IPC Test- 1

>___ -Used to measure the length of time a patient can walk before claudication is experienced The patient walks on a level-grade treadmill at 1 mile/h until claudication occurs; the time elapsed is recorded when calf pain prevents continuation of walking The test can be repeated at specified intervals, and the time elapsed values can be compared

Claudication

-___ (e.g., Collagen/Ag, BIOSTEP, and Medifil) >When added to a wound, it acts as a hemostatic agent; continued application seems to hasten healing; it absorbs 40-60 times its weight in fluid

Collagen

Rationale for Client/Patient: -___ approach -Reduction in duplication or fragmentation of professional services and activities -Team is better able to address complex problems -Team decision making is better because of input from different professionals -Results in interventions for complex problems that exceed what an individual could accomplish

Comprehensive

___ are used to control edema in an extremity, assist in the return of venous circulation in a lower extremity, and decrease the formation of extensive scar tissue resulting from a burn. These applications would be beneficial to decrease the development of ___ for a person who has been burned.

Compression garments scar tissue

Orientation: Name the 4 I's: ___-> ___-> ___-> ___ PROCEDURE 1.1 Always confirm patient and diagnosis Direct access Red flags

Introduce -> inform -> interview -> instruct

Heat Related Illnesses: •Remove or reduce the cause of illness, return to normal state •Hot, humid environment; vigorous PA; dehydration; deleted body electrolytes •___ in legs and abdomen •Treat by ___, increased ___ intake, gentle stretching and massage

Muscle cramps rest fluid

•3-point: involves a sequence of three moments of contact with the floor to complete the cycle. ●___ patients

NWB

Ambulation Pattern, Weight-Bearing Status, and Appropriate Walking Aids: >Three-point -Weight bearing status- ___ -Walking aid- ___, if indicated; progress to ___

NWB Walker bilateral crutches

Continued: ___ is a congenital malformation, whereas ___ generally is acquired after surgical removal of lymph nodes, infection of the lymphatics, radiation therapy for cancer, or trauma. Lymphedema can occur in any body part but usually is seen in the ___ and is a chronic condition if it is left untreated.

Primary lymphedema secondary lymphedema limbs

Screening Exam: •Tests in Sitting ●Sits without ___ support. ●If cannot sit without UE support, test with UE support. If pt cannot sit with UE support, screening exam is ___ ●Push up- test ___ ●Grip Strength ●LE ROM and strength ●Sit to Stand ●If pt cannot assist with sit to stand, do not attempt ___

UE over triceps ambulation

•Total Hip Replacement ●Posterior vs Anterior Approach •Low Back Trauma or Discomfort ●Spinal precautions •Spinal Cord Injury ●Spinal precautions, weakness, spasticity, syncope, osteoporosis •Burns ●Graft sites •Hemiplegia ●___ weakness, neglect, spasticity, affected shoulder separation

Unilateral

Sitting, Independent Transfer: In a sitting, independent transfer, the patient is able to move safely and efficiently from one surface to a second surface while in a sitting position without ___ from another person.

assistance

>___ -Safe choice for unstaged wounds; use on stage II partial-thickness wounds and stages II and IV wounds; dressing will need to be changed every 8 h to maintain moist wound base; moisten dressing with saline solution before removal if dressing is dry to prevent bleeding and disruption of granulation bed; moisture barrier must be used on surrounding tissue to prevent maceration

Wet to wet

On people with a dark complexion, the only signs may be the ___, and thus it may be necessary to describe the affected area using objective and subjective information.

cardinal signs of inflammation

The term "___" (rather than therapist, nurse, health care practitioner, therapist assistant, technologist, technician, aide, or family member) is used to designate the person who is treating or working with the patient or client. Sometimes the term "___" is more appropriate to describe a person who receives treatment. Furthermore, the term "___" may be used to describe the person who receives care.

caregiver client consumer

Goals of CPT include improvement of airway ___, ventilation, and ___ tolerance; reduction in the work of ___; and restoration of the patient to the fullest potential in the inpatient, outpatient, pulmonary rehabilitation, and home care settings

clearance exercise breathing

Heat stroke: No ___ (THIS IS HOW DIFFERENT FROM HEAT EXHAUSTION) - skin is dry, nausea, headache, labored breathing, strong/rapid pulse, flushed color or changes to gray, temperature very elevated (106-110 deg), exhaustion/collapse/convulsions, unconscious, pupils contract then dilate

diaphoresis

The calibrated container, which is usually a column, collects the ___. After the water is collected in the container, it should be placed on a firm, level surface and at a height that allows the caregiver to read the scale at eye level.

expelled water

Sports WC: •Low-profile •Fixed ___ •Lightweight (15-24 lbs) •Features including low back, cantered rear wheels, fixed or adjustable axels, fixed or adjustable seat/backrest •Bought or customized for various sports activities

frame

Prone position: When a patient is in the prone position, place a small pillow or towel roll under the patient's ___, or position the head to the left or right A rolled towel should be placed under each anterior shoulder area to ___ the scapulae, reduce the stress to the interscapular muscles, and protect the head of the humerus. The patient's upper extremities may be positioned for ___

head adduct comfort

You CANNOT make a physician's diagnosis, can only say where their pain is, weakness is, or where stiffness is. But CANNOT say they have a "rotator cuff tear" or some other physician ___ Need to know how long it'll take to heal, what needs to be done, and what ___ need to be taken >___- how often will you see them/how long to achieve the goal you need Interventions next Then ___ all over again- goals may be different at this point

diagnosis innerventions Plan reevaluate

Differential Diagnosis: Symptoms associated with ___ needs to be determined Clinical reasoning is required to differentiate symptoms Arrive at initial diagnosis >Problem solving requires: -Knowledge -Evidence -Clinical reasoning

two or more illnesses/conditions, and the condition

Assessment of Respiration: •Do not explain to patient - will produce a ___ •Either watch, feel while simulating radial pulse, or palpate at the thorax •Count either the ___ OR ___ for 1 minute

voluntary response inspirations or expirations

Standing, Standby Pivot: Patients using this transfer may be able to stand, pivot, and sit as they move from one object to another. The assistance required may vary from ___ to close or casual ___.

verbal cueing guarding

Continued: The exudate stage can have any of several appearances: ___ (typically pale yellow and transparent, as in a blister), ___ (pus), fibrinous (clotting), or ___ (bleeding). In the ___ stage, a fluid passes through the walls of vessels into adjacent tissues or spaces to help deposit fibrins and leukocytes, which are necessary to initiate wound healing. During the ___ stage, damaged cells are replaced and true wound healing begins. Damaged cells are removed through phagocytosis, which is accomplished by polymorphonuclear cells and monocytes

serous purulent hemorrhagic exudate reparative

Seat too ___: •Decreased trunk stability due to less support under thighs •Increased weight bearing on ischial tuberosities because body weight will be shifted posteriorly as a result of lack of thigh support •Poor balance because BOS has been reduced Seat too ___: •Increased pressure in popliteal area leading to skin discomfort or compromised circulation

short long

SAFETY CONSIDERATIONS AND PRECAUTIONS: Proper guarding techniques must be used to protect the patient during ambulation and associated functional activities. Guarding from ___ of the patient is not recommended because this position does not allow you to move smoothly with the patient, it blocks the patient's view, you cannot see objects or hazards behind you, and you must stay too far from the patient to have sufficient space for a step to be taken.

in front

Standing with Axillary Crutches (See Fig. 9-21) • The patient establishes balance and uses the right hand to place one crutch in the right axilla; the remaining crutch is placed in the left axilla using the left hand (D). • The crutches are positioned to form a ___ before ambulating.

tripod

Volumetric Measurement: Volumetric displacement using a volumeter is a method of measuring changes in the distal aspect of an extremity caused by edema or muscle atrophy. The technique is more accurate than girth measurements because of the ___ of the hand and foot, but it requires proper equipment.

irregular shape

Partial Squat Lift or Stoop Lift >For small light objects with handles close to ___ height

knee

Safety first: oMake sure transfer surfaces are ___ (wheelchairs, beds, etc.) oMove foot rests, arm rests, or anything obstructing path oUse a gait belt oMaintain proper body mechanics oPosition patient's ___ side toward the bed or transfer surface oCommunicate steps with patient oBlock weak areas

locked stronger

Ear Thermometer: A thermometer that measures body temperature on the basis of heat generated by the ear canal and its surrounding tissue (Fig. 3-2) is especially useful for infants, toddlers, and older persons for whom it is difficult to use an ___.

oral thermometer probe

PUSHING AND PULLING ACTIVITIES Flex your knees and face the object squarely. Use your arms and legs to push or pull; push with your arms partially flexed. Push or pull in a straight line; your force should be ___ to the floor. Be certain there are no objects in your path and doorways are wide enough for the object to pass through.

parallel

Standing, Independent Pivot: With a standing, independent pivot, the patient is able to perform the entire transfer safely and consistently without any ___ or ___ from another person.

physical or verbal assistance

Rationale for Lumbar Lordosis Posture: Lordosis reduces ___ to the lumbar ligaments and the intervertebral disk. • When the back is in the lordosis posture, compression forces on the intervertebral disk are directed ___ rather than posteriorly, a direction that reduces the potential for a posterolateral rupture of the disk.

mechanical stress anteriorly

Dressings and Bandages: -The composition of a dressing and its bandage varies, but in many instances several layers are involved. -The functions of a dressing are to prevent additional wound contamination, keep ___ in the wound from infecting other sites, prevent further injury to the wound, apply pressure to control hemorrhage, absorb wound drainage, and assist in wound healing.

microorganisms

•Selection of appropriate ___ is dependent upon patient's: •Balance •Strength •Coordination •Functional needs •Weight-bearing status •Energy level

gait pattern

Electrical lift: The patient can be raised and lowered by ___ on the control unit. The remainder of the features of the lift are similar to those of the manual lift

pressing a button

Red areas indicate areas of ___, and pale (or blanched) areas may indicate severe, ___

pressure dangerous pressure

DESCENDING A CURB, STAIR, OR RAMP: GUARDING THE PATIENT FROM THE FRONT: • Follow the general considerations listed previously in this procedure. • Stand ___ and ___ of the patient in the area where there is the least protection. • Place your outside foot on the step onto which the patient will step; place your other foot on the step below.

in front and to the side

Causes: A pressure ulcer is a wound that develops as a result of two primary factors: • Pressure on soft tissue that exceeds the normal capillary ___ of the local circulation • The application of friction or shear force to ___

pressure superficial skin

Sitting position: The patient should be seated in a chair with adequate support and stability for the ___, which can be provided by pillows, belts, straps, or the back of the chair, or by leaning forward onto a treatment table. The patient's lower extremities should be supported with the feet on a footstool, on the footrests of a wheelchair, or on the floor.

