaution is associated with a value less than 8?
Normal values are 12-18 g/dl, and if it's "less than 8, don't ambulate".
How is Hematocrit related to Hemoglobin values?
Hematocrit is roughly 3x the values for hemoglobin
What mnemonic is suggested for Beta blockers?
Beta blockers all end in "olol" (atenolol, metoprolol, propranolol), "basketball or bball" because beta starts with a b and ends in olol and it sounds similar.
What mnemonic is suggested for ACE inhibitors?
ACE inhibitors end in "pril" (lisinopril), "APRIL" to remember.
What explanation is given for anticoagulants and the suggested mnemonic?
Reduce risk for blood clots "don't want them 'in' me" because warfarin, coumadin, and heparin end in "in".
What is atorvastatin used for?
for cholesterol
Reference Laboratory Values - Katelyn Welch
What are some types of laboratory values mentioned as relevant for PTAs?
Cardiac status (enzyme levels)
ABG analysis (oxygenation level of blood)
Blood chemistry (RBC, WBC, Hgb, and Hct)
What tables are referenced for Arterial Blood Gases/Blood Chemistry values and exercise precautions with abnormal blood values?
Table 10.1 and Table 10.2
Anticoagulation
What is the purpose of anticoagulants?
Reduce the risk of blood clots
What are some examples of anticoagulants given?
Warfarin, Coumadin, Heparin
What does INR stand for?
International normalized ratio
Guidelines for exercise, says how thick blood is
What is considered the normal range for INR?
0.8-1.2
What activity is suggested for an INR value < 4.0?
Participate in PT and Ot evaluation and regular exercise (no progression)
What activity is suggested for an INR value between 4.0 and 5.0?
Light exercise, no resistive exercise
What activity is suggested for an INR value > 5.0?
Hold exercise or evaluate current mobility for safety and assist in discharge planning.
What activity is suggested for an INR value > 6.0?
Bed rest, no stairs, or resistive exercise
Stages of Dying (Coping with Death or Grief) - Iascara
List the stages of dying mentioned.
Denial - •“I can’t believe this is terminal”
•Avoid trying to make the patient accept their condition
Anger - •“Why me?
•Therapists should avoid taking anger personally
Bargaining - •Deal making with a higher being in exchange for something
•Good behavior, compliance with HEP, dedicating their life to a cause
Depression - •Deep depression, may show little interest in medical intervention
•Therapist should listen and show patience during this stage
Acceptance - •Individuals come to terms with their fate
•They may experience sense of inner peace
•Therapist encourage pt’s to spend meaningful time with people they love
What is suggested for therapists during the Denial stage?
Therapists should avoid trying to make the patient accept their condition
What is suggested for therapists during the Anger stage?
Therapists should avoid taking anger personally.
Describe the Bargaining stage.
Deal-making with a higher being in exchange for something
Good behavior, compliance with HEP, and dedicating their life to a cause
What should the therapist do during the Depression stage?
The therapist should listen and show patience during this stage
Describe the Acceptance stage and what therapists should encourage patients to do.
Individuals come to terms with their fate
May experience a sense of inner peace
The therapist should encourage pt’s to spend meaningful time with people they love
EDGE Principles for Family Training
List and briefly describe the four EDGE principles for family training.
E – educate: instruct proper setup, technique, safety, application, and troubleshooting
D – demonstrate: show how to perform the task.
G – guide: Have the person perform the task and help them troubleshoot their own difficulties
E – enable: give them the opportunity to apply the newly acquired skill or knowledge. This reinforces learning and builds confidence
What is the goal of the "Enable" principle?
Independence returns
A small talk on small talk
What are the 5 suggested items to start a conversation, according to the source?
Where do/have you lived?
What kind of work do you do?
What do you do for fun?
Do you have any children/grandchildren?
Do you have any pets?
What should you do if the patient is super quiet?
If your pt is super quiet, answer these questions about yourself
What caution is given regarding conversation topics
Careful not to pry too deep