trunk

Continued: When Balance Is Lost Forward • Pull back on the gait belt, use your other hand to pull the ___ upward and back, and do not pull on the patient's clothing or upper extremity. • It may be helpful to push forward against the ___ as you pull back on the trunk. • Help the patient regain a balanced position or help him or her to the floor or a chair.

trunk pelvis

A ___ should be established for patients who are confined to bed. Data do not indicate how often patients should be turned to prevent ischemia of soft tissue, but ___ in a single position is the maximum duration recommended for patients with normal circulatory capacity.

turning schedule 2 hours

Continued: Infection- The pulse rate tends to ___ with a major infectious process Physical activity- Normally the pulse rate should ___ rapidly in response to vigorous physical activity, plateau or stabilize as the intensity or severity of the exercise plateaus, and then decline as the intensity of the exercise declines; the pulse rate after exercise should revert to the person's resting pulse rate within ___ to ___ after cessation of exercise; a person with a conditioned cardiopulmonary system will probably exhibit less change in the pulse rate, and the rate should return to its normal resting level in a shorter time than that required by an unconditioned or debilitated person

increase rise 3 to 5 minutes

Emotional status- The pulse rate ___ during episodes of high stress, anxiety, or emotion (e.g., anger or fear) and may ___ when the person is asleep or in a state of extreme calm Medications- Various medications may cause the pulse rate to increase or decrease, depending on their effect on the cardiovascular system

increases decrease

Abnormal Responses Exhibited by Respiration Rate: • The respiration rate slowly ___ during exercise or activity. • The respiration rate does not ___ during exercise or activity. • The respiration rate increases as the intensity of the exercise or activity plateaus. • The respiration rate slowly ___ as the intensity of the exercise or activity declines and terminates. • The respiration rate does not decline as the intensity of the exercise or activity declines. • The respiration rate declines during exercise or activity before the intensity of the exercise declines. • The increase in the rate or the amount of increase in the patient's respiration rate is excessive during the exercise period. • The rhythm of the respiration pattern becomes irregular during or after exercise or activity

increases increase declines

Continued: • Take your time and lift the item with a smooth motion; avoid ___ movements. • Perform all activities within your physical capability. • Do not lift an object immediately after a prolonged period of sitting, lying, or inactivity; gently ___ the back and lower extremities first. • When performing a lift with two or more persons, instruct everyone how and when they are to assist; use a mechanical lift or other appropriate equipment if it is available.

jerking stretch

Pivot Technique: >When you must lift an object and then turn to carry it away, it is common to ___ the body. >Twisting while lifting can cause serious damage to the tissues of the ___. >Use the ___ technique to avoid twisting while lifting.

twist back pivot

Continued: Wrap the tape snugly over the dorsum of the wrist and then "lay on" the tape on the volar surface to avoid compression of blood vessels and the median nerve. Repeat the wrap ___ or ___ repetitions and ask the patient to extend and flex his or her wrist; motion should be limited. When treating a patient for tennis elbow, have him or her wear an adjustable tennis elbow strap approximately 1 to 2 inches ___ to the olecranon process

two or three distal

Continued: Instruct the patient to (1) ___ with the lower extremities (i.e., perform a bridging maneuver) to lift the pelvis and move it toward the abducted upper extremity and (2) elevate the upper trunk by pushing into the bed with the elbows and the back of the head to move toward the abducted elbow

push down

Continued: The patient lowers the hips onto the chair using the upper extremities and the stronger lower extremity and then positions the body in the chair by moving the hips back into the seat. It is important to teach the patient to ___ on the walker hand grips and avoid pulling or pushing the walker when attempting to stand or return to sitting.

push down

Continued: • A second person stoops or squats at the side of the patient's lower extremities, facing the bed, and positions one forearm under the thighs and one forearm under the lower legs to cradle the lower extremities. • The person standing behind the patient instructs the patient to ___ and hold the position with the shoulder muscles. • On command from the person standing behind the patient (e.g., "One, two, three, lift"; "Ready, lift"; "Prepare to lift"; or "Lift"), the two persons simultaneously lift and place the patient on the near side of the mattress; the patient's knees should be ___ during the lift. • The patient is maintained in an upright position (longsitting position) by the person at the patient's back while the other person moves the wheelchair. • The two persons partially lift and move the patient to a safe position on the bed; the person holding the forearms or safety belt helps the patient lie down and adjust the body position for safety and comfort

push down straight

Continued: A person whose normal core temperature is 98.6° F or higher is considered to have a fever, or to be ___, with a temperature higher than 100° F (38° C). A person is considered to be ___ with a temperature higher than 106° F (41.1° C).

pyrexic hyperpyrexic

Sitting, Dependent: One-Person Dependent. -The one-person lift transfer (sometimes referred to as the "___") can be used when a patient is unable to stand or is unable to perform any type of ___ and when the assistant is sufficiently strong and skilled to perform the lift.

quad pivot assisted transfer

Emergency Care: •Provide immediate initial aid •Make effort to obtain immediate assistance from the most ___: physician, nurse, EMT •Document in medical record ▫Type of care given and by whom ▫___- maybe create an account of what they saw ▫Who was notified, time, events leading up to •Notify superior and/or risk manager •File ___

qualified individual Witnesses incident report

Assessment of Pulse: The most common sites used are the ___ and ___ arteries because they are easily accessed. The temporal or carotid sites can be used when access to the radial site is restricted.

radial and carotid

Stair and Curb Navigation: •Walker- have the patient turn the walker with the cross bar towards them, only works if patient has a ___, up with good and down with bad- have a family assist them with navigating stairs at home with walker, patient needs to be strong enough and safe enough

rail

Stair and Curb Navigation: Instruction will depend ●1) Assistive device ●2) number of ___ - none, one, or two ●3) curb height

rails

Continued: The patient's upper extremities may be elevated on pillows or positioned in whatever way the patient desires for comfort (such as by the patient's side, in a ___ position, or folded on the chest). The patient's body and extremities should be totally supported on the mat or table.

reverse T

Head and Trunk: >side-lying position (Lowermost extremity): ___, ___, ___

-lateral ear -lateral rib -lateral acromion process

Continued: When Balance Is Lost to One Side, Toward You • Move your body so you face the patient's ___, widen your stance, and use your body to support the patient. • Help the patient regain a balanced position or help him or her to the floor or chair.

side

Hypoglycemia: Onset: sudden, skin: pale, moist, behavior: agitated, irritable, Breathing: normal/shallow, hunger: present, thirst: absent, glucose in urine: absent or slight, shakiness: present, sweating: present, tingling sensation in mouth: present, visual disturbance: double vision, headache: absent

.

Palpate patient areas- guidelines: Skin and subcutaneous tissue to determine texture, temperature, color, laxity, firmness, pliability, edema, presence of scar formation, and nodules Muscles, tendons, ligaments to determine tone, pain, bulk, composition, stability, and laxity Joints to determine swelling, shape, response to movement, joint space, crepitus, stability, and presence of pain Bony structures to locate landmarks and to determine alignment, response to pressure, and presence of pain Arterial pulses to determine presence or absence, rate, rhythm, and force Respiratory rate

.

Positive Psychology: •Shawn Achor -Harvard graduate -Co-Founder and CEO of GoodThink, Institute of Applied Positive Research -New York Times best selling author for "Before Happiness" and "The Happiness Advantage"

.

Progression of Plan of Care: >Assess/Examine/Evaluate-> Diagnosis-> Prognosis-> Plan-> Innerventions

.

Reporting Respiratory Rate: •Rate •Rhythm •Depth •Character •Abnormal sounds: wheezing, rales, stridor •Orthopnea, apnea, SOB

.

Review other reports and tests when available- guidelines: Radiograph films, scans, other imaging reports Laboratory reports such as blood chemistry, liver function, urinalysis, general chemistry, and arterial blood gases. Electrodiagnostic tests such as electrocardiogram, electromyography, and electroencephalogram. Biopsy reports Speech, hearing, language, and vision tests and reports Psychological evaluations

.

Screening Exam: •Helps inform you on your patient's mobility and a safe transfer technique •To be performed prior to moving the patient because want to know what they are able to do and how strong they are •Tests in Supine: ●Arms overhead ●Open/close first ●Active knee to chest or passive knee to chest ●Perform Supine -> Sit

.

Standard wheelchair parts: WC fit may depend on: •Decreased sensory awareness •Inability to alter position •Presence/absence of subcutaneous soft tissue •Impaired peripheral circulation •Abnormal skin integrity Need for use for extended periods

.

Continued: •Avoid positioning the patient's extremities beyond the ___ surface- don't let legs hang off the mat •Avoid excessive, prolonged ___ to soft tissue and circulatory and neurological structures- ex. Don't have a lot of pressure in popliteal fossa in back of leg or axilla because lots of neurovasculature here

support pressure

Transfers: •Communicate with all involved •Use ___ instructions •Use body mechanics •Lead with "ready," or count - "on three" ●*The person at the ___ calls the shots •Give full attention •Anticipate unusual or unexpected events ●Locks on WCs or beds ●Barriers to movement (WC arm rests)

brief, concise head of the patient

The general rule to remember is that prolonged immobilization and failure to change positions frequently are precursors to the development of ___, ___, and ___

contractures, pressure areas, and decreased function

Posture and body control: >A healthy back has three natural curves: -slight cervical curve- ___ -slight thoracic curve- ___ -slight lumbar curve- ___ >Weak and inflexible abdominal, hip, and leg muscles cannot support your back's natural curves >Hip, knee, and ankle joints balance the natural curves, making it possible to maintain good posture in any position.

lordodic kyphhotic lordodic

___ are used to lock the caster wheels to prevent them from turning. Usually these locks have a pin or small flat metal bar that engages a hole or notch located in a metal ring attached to the caster wheel. Caster locks are an optional item for most wheelchairs.

Caster locks

___ of the hips and knees allows the lifter to lower the COG closer to the COG of the object and provides an effective position for the muscles of the lower extremities to perform the lift.

Flexion

>___ -Used to evaluate the arterial circulation by observing skin color changes that occur with the lower extremity elevated and level When the patient is supine, observe and record the color of the plantar surface of the foot (normal = pinkish); elevate the lower extremity approximately 45 to 60 degrees for 1 minute (abnormal = rapid loss of color) Return the extremity to a level position; observe and record the color of the plantar surface (normal = rapid pink flush; abnormal = 30 seconds or longer for color to appear; color will be bright red)

Arterial sufficiency tests Rubor of dependency test

Surgical Asepsis: Surgical asepsis techniques are used to exclude all microorganisms ___ they can enter a surgical wound or contaminate a sterile field before or during surgery. All personnel who enter the sterile field must perform a surgical hand scrub with a ___ and don sterile gloves and a sterile gown.

before antimicrobial agent

A drug can be a restraint when it is used to control ___ or restrict a patient's ___ of movement and when the drug is not a usual form of treatment for the patient's condition.

behavior freedom

Transfers: Principles and Concepts: •Lead with "ready," or count - "on three" ●*The person at the ___ of the patient calls the shots- even if don't use this person, make sure you know who is calling the shots •Give full attention •Anticipate unusual or unexpected events ●Locks on WCs or beds ●Barriers to movement (WC arm rests)

head

Assessment of Blood Pressure: The cuff must be the proper size to obtain an accurate measurement. If the bladder in the cuff is too narrow in relation to the circumference of the patient's arm, the reading will be erroneously ___; if the bladder is too wide the reading will be erroneously ___.

high low

Armrest too ___: •Poor posture or back discomfort due to excessive forward trunk inclination •Increased abdominal discomfort when leaning forward •Inadequate balance •Difficulty rising to standing due to poor functional position for push

low

Staging of Pressure Ulcer: >Stage I -Intact skin with ___ redness of a localized area, usually over a bony prominence; darkly pigmented skin may not have visible blanching—its color may differ from the surrounding area Further description: The area may be painful, firm, soft, warmer, or cooler compared with adjacent tissue; stage I may be difficult to detect in persons with dark skin tones; may indicate "at risk" persons (a heralding sign of risk)

nonblanchable

Continued: • Bronchovesicular sounds are high pitched and soft and are best heard between the ___. These sounds come from the mainstem bronchi. • Vesicular breath sounds are soft and low pitched and are heard over the periphery of ___ fields. The expiratory phase heard is ___ than the inspiratory phase.

scapulae both lung shorter

Split-Thickness Burns and Grafted Burn Areas: Healing or regenerating skin is likely to develop ___, and ___ are likely to occur. It is important to avoid prolonged positioning of the joints that have been affected by the burn or the graft used to repair the wound. Prolonged flexion or adduction of most peripheral joints should be avoided when the burn is located on the flexor or adductor surface of a joint. When the patient is unable to perform active exercise, ___ should be performed.

scar tissue contractures passive exercise

•Spinal Precautions?

BLT

Indications and Contraindications for Lymphedema Treatment: INDICATIONS: • Primary lymphedema • Secondary lymphedema • After a trauma, radiation • After a burn • After obstruction resulting from a tumor, scar, inflammation, or parasite • Idiopathic lymphedema • Postoperative edema • Venous or arterial ulcer • Scar treatment Contraindications: • Acute infection (the patient should be taking antibiotics at least 4 days before treatment) • Active cancer • Presence of congestive heart or kidney failure • After radiation treatment (requires medical clearance)

.

Mental and cognitive function- guidelines: Problem solving, planning, decision making, comprehension, response to instructions, and communication skills (verbal and written)

.

Pain- the fifth vital sign: •Onset •Temporal pattern •Location •Severity (Intensity - pain scales p 64-65) •Irritabilty (What relieves/aggravates) •Nature (Description - table 3-2)

.

Continued: •Back Height •4 fingers, hand held vertically, between the top of the back upholstery and the floor of the user's axilla •Inferior angles of scapulae should be approx. ___ above back upholstery

1 fingerbreadth

Forearm crutches: •Setup ●Top of forearm cuff should be located ~___ to ___" distal to olecranon process when patient grasps handpiece with cuff applied to forearm and wrist in neutral

1 to 1.5

Positioning guidelines: •Make skin checks initially every ___ •Reposition patient every ___ in bed, or every ___-___ in a chair •Support weakened extremities •Elevate dependent body parts- ex. If arm if pulling stroke patient's arm down, will end up with swelling here •Position the ___ before the extremities •Protect bony prominences and awareness of neural and vascular structures •Ultimate goal is good ___

10 minutes 2 hours 10-15 min trunk body alignment

Patients who are able to reposition themselves should be instructed to do so at ___ to ___ intervals

10- to 15-minute

Spreading Happiness: •___ rule -The Ritz-Carlton -10 feet: make eye contact and smile -5 feet: say hello

10/5 rule

Continued: Hypotension is defined as a systolic pressure that is consistently below ___ mm Hg. This condition is usually nonthreatening, but some hypotensive patients may experience dizziness or syncope when abruptly standing from a previous lying, sitting, or squatting position

100

The AHA has changed the guidelines for the first time since their inception in 1962 and now instructs bystanders (those not trained in basic life support techniques) to compress the person's chest at a rate of ___ times per minute to a depth of ___ until paramedics arrive or the bystander is unable to continue compressions. Untrained lay rescuers are no longer advised to stop the compressions to administer breaths to a person undergoing cardiac arrest who is found out in the community. A-B-C (Airway, Breathing, and Circulation) has been changed to ___ for those trained in CPR.

100 2 inches C-A-B or Circulation (chest compressions), Airway, and Breathing

Compress patients chest at rate of ___-___ times per minute to depth of ___-___ inches if a bystander and not trained in basic lift support techniques For persons trained: CAB (___, ___, ___)

100 - 120 2-2.4 circulation, airway, and breathing

CANES: • Position the cane so the tip is approximately ___ inches lateral and ___ to ___ inches anterior to the toe of the shoe. • Observe the angle of elbow flexion; it should be approximately 20 to 25 degrees.

2 4 to 6

•___: a sequence of 2 moments of contact with the floor to complete a cycle •Normal gait pattern

2 Point

frequent changes in the dependent patient's position—at least every ___—are necessary to prevent contractures and relieve pressure on the skin, subcutaneous tissue, and the circulatory, neural, respiratory, and lymphatic systems, as well as other structures.

2 hours

WALKERS • Position the walker in front of the patient so the rear tips of the walker are placed opposite to the midportion of the feet (foot). • Have the patient grasp the handpieces. • Observe the angle of elbow flexion; it should be approximately ___ to ___degrees when the patient grasps the handpiece and positions the device in preparation for ambulation.

20 to 25

Parallel Bars: Setup Each bar should provide ___ to ___ degrees elbow flexion when standing and grabbing bar ~___ in anterior to hips ___" wider than patient's trochanters Wrist crease, greater trochanter, or ulnar styloid process at ___ level Stand in front of the patient to assess

20 to 25 6 2 bar level

Wound Assessment: Length measurements are made along a line from ___ (head) to ___ (foot), and width measurements are made from ___ (left) to ___ (right).

12 o'clock 6 o'clock 9 o'clock 3 o'clock

Ultralight WC: •Lightweight (___-___ lbs) •May have rigid or folding frame •Can be made with titanium •Efficiency in ___ •Reduction in cumulative trauma to UE •Weight capacity to ___ lbs

12-30 propulsion 300

Depending on the source, accepted normal BP ranges in adults are systolic, ___ mm of mercury (mm Hg) or less, and diastolic, ___ mm Hg or less. A systolic/diastolic value of ___ mm Hg is frequently used as the normal value When the resting systolic pressure is consistently found to measure more than ___ mm Hg or the resting diastolic pressure consistently measures more than ___ mm Hg, the person is usually considered to be stage 1 hypertensive. A consistent reading of ___/___ mm Hg is considered indicative of stage 3 hypertension.

120 80 120/80 140 90 180/110

Heavy-duty adult WC: •Individuals weighing > ___ lbs •For vigorous activities

200

Standard adult WC: •Individuals weighing < ___ lbs •Limited use on ___ surfaces •Not for vigorous functional activities

200 rough

Standing, Assisted Pivot: With a standing, assisted pivot, the caregiver provides assistance for the patient to stand, pivot, and transfer to another object such as a bed, wheelchair, plinth, or toilet seat. The patient must be able to provide minimal (up to ___%) to maximal (___% or more) physical effort during the transfer.

25 75

Stages of Hypertension: •Stage 1 >___/___ •Stage 2 >___/___ •Stage 3 (severe) >___/___ •Stage 4 > ___/___

140-159/90-99 160-179/100-109 180-209/110-119 >210/>120

Positive genius: •___% of success is based on intelligence and technical skills •___% of success predicted by: -Optimism -Social connections -The way you perceive stress •Changing levels of optimism-> change social connections-> change the way you see ___

25 75 stress

Continued: >Sitting -Unlike when the patient is lying down, this position needs to be modified AT LEAST every ___ min, Use a properly fitted wheelchair that enhances upright posture; avoid sling back and sling seat designs, Use a wheelchair seat cushion (and a wedge with the wider side to the front if the patient is likely to slide forward in the chair), Educate the patient to perform pressure relief by either leaning, tipping, or doing push-ups (all are good techniques for assisting with upper extremity strength), Avoid restraints, Feet should be in properly fitting shoes and well supported on properly aligned foot and leg rests

15

One-hand drive WC: •___ on 1 drive wheel •2 drive wheels connected by linkage bar •Smaller hand rim propels the ___ •Larger hand rim propels ___ •When both rims moved together, both wheels propelled

2 hand rims near drive wheel far drive wheel

Parallel Bar Method for Measurement of Axillary Crutches: To measure a patient for axillary crutches, have him or her stand inside the parallel bars with the head erect, the shoulders level and relaxed, the upper extremities grasping the parallel bars, the trunk erect, the hips straight, the pelvis level, the knees slightly flexed, and the feet flat on the floor. Use this position to measure from a point at the anterior axillary fold to a point on the floor approximately ___ inches lateral and ___ to ___ inches anterior to the patient's toes for the overall crutch length.

2 4 to 6

FOREARM CRUTCHES • Have the patient grasp the handpieces with the forearms inserted in the forearm cuffs. • Position the crutch tips approximately ___ inches lateral and ___ to ___ inches anterior to the toe of the shoe(s). • Observe the angle of elbow flexion; it should be approximately 20 to 25 degrees. • Observe the position of the upper edge of the cuff; it should be approximately ___ to ___ inches below the olecranon process.

2 4 to 6 1 to 1.5

AXILLARY CRUTCHES • Position the axillary rest in the axilla; position the tips approximately ___ inches lateral and ___ to ___ inches anterior to the toe of the shoe(s). • Have the patient grasp the handpieces with the wrists straight (avoid wrist flexion or extension). • Evaluate for space between the top of the axillary rest and the floor of the axilla; it should be approximately ___. • Observe the angle of elbow flexion; it should be approximately ___ to ___ degrees when grasping the handpiece with the wrists in a neutral position.

2 4 to 6 2 inches 20 to 25

Below are areas of important consideration for position changes: • The body position of patients who are at risk for pressure sores (e.g., patients who are confused, medicated, have poor nutritional status, have fecal or urinary incontinence, are immobile, or are inactive) should be changed at least every ___. Many at-risk patients will need to have their position changed more frequently. • Most positions can be easily modified (without a full position change) at the ___ mark, allowing pressure relief. • Avoid placing flaccid or weak extremities in a gravity-dependent position, which facilitates the development of dependent edema. In these cases the most distal part of the extremity should be ___.

2 hours 1-hour higher than the heart

These orders are good for not longer than 4 hours for adults, 2 hours for persons 9 to 17 years of age, and 1 hour for children younger than 9 years. The total time limit of an order is ___, at which time a new order may be prescribed.

24 hours

Documentation: Initial examination Visit/encounter Re-examination- every ___ or ___; if haven't improved at all or got worse, either ___ or not ___ ___- if didn't complete therapy, say why Documentation makes or breaks ___ >Provide accurate, current, function-oriented documentation Greatest likelihood of obtaining a favorable reimbursement

30 days or 10 visits missing something treating the right thing Discharge/Discontinuation reinbursement

Handwashing for Surgical Asepsis: Remove all jewelry from your hands, neck, and ears, and approach the wash area with your arms exposed to approximately ___ above the elbow. Adjust the water to a warm temperature. This process requires approximately ___.

3 inches 7 minutes

Balance and Initial Gait Pattern Activities: While standing in parallel bars, the patient should perform the following maneuvers: • Slowly shift the body from side to side and forward and back while maintaining the shoulders and pelvis in line and the trunk erect, hold each position change for ___ to ___, and maintain the proper weight-bearing status on each lower extremity. • Briefly and alternately lift the hands from the bars to promote a sense of the decreased support that will be experienced when the assistive device is moved; later, both hands may be lifted simultaneously. • Perform a "___" using the bars to improve arm strength and to experience the sense of effort required to support the body when the lower extremities are not in contact with the floor or ground. •

3 to 5 seconds push-up

Continued: >Side lying on the left or right side -Body is well aligned, Avoid direct side lying; the patient should be about ___ degrees off a 180-degree position, Carefully monitor the lowermost shoulder position, The lowermost greater trochanter may need to be bridged, Knees should be slightly ___ with a pillow between the legs and the legs not on top of each other, depending on patient comfort, Support the lowermost foot well to avoid excess pressure on the lateral malleolus or fifth metatarsal head

30 flexed

The other responder with training in CPR should immediately begin CPR with ___ chest compressions (which should take approximately 18 seconds) before checking the airway and giving ___.

30 two rescue breaths

Determining Tissue Tolerance: •Observe patient and inspect skin •15 to 20-minute period and re-inspect skin •No redness: ●can increase tolerance by ___ periods up to ___ •Redness: ●check skin again in 20 to 30 minutes, if none can repeat 15 to 20 minutes ●If redness persists then relieve pressure •*Red spots that do not ___ indicate beginning of tissue damage- if they don't turn white when press on it

30 minute periods up to 2 hours blanch

In general, a patient who is inactive, has restricted mobility, or is unable to alter body positions should not be positioned for an extended period (more than ___) in any position that causes or produces the following: • Excessive rotation or bending of the spine • Bilateral or unilateral scapular abduction or a forward head position • Compression of the thorax or chest • Plantar flexion of the ankles and feet • Hip or knee flexion; hyperextension of the knees • Adduction and internal rotation of the glenohumeral joint • Elbow, wrist, or finger flexion • Hip adduction or internal/external rotation

30 minutes

Hand Hygeine for Medical Aspesis: Wash up to ___ (vigorously)

30 seconds

Precautions for ambulation at home: • Position furniture in each room to provide a ___ unobstructed pathway when possible; eliminate electrical cords or other loose objects from walking surfaces.

36-inchwide

>Armrest height • Observe the angle made by the posterior aspect of the upper arm and the back post when the elbows rest on the armrest approximately ___ in front of the back post

4 inches

Continued: Position the wheelchair parallel or at a ___ angle to the bed midway between the head and foot of the bed. Apply a safety belt or use a large towel or sheet as a sling under the buttocks and lock the wheelchair with the caster wheels positioned forward to increase the BOS of the wheelchair. Remove the patient's feet from the footrests and elevate the footrests; remove or swing away the front rigging, and place the patient's feet flat on the floor. Remove the armrest nearest to the bed if the top surface of the bed is lower than the armrest. Move the patient forward in the chair by grasping the posterior area of the ___ and guiding it so that the buttocks slide forward, position the feet parallel to each other, and position the trunk over the pelvis.

45- to 60-degree pelvis

During measurement of the lower extremity, the patient should stand on a level surface with the feet approximately ___ apart and the body relaxed. During measurement of the upper extremity, the extremity should be exposed in a position of relaxation.

6 inches

Three-Point Pattern: To move backward in a three-point pattern, instruct the patient to start with the crutch tips lateral to, but even with, the toes of the shoes, then step back approximately ___ and reposition the crutches. The pattern should be repeated as necessary. An alternative advanced technique is to instruct the patient to place the crutches approximately 6 inches behind the heels to form a reverse tripod and then step back through the crutches to create a forward tripod.

6 inches

Length of Crutches: If the height of the patient is known, multiply it by ___% (e.g., 70 inches × 77% = 53.90, or 54 inches) or subtract 16 inches from the height (e.g., 70 inches − 16 inches = 54 inches) and use the resulting value for the overall crutch length (i.e., axillary rest to tip). These measurements are only ___ of the length of the crutch; their fit must be confirmed with the patient standing.

77 estimates

For adults, the head and neck is ___%; each upper extremity is ___%; each lower extremity is ___%; the front trunk area is ___%; the back trunk area is ___%; and the genital area is ___%. For children, the head and neck is 18%, the lower extremities are 14%, and the remainder of the body areas have the same values as those listed for adults.

9 9 18 18 18 1

Continued: Usually it will not be necessary to elevate the table to ___ degrees to help the patient adapt to or become accommodated to an upright position. An elevation of approximately ___ to ___ degrees for 15 to 20 minutes, for several sessions, should be sufficient; however, each person must be considered individually. When the patient is elevated more than ___ degrees, the sensation of falling forward may occur because his or her COG will be shifted forward as a result of the pressure from the surface of the table against the back. If the patient is elevated beyond ___ degrees, a chest strap should be applied to prevent the upper body from falling forward. A session may be as brief as 5 or 10 minutes or as long as 1 hour, and sessions may occur once or twice per day or on alternate days.

90 70 to 80 80 70

Half-Kneeling Lift: To perform the half-kneeling lift, the lifter aligns the body by kneeling on one knee positioned behind and on one side of the object and the opposite lower extremity to one side of the object with the foot flat and the hip and knee flexed approximately ___. The object is grasped and lifted by the upper extremities, placed on the thigh of the flexed lower extremity, and moved close to the body before the flexed lower extremity begins rising to standing. The opposite lower extremity assists with raising the body as the person continues to stand.

90 degrees

Mobility and Transfer Activities: Special Precautions: •Total Hip Replacement ●Posterior vs Anterior Approach- need to note in chart -this is important because different muscles are affected -> posterior- patient shouldn't bend more than ___ at the hip, shouldn't ___ legs, or turn ___ inward or outward ->anterior- these patients usually have no precautions or very few; but still inform patients not to ___ legs or ___ their leg, no rotating at the ___

90 degrees cross toes cross hyperextend trunk

Temperature: -Oral >Range: ___ to ___ >Single value: ___ -Rectal >Range: ___ to ___ >Pyrexic: above ___ >Hyperpyrexic: above ___

96.8 - 99.3 F (36 - 37.3 C) 98.6 F (37 C) 97.8 - 100.3 (36.6 - 38.1 C) 100 F (38 C) 106 F (41.1 C)

Active vs. Latent Errors: ___- Usually caused by an individual Effects of an active error becomes apparent quickly ___- Usually caused by a third party Causes may include faulty equipment (installation, maintenance, or irregularities), flaws in the care system, or organizational design Effects of a latent error may not become apparent quickly; they may only emerge after the fact

ACTIVE ERROR LATENT ERROR

___- Acronym for acquired immunodeficiency syndrome, which is caused by the human immunodeficiency virus (HIV). ___- Absence of microorganisms that produce disease; the prevention of infection by maintaining a sterile condition. ___- When something is rendered unclean or nonsterile; an item, surface, or field is considered to be contaminated when it has come into contact with anything that is not sterile. ___- The use of physical or chemical means to remove, inactivate, or destroy bloodborne pathogens on a surface or item to the point at which they are no longer capable of transmitting infectious particles and the surface or item is rendered safe for handling, use, or disposal

AIDS Asepsis Contamination Decontamination

___- A pathological condition resulting from the accumulation of acid or the depletion of the alkaline reserve in the blood and body tissues that is characterized by an increase in hydrogen ion concentration. ___- A protein or nonprotein substance that is capable of inducing an allergy or a specific hypersensitivity. ___- An uninhibited and exaggerated reflex of the autonomic nervous system as a result of a stimulus. ___- The sudden and often unexpected stoppage of effective heart action. ___- The reestablishment of heart and lung action as indicated for cardiac arrest.

Acidosis Allergen Autonomic hyperreflexia (dysreflexia) Cardiac arrest/death Cardiopulmonary resuscitation (CPR)

•___ ▫Can lead to diabetic coma, and death ▫Medical emergency! ▫Do not give ___ ▫Usually and injection of ___ needed by nurse or physician

Acidosis (Hyperglycemia) sugar insulin

>___- Attacked by disease; afflicted. >___- Act of walking or being able to walk. >___- A piece of equipment (e.g., a crutch, cane, or walker) used to provide support or stability for a person when he or she is walking. >___- Wooden or metal crutches, adjustable or nonadjustable, that fit under a person's upper arms and into the axilla and have a handpiece to grasp. >___- Pertaining to two sides

Affected Ambulation Assistive device Axillary crutches Bilateral

• ___: Microorganisms are transferred by small infectious particles (infective over time and distance) in the respirable size range. Airborne transmission can occur with measles, varicella (chickenpox), and Mycobacterium tuberculosis. A fit-tested N-95 respirator (Fig. 2-5) or higher should be worn.

Airborne

___ is removal of a body part as a result of trauma or surgery. Surgery is performed because of pain or a disease process in the limb resulting from cancer, gangrene, infection, diabetes, or vascular insufficiencies.

Amputation

>___ -Used to determine if a person has peripheral artery disease; the blood pressure is measured at the ankle and in the arm while a person is at rest; the test is often repeated after 5 min of walking on a treadmill; if the blood pressure at the ankle is the same or greater than in the arm, this is an indication of normal blood flow; if the blood pressure at the ankle is lower initially or after exercise, this is an indication of peripheral artery disease

Ankle-brachial test

>___- Situated at or directed toward the front of a body or object; the opposite of posterior. >___- The area on which an object rests and that provides support for the object. >___- The point at which the mass of a body or object is centered. >___- Relates to a group of muscles bounded by the abdominal wall, the pelvis, the diaphragm, and the lower back that are contracted to assist in posture, balance, and stability.

Anterior Base of support (BOS) Center of gravity (COG) Core stabilization

>___- From the front to the rear of an object or a living being. >___- field of medicine that is concerned with weight loss or that deals with causes, prevention, and treatment of obesity. >___- On the other—or opposite—side. >___- Requiring some level or type of assistance, which may be human or mechanical. The patient is unable to assist with transfers. >___- An increase in the severity of disease or any of its symptoms. >___- Any tissue or organ for transplantation or

Anteroposterior Bariatric Contralateral Dependent Exacerbation Graft

___: •Determine and remove the noxious stimulus to return the patient to normal state •In individuals with relatively recent complete injury to cervical and upper thoracic spinal cord to ___ level •HTN, bradycardia, diaphoresis above level of cord lesion, discomfort, red skin blotches, headache, piloerection

Autonomic Hyperreflexia (Dysreflexia) T6

Development of a Pressure Sore: •First Stage ●___- area is warmer than surrounding skin ●Ill-defined flat red area that goes white when pressed on ●Color is pale pastel to bright red. ●Area is ___ than surrounding skin

Blanchable Erythema warmer

BODY TEMPERATURE: -___ is an indication of the intensity or degree of heat within the body. It represents a balance between the heat that is produced in the body and the heat that is lost. In humans, body temperature remains relatively ___ regardless of the environmental temperature. an accepted normal range for human oral core or body temperature is ___ to ___ F (___ to ___ C). The average temperature of ___ F (___° C) is the most generally accepted single value. The normal range for human rectal temperature is ___-___ F (___-___ C).

Body temperature constant 96.8° F to 99.3° F 36° C to 37.3°C 98.6° F (37 C) 97.8° F to 100.3° 36.6° C to 38.1°

>___- A slow heartbeat (i.e., pulse rate less than 60 beats/min); may be a normal finding in a well-conditioned person or an abnormal finding. >___- The amount of blood that is pumped from the heart during each contraction. >___- Profuse perspiration. >___- The period when the least amount of pressure is exerted on the walls or the arteries during the heartbeat; usually indicates the resting phase of the heart.

Bradycardia Cardiac output Diaphoresis Diastole

Traditional Lift: the lifter faces the object with the feet anteroposterior on each side of the object and the lower extremities in a deep squat. This position provides a low ___ and a wide ___ for the lifter. The person grasps the underside of the object with the upper extremities parallel or anteroposterior to each other.

COG BOS

Standing and Sitting Activities: Before a patient attempts to stand, he or she must move forward in the chair seat. This will position the ___ nearer to the ___ (i.e., the feet and lower extremities) so the patient will be able to stand more easily and have better balance once standing. The position also provides a wide BOS when the patient is standing and approximates the foot position most people use to stand from a chair. If both lower extremities have essentially equal strength and weightbearing capacity, the foot of the dominant lower extremity is usually positioned most ___.

COG BOS posterior

___ >uses -Used to compensate for impaired balance or to improve stability and are more functional on stairs and in narrow, confined areas >advantages -A cane can be stored and transported more easily than crutches or a walker Types include "J," "T," pistol grip, offset shaft, three- or four-legged or four-footed (sometimes referred to as a quad, hemi, or crab cane), and Walkane (walk cane) (see Fig. 9-1, C) >disadvantages -Provides very limited ___ because of its small base of support

Canes support

___ wheels are usually located at the front of the chair to permit changes of direction and turns. ___ or ___ wheels, which are used to propel the chair, may have solid rubber, semipneumatic, or pneumatic tires.

Caster Drive wheels, or rear

___: •Up to approximate age of 6 years Indoor WC: •For use indoors •Larger ___ placed at front of chair •Caster wheels at rear •Functions better in ___ •More difficult to propel •More difficult for functional activities

Child/youth WC drive wheels confined spaces

>___- The caregiver is positioned close to the patient with his or her hands on the patient or a safety belt; it is very likely the patient will require protection during the performance of the activity >___- The patient uses adaptive or assistive equipment to perform a task independently (e.g., a transfer board, bed rail, grab bars, or furniture); the patient may have safety or timeliness issues >___- The patient performs 75% or more of the activity; assistance is required to complete the activity

Contact guarding Modified independent Minimal assistance

___: shortening or tightening of the skin, muscle, fascia, or joint capsule that prevents normal movement or flexibility of the involved structure.

Contractures

___- A series of involuntary contractions of the voluntary muscles. ___- A person trained to manage the emergency care of sick or injured persons during transport to a hospital or at the scene of an injury. ___- An excess of glucose in the blood. ___- An abnormally low level of sugar (glucose) in the blood. ___- A double-chain protein hormone formed from proinsulin in the beta cells of the pancreatic islets of Langerhans

Convulsion Emergency medical technician (EMT) Hyperglycemia Hypoglycemia Insulin

Continued: ___- can require proper movement and a stable base for limb movement ___- want load or effort to be as close to this as possible (located at second sacral level)- the further the object is, the more torque required Always pick smarter rather than quicker to lift thing -don't ___ body when lifting, avoid jerking -don't lift after prolonged sitting

Core stability COG twist

Development of a Pressure Sore: •Third Stage ●____ ●Skin appears to have a rash with scales and crust within the area. ●Some of the tissue has already ___. ●If the individual can feel it, it may be tender and very painful. ●Will take ___ to ___ to heal.

Decubitus Dermatitis died 2 to 4 weeks

___- The destruction or removal of pathogenic organisms, but not necessarily their spores. ___- Infections associated with health care delivery in any setting; previously known as nosocomial infection. ___- Inflammation of the liver. ___- The production of a disease or harmful condition by the entrance of disease-producing germs into an organism.

Disinfection Health care-associated infection Hepatitis Infection

>___ -Wrap a blood pressure cuff around the calf and test if the patient can tolerate a pressure of 40 mm Hg

Cuff test Deep vein thrombophlebitis

>___ Differences in race, ethnicity, language, nationality, or religion among various groups within a community, organization, or nation; a city is said to be culturally diverse if its residents include members of different groups >___ • An awareness of the nuances of one's own and other cultures

Cultural Diversity Cultural Sensitivity

>___ • Demonstrating both sensitivity to cultural differences and similarities as well as effectiveness in using cultural symbols to communicate >___ • Belonging to a common group often linked by race, nationality, and language with a common cultural heritage or derivation >___ • A socially defined population that is derived from distinguishable physical characteristics that are genetically transmitted

Cultural appropriate Ethnic Race

>___ • The shared values, norms, traditions, customs, art, history, folklore, and institutions of a group of people >___ • A set of academic and interpersonal skills that allow individuals to increase their understanding and appreciation of cultural differences and similarities within, among, and between groups; this requires a willingness and ability to draw on knowledgeable persons of and from the community in developing focused interventions, communications, and other supports

Culture Cultural Competence

Barriers to Effective Communication: • ___ between the sender and receiver (excessive distance decreases effectiveness); Inadequate amount of ___ between the receiver and sender

Distance feedback

>___ -Used to assess the possible presence of a thrombus The caregiver grasps and lightly presses the patient's calf while passively forcing the foot into dorsiflexion; if the patient complains of pain in the calf, a positive response is reported; this is known as a positive Homans' sign Another method is to apply a blood pressure cuff around the patient's calf and inflate it gradually; a patient with an acute condition will not tolerate an inflation pressure higher than 40 mm Hg; once the pain threshold has been reached, do not continue to inflate the cuff; test the noninvolved lower extremity first if only one extremity is suspected of having a deep vein thrombosis

Deep vein thrombophlebitis test

•Respect the pt's modesty ●___ if need •Place gait belt securely around the patient •Allow pt to ___ the surface to which he is going •Only ___ when needed •When in doubt, have assistance nearby

Double gown see assist

>___- Disturbance, impairment, or abnormality of the functioning of a body part. >___- The act of rubbing one object against another. >___- The force that pulls toward the center of the Earth and affects all objects. >___- Maintaining or pertaining to the same length. >___- Abnormally increased convexity in the curvature of the thoracic spine as viewed from the side.

Dysfunction Friction Gravity Isometric Kyphosis

>___- Labored or difficult breathing. >___- Disturbance of rhythm. Ectopic Arising or produced abnormally. >___- The passive phase of respiration when the person breathes out; also referred to as exhalation. >___- Body temperature that is above the normal level; also referred to as pyrexia.

Dyspnea Dysrhythmia Expiration Fever

Continued: •May show convulsions, respiration difficulty, unconscious •Causes: bladder distension by urine retention, fecal impaction, open pressure ulcers, tight orthosis or urine bag, pressure, exercise •Medical ___! >Place in ___ or ___ position to reduce hypertension-> do not place in supine Remove noxious stimulus

Emergency sitting or semirecumbent

-___ (e.g., Accuzyme, Kovia ointment, Gladase, Ethezyme, and papainurea debriding ointment) >Particularly effective for tunneling ulcers that may be hard to see or reach; some of these debriders are selective for necrotic tissue, while others are not; by loosening necrotic debris, surgical debridement may be avoided

Enzymatic debriding agents

Characteristics of Normal Walking: •___ posture •___ (rate of steps)- not too fast but not too slow •Step length- step through pattern equal •Wt shift- when can't do this it's a netalgic gait? •Swing and stance phase •Trunk rotation •___ arm swing

Erect Cadence Reciprocal

>___- A dynamic process in which the practitioner makes clinical judgments based on data gathered during the examination and identifies problems pertinent to patient/client management. >___- The process of obtaining a history, performing relevant systems reviews, and selecting and administering specific tests and measures. >___- The measurement of the range of motion of a joint of the body. >___- A federal law enacted to protect health care-related information.

Evaluation Examination Goniometry Health Insurance Portability and Accountability Act of 1996 (HIPAA)

___- Movement that increases or straightens the angle between two adjoining body parts or bones. ___- Outward turning or pivoting around an axis. ___- Movement that decreases the angle between two adjoining body parts or bones. ___- Extension of a limb or part beyond the normal limit; overextension of a limb or part.

Extension External rotation (lateral) Flexion Hyperextension

•"evidence from published randomized controlled trials addressing rehabilitation of chronic musculoskeletal pain has revealed that self-efficacy, depression, pain catastrophizing and physical activity should be the primary treatment targets for patients with chronic musculoskeletal pain" •Therapist beliefs that pain is only associated with anatomical cause of pain or poor mechanics will allow the pt to reflect similar beliefs -> may create ___

FEAR AVOIDANCE

Continued: Any of the aforementioned patterns may be chosen depending on the patient's abilities -weight-bearing status- ___ -walking aid- Walker to axillary crutches to forearm crutches to bilateral canes to single cane to independent of walking aids

FWB

Ambulation Patterns with Assistive Devices: A.___: The assistive aid and opposite lower extremity (foot) advance alternately; bilateral canes, crutches, or a reciprocal walker may be used. B. ___: The assistive aid and opposite lower extremity (foot) advance simultaneously; bilateral canes, crutches, or a reciprocal walker may be used.

Four-point Two-point

Observe the patient- Guidelines: ___ appearance: body build, deformities, absence of body part ___ appearance: color, lesions, scars, texture ___: Look for deviations while sitting and standing ___: Consider mobility patterns, use of aids (e.g., wheelchair, crutches, walker, cane, other), level of independence, and ability to manage stairs, inclines, and uneven surfaces Balance, stability, coordination, equilibrium, motor control, and flexibility when standing, ambulating, sitting, and performing functional tasks Application of assistive devices such as a prosthesis, orthosis, splint, or bandage

General Skin Posture Ambulation

Removal: ___ are the first thing you remove- don't touch outside, grab from underneath, next take off ___ by grabbing from behind the ears, then take off gown, lastly take off __ and perform hand hygeine

Gloves goggles mask

Major Phase of Function and Purpose of LE: ___: phase- Initial contact to foot flat; purpose- Stabilize limb ___: phase- Terminal stance to preswing; purpose- Stabilize the pelvis in the frontal plane ___: phase- Preswing to midswing; purpose- Accelerate limb ___: phase- Loading response, purpose- Absorb shock, eccentric contraction stabilizes the knee ___: phase- Midswing to initial contact; purpose- Decelerate limb ___: phase- Initial contact to midstance and preswing to initial contact; purpose- Absorb shock, elevate foot ___: phase- Midstance, terminal stance to preswing; purpose- Knee stability at terminal stance, push off ___: phase- Initial contact to initial contact; purpose- Stabilize trunk

Gluteus maximus Gluteus medius/minimus Hip flexors/adductor Quadriceps Hamstrings Tibialis anterior/ peroneals Gastrocnemius/soleus Erector spinae

One-Leg Stance Lift: >___ -For light objects that can be lifted with one upper extremity

Golfer's Lift

Pulse: • ___ - indirect measurement of the contraction of the left ventricle. •Accepted normals >Newborn -___ to ___ bpm >Child (1-7 yo) -___ to ___ bpm >Adult -___ to ___ bpm

Heart rate 100 - 130 80 - 120 60 - 100

Suggestions for reducing pressure: >supine -Body is well aligned (i.e., the head is in a neutral position and is in line with the shoulders; the pillow should not be too high or too low) ____ are off the bed, ___ are supported or protected, Hands are higher than the elbow, particularly if the patient has a flaccid extremity, The lower extremity is in a ___ position; excessive internal or external rotation at the hips is avoided; support with towel rolls, pillows, or adjunctive devices may be needed

Heels Elbows neutral

Lower Extremity Amputations: types of lower extremity amputations: • ___ (the entire pelvis and distal structures are removed) • ___ (removal of half of the pelvis) • ___ (removal at the hip joint with the pelvis left intact) • AK, also referred to as a transfemoral amputation • ___ (removal at the knee joint with the femur left intact) • BK, also referred to as a transtibial amputation • ___ or ___ (the entire ankle is removed) • Chopart, Lisfranc, transmetatarsal • Toe or digit (phalangeal)

Hemicorpectomy Hemipelvectomy Hip disarticulation Knee disarticulation Ankle disarticulation or Syme's disarticulation

Falls: •___ factors- old age, impaired vision or hearing, decreased strength of flexibility, previous history of falls, vertigo, seizures, syncope, sedatives, inattentiveness while walking •___ factors- pathway to bathroom, lighting, height of bedding, uneven walking surface, rugs, toys, electrical cords, icy or waxed surfaces, steps, absence of handrails, chairs with unstable bases or no arm rests

Human Environmental

>___ (e.g., DuoDerm, Restore [paste or granules], Tegasorb, Hydrocol, and DermaFilm) -Dressing of choice for stages II and III wounds with minimal drainage; provides moist wound bed; absorbs small amount of drainage; self-adherent and provides cushioning over bony prominence; do not use on infected wounds; medications cannot be used under the dressing

Hydrocolloid

-___ (e.g., Aquacel and Aquacel Ag Hydrofiber) >Indicated for wounds with moderate to high exudate that are infected or at risk for infection; provides a moist wound environment and provides sustained antimicrobial activity for up to 7 days

Hydrofiber

Insulin-related illnesses: •___ (Insulin reaction) ▫Provide some form of sugar (candy or orange juice) if conscious ▫If unconscious, glucose may need to be given by IV ▫Rest until return to normal state ▫Counsel on how to balance food and activity

Hypoglycemia

Continued: •Treatment ▫Calm and reassure ▫___ allergen: Avoid contact or remove it ▫Apply ___ or ___ to itchy areas ▫Observe S/S ▫Obtain or refer for medical assistance

Identify cool compresses or calamine

>___- An object or apparatus that immobilizes or prevents motion, such as a cast or brace. >___- To check on a given condition or phenomenon, such as blood pressure or heart or respiration rate. >___- Adjustable or nonadjustable wooden or metal bars that are horizontal and parallel to each other and attached to vertical uprights to provide a stable, nonmobile support for a person who requires an assistive device. >___- Wooden or metal crutches with an adjustable or nonadjustable platform for a person's forearm to rest on and aid in weight bearing.

Immobilizer Monitor Parallel bars Platform attachment

___- Able to function or perform without assistance from another person. ___- The ability to move from one place to another. ___- Pertaining to the foot or feet. ___- Of or containing air or gases. ___- Pertaining to the area behind the knee. ___- The act of propelling; movement of a wheelchair by the person in the chair or by another person

Independent Locomotion Pedal Pneumatic Popliteal Propulsion

>___- Constructed for use indoors, with the larger drive wheels placed at the front of the chair and the caster wheels at the rear; it functions better in confined areas but is more difficult to propel and makes it more difficult for the user to perform many functional activities >___- The seat is lowered approximately 2 inches to allow better use of the user's lower extremities to propel the chair; however, the lower seat may make it more difficult for the user to perform a standing transfer

Indoor "Hemiplegic"

>___- The quality of being hard; abnormal firmness of tissue with a definite margin. >___- A functional overload of the lymphatic system in which lymph volume exceeds transport capabilities, resulting in obstructed lymph flow. >___- The softening of a solid or tissue by soaking. >___- The morphological changes indicative of cell death.

Induration lymphedema Maceration Necrosis

Phases of Healing: Three phases of wound healing are described in the literature: • ___ • ___ • ___

Inflammatory Proliferative Remodeling (maturation)

Continued: ___ (or short-term) goals and ___ (or longterm) goals must be developed and agreed upon. The family member must be instructed about the responsibilities and level of assistance required.

Interim terminal

Continued: >___- Designed for persons with a body build smaller than that of an adult but larger than that of a child >___- Designed to permit adjustments in the frame to accommodate the growth of the user >___- Designed for persons up to the approximate age of 6 y

Intermediate or junior Growing Child or youth

___: •Individuals smaller than an adult but larger than a child ___: •Permit adjustments in frame to accommodate growth of user

Intermediate/junior WC Growing WC

___- Inward turning or pivoting around an axis. ___- Deficiency of blood in a part of the body from functional constriction or obstruction of a blood vessel. ___- The protuberance of the ischium; the inferior, distal portion of the pelvis. ___- The softening of a solid by soaking.

Internal rotation (medial) Ischemia Ischial tuberosity Maceration

Gather subjective and objective information and data- Guildlines: Patient history: ___ the patient, family members, relatives, and other caregivers; review the medical record; observe the patient; perform/review tests and measures Identify the primary complaint or problem and its effect on function; identify prior function. Obtain a history of the current illness or condition, including progression or regression of symptoms; pain factors (location, onset, duration, severity, description); factors that exacerbate or relieve symptoms; previous and current treatment, medications, modalities, activity

Interview

Creating lasting change: •1. Reflecting on 3 gratitudes every week •2. ___ daily -One positive experience of the day -Most meaningful experience of the day •3. ___ -10-30 minutes •4. ___ -Two minutes •5. Random acts of ___ -Writing one positive email in your social network each week

Journal Exercise Meditation kindness

___ is used over muscles and joints and is pulled at varying degrees of tension, or the body or body part is flexed, extended, or rotated to create the desired effect. The tape is usually worn from ___ to ___ days, and the person is able to take a shower with the tape on and pat dry.

Kinesiology Taping 2 to 5

>___- Pertaining to a side; away from the midline of the body or a structure. >___- A component of a mechanical lever; it may be the force arm or the weight (resistance) arm; when the length of the force arm is increased or the length of the weight arm is decreased, a greater mechanical advantage is created for the lever system. >___- An increase in one of the forward convexities of the normal vertebral columns; a lumbar or cervical lordosis can occur. >___- Pertaining to the lower region of the back superior to the pelvis.

Lateral Lever arm Lordosis Lumbar

•Heat Stroke ▫___ illness ▫Need care and treatment by medical personnel an need to be sent to medical facility ASAP ▫Place in semi-reclining position in cool area, remove clothing, monitor pulse and respiration, obtain assistance, cool down, transport immediately ▫NEED ___ immediately

Life Threatening care and treatment but medical personnel

Types of Ambulation Aids: >Basic categories of assistive devices from ___ STABILITY to ___ STABILITY: °Parallel bars °Walkers >Four point and rolling walker °Bilateral crutches >Axillary and Lofstrand °Single crutch °Bilateral canes °Crab canes/four point cane °Single canes

MOST LEAST

Parallel Bars: PROS: ___ stability, support, and safety Good to initiate balance training and gait patterns Can evaluate fit of ambulation aids in safe environment CONS: Can limit ___ (distance, width of bars)- only so far can walk and width can be narrow depending on type of patient Can be time consuming to adjust if they aren't ___- most places have to unscrew each point (ours is motorized) Need to be progressed to another AD for mobility

Maximal mobility motorized

>___- Pertaining to or situated toward the midline of the body or a structure. >___- Movement of the pelvis so the anterior superior iliac spine moves anteriorly or posteriorly to produce an anterior or a posterior tilt or inclination of the pelvis. >___- Situated at or directed toward the back of a body or object; the opposite of anterior. >___- Lying down. >___- Anteroposterior plane or body section that is parallel to the median plane of the body

Medial Pelvic tilt (inclination) Posterior Recumbent Sagittal plane

Allergic Reactions: •Pollen, dust, eggs, shellfish, mild, wheat, soy, nuts, insect stings, chemicals, medications (antibiotics), latex, dyes •___/___: ▫Itchy skin ▫Skin redness, rash, areas of swelling ▫Itchy, watery eyes ▫Sneezing ▫Hives

Mild/Moderate

___- Pt performs at least 50% -74% of the work, PT performs at most 50% of the work ___- Pt requires a lot of physical assist; can do 25% of the work; PT performs 75% of the work ___- Pt unable to assist; does 0% of the work; PT performs 100% of the work and/or requires more than 1 person assist

Moderate Assist (ModA) Maximal Assist (MaxA) Dependent (Dep)

Continued: >___- Pt performs at least 50% -74% of the work, PT performs at most 50% of the work >___- Pt requires a lot of physical assist; can do 25% of the work; PT performs 75% of the work >___- Pt unable to assist; does 0% of the work; PT performs 100% of the work and/or requires more than 1 person assist

Moderate Assist-Mod A Maximal Assist- Max A Dependent- Dep

>___- The patient performs 50% to 74% of the activity; assistance is required to complete the activity >___- The patient performs 25% to 49% of the activity; assistance is required to complete the activity >___- The patient requires total physical assistance from one or more persons to accomplish the activity safely; special equipment or devices may be used

Moderate assistance Maximal assistance Dependent

___- Morphological changes indicative of cell death. ___- The protuberance of the occipital bone; the posterior area of the skull. ___- The pelvic floor and associated structures occupying the pelvic outlet. ___- Lying face downward on the ventral (front) surface of the body; lying on the abdomen and chest.

Necrosis Occipital tuberosity Perineum Prone

Stage IV: -___/___ >Maintain moist wound bed; protect surrounding tissue; observe for infection; soften and remove eschar, necrotic tissue

Necrotic/draining

Stage IV: ___/___ -Maintain moist wound bed; protect surrounding tissue; observe for infection; soften and remove eschar, necrotic tissue

Necrotic/nondraining

Three-Point: •Also called a ___ pattern •Requires ___ AD or a ___, but cannot be performed with bilateral canes •Pattern description: walker or crutches and NWB extremity are advanced and then pt steps up to the front rail of the walker or through the crutches •For example: AD advances simultaneously with NWB LE then full-weight-bearing LE steps through the aids •Described as "step to" or "step through" pattern •This pattern is used when the patient have ___ LE but NWB on opposite LE •Less stability, but rapid ambulation is possible •Requires strength in BUE, trunk, and one LE •High energy expenditure; to reduce energy expenditure the pt should be taught to step to which also increases pt balance and stability

Non-weight-bearing bilateral walker full weight-bearing on one

Development of a Pressure Sore: •Second Stage ●___- it does not whiten when pressed on, feels soft ●Area is bright red to blue and will NOT ___ when pressed on. ●Has sharply defined borders with blood vessel changes under skin. ●Feels soft and watery.

Nonblanchable erythema whiten

>___- To fit close together; to close tight; to obstruct or close off. >___- A condition in which breathing is easier when the person is seated or standing. >___- A palpable wave of blood produced in the walls of the arteries with each heartbeat or contraction. >___- A medical device that measures levels of blood oxygen saturation, monitors pulse rate, and calculates heart rate. >___- An abnormal, discontinuous, nonmusical sound heard on auscultation of the chest, primarily during inhalation; also called a crackle. >___- Pertaining to the rectum or the distal portion of the large intestine.

Occlude Orthopnea Pulse Pulse oximeter Rale Rectal

>___- Two hand rims are fabricated on one drive wheel, and the two drive wheels are connected by a linkage bar; the smaller hand rim propels the near drive wheel, the large hand rim propels the far drive wheel, and when both rims are moved simultaneously, both wheels are propelled >___- The rear wheel axles are positioned approximately 2 inches posterior to their normal position to widen the base of support of the chair and compensate for the loss of the weight of the user's lower extremities

One-hand drive "Amputee"

>Unable to sit with UE support-> ___ (Dependent, 2-man, 3-man, Hoyer lift) >Able to sit with UE support, but has week shoulder depressors and triceps-> ___ transfer: Sliding Board, Squat Pivot, Scoot or Active Transfer: ___

Passive Transfer Active Stand Pivot

>___- A decreased mass per unit volume of normally mineralized bone when compared with that in age-matched and sex-matched control subjects; loss of bone mass. >___- Loss of power of voluntary movement in a muscle through injury or disease of its nerve supply. >___- Partial or incomplete paralysis. >___- A padded table for a patient to sit or lie on while performing exercises, receiving a massage, or undergoing other physical therapy treatment.

Osteoporosis Paralysis Paresis Plinth

Continued: Three-one-point (modified three-point) >weight bearing status- ___ as ordered by MD >walking aid- ___, ___

PWB Walker, bilateral crutches

___- Refers to a variety of barriers and respirators used alone or in combination to protect skin, mucous membranes, airways, and clothing from contact with infectious agents; includes gloves, respirators, masks, face shields, goggles, shoe covers, and gowns. ___- A new Centers for Disease Control and Prevention standard that applies to all persons entering a health care setting, including visitors, patients, and health care personnel; also known as "cough etiquette." ___- The presence of pathogenic microorganisms or their toxins in the blood or tissues.

Personal protective equipment (PPE) Respiratory hygiene Sepsis

___ attachment >use -Used for persons who are unable to bear weight through their wrists and hands, have severe deformities of the wrists or fingers that make it difficult to grasp the handpiece of a regular crutch, have a belowelbow amputation, or are unable to extend one or both elbows >characteristics -Types include a platform that can be attached to an axillary or forearm crutch or to a walker; it is sometimes referred to as a "trough" or "shelf" (see Fig. 9-1, B) >disadvantages -Patient loses the use of the ___ to elevate and maintain the body during the swing phase Another person may need to apply or remove them Are less effective on stairs

Platform triceps

Development of a Pressure Sore: •Fourth Stage ●___ ●Early ___ ●Erosion of the superficial skin ●Hole of irregular shape and indistinct borders ●___ to ___ tint ●Chronic Ulcer ●Average size of 5-12 cm in diameter ●Overhanging border with a thick fibrous ring shape ●Usually flat and center is red in color ●Deep hole that bleeds very little

Pressure Sore Ulcer Yellow to brownish

Symptoms of heat exhaustion vs heat stroke: Skin: big difference!!! ___ Nausea :Present Present Headache: Present Present Breathing: Shallow, rapid Labored Pulse: Weak, rapid Strong, rapid Color Pale Flushed or changes to gray Temperature Normal or slightly elevated Very elevated (106° F-110° F) Behavior: Exhaustion, collapse Exhaustion, collapse, convulsions Consciousness: Unconscious Unconscious Eyes: Pupils normal Pupils contract, then dilate

Profuse diaphoresis Dry; no diaphoresis (no sweating during heat stroke)

>___- The artificial replacement of an absent body part (e.g., an artificial limb). >___- An image or a record produced on exposed or processed film through radiography; a roentgenogram. >___- An acronym, the letters of which identify each section of a patient's status: S, subjective; O, objective; A, assessment; P, plan. >___- The ability to recognize the form (shape) of an object by touch. >___- A private, nonprofit organization whose purpose is to encourage the attainment of uniformly high standards of institutional medical care. >___- The ability to recognize or differentiate two blunt points when they are simultaneously applied to the skin.

Prosthesis Radiograph SOAP Stereognosis The Joint Commission Two-point discrimination

>___- A cane with three or four feet that forms a wider base of support than the single crutch tip; also referred to as a crab, three- or four-footed, or hemi cane. >___- Wooden or metal crutches with a full or half cuff that fits over a person's forearms and that have a handpiece to grasp; also known as Lofstrand or Canadian crutches. >___- The repetitive, alternate, reciprocal forward movement of an assistive device (e.g., a crutch or cane) and a person's opposite lower extremity. >___- Activities identified by an individual as essential to support the person's physical and psychological well-being and to create a personal sense of well-being.

Quad cane Forearm crutches Four-point gait Functional activities

Assessment of Respiration: "___" refers to the number of breaths per minute, "___" refers to the regularity of the pattern, "___" refers to the amount of air exchanged with each respiration, and "___" refers to deviations from normal, resting, or quiet respiration. A person may be classified as either an upper chest (thoracic) or abdominal breather. During periods of respiratory distress, a person may exhibit both breathing patterns. Persons who have difficulty breathing while at rest experience ___, or labored breathing. Frequent monitoring of the patient's RR may be necessary during the initial treatment sessions to ensure the person is functioning within safe limits.

Rate rhythm depth character dyspnea

>___- Corresponding but reversed on both sides. >___- A vertical piece of wood joining two steps; the back of the step. >___- One lower extremity is full weight bearing, and the opposite lower extremity is PWB; the patient uses bilateral canes, crutches, or a walker to partially support body weight as he or she bears weight on the PWB lower extremity; the full weight-bearing lower extremity advances independently, and the assistive devices and PWB lower extremity advance simultaneously

Reciprocal Riser Three-one-point gait (partial weight bearing [PWB])

>___- Used for persons who need to partially or fully recline at some time when they are in the chair; the chair may be a semireclining or fully reclining chair; semireclining chairs recline to approximately 30 degrees from vertical, and fully reclining chairs can recline to a horizontal position; elevating leg rests and headrest extensions are necessary components for these chairs

Reclining

Microorganisms and the Infection Cycle: The cycle of infection includes five elements: • ___- Microorganisms require a place where they can grow and reproduce (i.e., a host or reservoir); animals and human beings are both examples of microorganism hosts. • ___- Microorganisms also require a means by which they can leave the host (i.e., exit the reservoir). They can exit through a person's nose, mouth, throat, ear, eye, intestinal tract, urinary tract, body fluids (e.g., blood), or wounds.

Reservoir Exit

>___- The act of breathing. >___- SOB. >___- An instrument used to measure blood pressure; it may use a mercury column or an enclosed air-pressure spring system. >___- An instrument used to convey sounds produced in the body of a person to the ears of the examiner; it is comprised of a diaphragm, tubing, and earpieces. >___- A shrill, harsh sound, especially the respiratory sound heard during inspiration in a person with a laryngeal obstruction.

Respiration Shortness of breath Sphygmomanometer Stethoscope Stridor

___- The forcible confinement or restriction of movement of a person through the use of belts, straps, or other similar items. ___- A device attached to a door that closes the door through the use of compressed fluid or air. ___- Partially containing air or gases.

Restraint Self-closing device Semipneumatic

___- Medication used to control behavior or restrict the patient's freedom of movement that is not a standard treatment for the patient's medical or psychiatric condition. ___- Any manual method, physical or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely. ___- The position of the upper extremities when they are abducted to 90 degrees and externally rotated at the shoulders, with the elbows flexed to 90 degrees. ___- The involuntary confinement of a person in a room or area where the person is physically prevented from leaving

Restraint (drug) Restraint (physical) Reverse T position Seclusion

Sentinel vs. Potential Adverse Events: ___-An injury is caused as a result of the medical management process rather than the condition or diagnosis of the patient ___- No harm occurs either as a result of an intervention by an individual or because of chance; often referred to as a "close call" or "near miss"

SENTINEL EVENT POTENTIAL ADVERSE EVENT

>___- An adjustable belt or strap that is secured around a person's waist and is used to protect and control the person; also referred to as a guard, transfer, ambulation, or gait belt. >___- A temporary suspension of consciousness as a result of cerebral anemia; fainting. >___- The moving of a patient from one surface to another surface. >___- A sensation of rotation or movement of one's self or of one's surroundings.

Safety belt Syncope Transfer Vertigo

___- A convulsion or attack, as in epilepsy. ___- Acute peripheral circulatory failure caused by derangement of circulatory control or loss of circulating fluid. ___- A plate of bone forming the middle of the anterior wall of the thorax; the breastbone. ___- A decrease in the caliber of blood vessels.

Seizure Shock Sternum Vasoconstriction

•___: ▫Swelling of the face or mouth ▫Difficulty swallowing, speaking ▫Wheezing, difficulty breathing ▫Abdominal pain, nausea, vomiting ▫Dizziness or syncope •Treatment: ▫Check ___: if compromised, seek medical assistance; begin rescue breathing and CPR ▫Calm and reassure ▫Assist to ingest or inject ___ if they have one; do not use oral meds if having trouble breathing ▫Position person to prevent shock

Severe airway emergency allergy medication

___- An applied force that tends to cause an opposite, but parallel, sliding motion of the planes of an object; to subject to a shear force. ___- Continuous resistance to stretching by a muscle because of abnormally increased tension. ___- Lying with the face upward or on the dorsal (back) surface of the body; lying on the back. ___- The position of the upper extremities when they are abducted to 90 degrees and internally rotated at the shoulders, with the elbows flexed to 90 degrees.

Shear Spasticity Supine T position

Assisted Sitting Transfer: •Sliding board, Scoot, Sit, Squat pivot •Indications ●Unsafe to stand due to weightt bearing precautions, poor balance, large size differences between the therapist and the patient ●SCI, CVA, Bilateral LE trauma •___: can help reduce the friction and allow ease for transferring a patient •Your positioning is dependent on the patient's diagnosis

Sliding board

Abnormal Pulse Responses: •___ increase with activity •___ increase with activity •Continued increase (or decrease) with activity ___ •Slow decline with activity decline or cessation •No decline with activity decline or cessation •Declines without a decrease in activity •Excessive increase with activity •___ rhythm during or after activity

Slow No plateau Irregular

___- A hard, thick-walled capsule formed by some bacteria that contains only the essential parts of the protoplasm of the bacterial cell. ___- Containing no microorganisms; free from germs; aseptic. ___- A process by which all microorganisms, including spores, are destroyed. ___- Practices that render and keep objects and areas free of all microorganisms. ___- A bodily injury caused by physical means, with disruption of the normal continuity of structures.

Spore Sterile Sterilization Surgical asepsis Wound

>___- To sit on the heels with the knees fully bent. >___- To bend the body forward or downward by partially bending the knees. >___- The expression of the effectiveness of a force in turning a lever system; it is the product of a force multiplied by the perpendicular distance from its line of action to the axis of motion (T = F × D). >___- Increased intrathoracic pressure caused by forcible exhalation against a closed glottis. >___- A quantity possessing magnitude and direction, such as a force or velocity. >___- An imaginary vertical line that passes through the center of gravity of an object.

Squat Stoop Torque Valsalva phenomenon or maneuver Vector Vertical gravity line (VGL)

Transfers:Preparation (cont'd): •___ your equipment ● lock the w/c, stretcher, or bed •If pt has one-sided involvement, position w/c next to the ___ side. ●With pivot transfer w/c will be slightly angled to bed to allow for ___ to maneuver •Reduce distance between transfer surfaces by positioning w/c as ___ to bed as possible •Remove footrests, leg rests, armrests •Position ___ and ___ prior to transfer so they are free for movement •Position equipment (slideboard, walker, etc.)

Stabilize uninvolved foot close IVs and catheters

Normal Gait Pattern: •Normal ambulation or gait is composed of two phases: ___ and ___ •Stance phase: the reference limb is in contact with the ground •Comprises ___% of the total gait cycle •Swing phase: the reference limb is not in contact with the ground •Comprises remaining ___% of total gait cycle •These two phases can be further broken down into:.

Stance and Swing 60 40

Continued: • ___ and ___ indicates even beats with a good force to each beat. • ___ and ___ indicates even beats with a poor force to each beat. • ___ indicates that both strong and weak beats occur during the period of measurement. • ___ indicates a weak force to each beat and irregular beats. • ___ indicates a rapid HR (>100 beats/min). • ___ indicates a slow HR (<60 beats/min).

Strong and regular Weak and regular Irregular Thready Tachycardia Bradycardia

___: This device uses adjustable suspension straps, a harness that fastens around the patient's trunk, optional thigh straps to avoid loads to the groin area, and a type of suspension with a Y-shaped yoke that supports the patient from directly over each shoulder to maintain posture and balance.

Supported Suspension Ambulatory Aid

Pulse measurement sites: ___- Anterior and adjacent to the ear ___- Inferior to the angle of the mandible and anterior to the sternocleidomastoid muscle ___- Medial to the biceps in the antecubital fossa or on the medial aspect of the mid shaft of the humerus ___- At the wrist on the volar forearm medial to the stylus process of the radius ___- At the femoral triangle slightly lateral and anterior to the inguinal crease ___- In the midline of the posterior knee crease between the tendons of the hamstring muscles ___- Along the midline or slightly medial on the dorsum of the foot ___- On the medial aspect of the foot inferior to the medial malleolus

Temporal Carotid Brachial Radial Femoral Popliteal Dorsal pedal Posterior tibial

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT: ___ is a federal law enacted to protect health care-related information. The HIPAA Privacy Rule protects all "individually identifiable ___ information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, oral, or on paper. The Privacy Rule calls this information "protected health information," as found at the U.S. Department of Health and Human Services Web site under Summary of the HIPPA Privacy Rule.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) health

___ deal with organizational quality of care issues and the safety of the environment in which care is provided. The purpose of any survey is to evaluate an organization's compliance with nationally established Joint Commission standards. The Joint Commission team currently surveys facilities by a "___": a survey team enters a facility, selects a number of patients, and follows the patients' course throughout the facility.

The Joint Commission standards tracer methodology

Korotkoff's Sounds: I ___ II ___ III ___

The first faint, clear tapping sounds are detected and gradually increase in their intensity; these sounds are the initial indication of systolic pressure in an adult, according to the American Heart Association The sounds heard have a murmur or swishing quality to them The sounds become crisp and louder than those previously heard

IV ___ V ___

There is a distinct and abrupt muffling of the sounds until a soft, blowing quality is heard; this phase is the initial indication of the diastolic pressure and is the best indicator of diastolic pressure in adults, according to the American Heart Association The sounds essentially disappear totally; the phase is also referred to as the "second diastolic pressure phase"

Continued: C. ___ : The assistive aid advances simultaneously with the non-weight-bearing lower extremity; then the full-weight-bearing lower extremity (foot) steps through the aids. Bilateral crutches or a walker may be used. D. ___: The assistive aid and partial-weight-bearing lower extremity (foot) advance simultaneously; then the full-weight-bearing lower extremity steps through the aids. A bilateral cane, crutches, or a walker may be used.

Three-point (non-weight bearing) Three-one-point (partial weight bearing)

>___- One lower extremity is full weight bearing, and the opposite lower extremity is non-weight bearing; the patient uses bilateral crutches or a walker to support his or her weight when the weight-bearing lower extremity advances. >___- The use of three points as supports, such as a cane or crutch tips and a person's feet, with the tips in front of and to the side of the person's feet to form a base of support when the person stands.

Three-point gait (non-weight bearing [NWB]) Tripod position

Continued: •___- leg cut at femor •___- below knee amputation •___- can't move part of body •___- joints •Split-thickness burns and grafted burn areas

Transfemoral amputation Transtibial amputation Hemiplegia Rheumatoid arthritis

>___- The repetitive, simultaneous, reciprocal forward movement of an assistive device (e.g., a crutch or cane) and a person's opposite lower extremity. >___- Pertaining to one side. >___- An assistive device that usually has four contacts that are placed on the floor and a frame to support the patient's weight and provide stability during ambulation.

Two-point gait Unilateral Walker

• ___- Microorganisms must pass from one person to another to spread the infection. Transmission can occur through the air, droplets (from a cough or sneeze), or direct contact with items such as another person's skin, equipment, mat pads, instruments (e.g., needles, scalpels, and thermometers), eating utensils, linens, and body fluids such as blood, semen, saliva, and vaginal secretions. • ___- To infect another person, the microorganism must be able to enter that person (i.e., it must have a portal of entry). Examples of such portals are a break in the person's skin barrier, mucous membranes, the mouth, the nose, the ears, and the genitourinary tract. • ___- Finally, the person who receives the microorganisms must be susceptible to them (i.e., be a susceptible host). A person whose body systems cannot destroy, repel, remove, or ward off the microorganisms is a susceptible host.

Transmission Infection Susception

>___ -Used to determine the length of time required for superficial veins to refill, after they have been emptied, as a result of arterial flow through the capillaries into the veins (Note: The patient must have a normal venous system) The patient is supine, and the lower extremities are elevated 45-60 degrees for 1 min; then the legs are dangled over the edge of the bed or table; refilling of the veins is observed and timed (normal = 10 to 15 s for refilling)

Venous filling time test

Continued: Four-point, two-point, three-one-point -Weight bearing status- ___ -Walking aid- Axillary crutches, if indicated, to bilateral canes

WBAT

Continued: Modified four-point, modified two-point -weight bearing status- ___ -walking aid- One crutch or one cane

WBAT

•___: Wt bearing as tolerated- can put as much weight as they want •___: Partial wt bearing- can't put full weight; anything that is not full WB •___: Non wt bearing- no weight at all •___: Toe touch wt bearing- can put foot on ground but no weight through their foot •___: bringing feet in line with hands- ex. Wedding march •___: bringing feet past hands- normal gait pattern

WBAT PWB NWB TTWB Swing/step TO Swing/step THROUGH

Ambulation Pattern, Weight-Bearing Status, and Appropriate Walking Aids: >Four-point, two-point -Weight bearing status- ___ or ___ -Walking aid- Reciprocal walker, bilateral crutches, bilateral canes

WBAT or FWB

Wheezes, rhonchi, and stridor make up the continuous, musical abnormal breath sounds. ___ occur in patients with chronic obstructive pulmonary disease, asthma, chronic bronchitis, congestive heart failure, and pulmonary edema and can be heard anywhere in the lungs where obstruction exists. ___ sound like snoring or gurgling and imply larger airway obstruction by secretions. ___ is heard over the trachea and is an inspiratory musical wheeze that suggests obstruction of the trachea or larynx; it is considered a medical emergency.

Wheezes Rhonchi Stridor

Reaching an Object on the Floor in Front of the Chair: Reaching an object on the floor in front of the chair should be considered a relatively unsafe maneuver and should be used primarily in an emergency. If the object weighs more than ___ to ___ lb, the chair is likely to tip forward onto the footplates when the object is lifted from the floor, especially if the caster wheels are positioned backward. It is imperative to have the caster wheels positioned forward (Fig. 7-30, B) before the user attempts this task.

`5 to 10

Total hip replacement, especially within the initial 2 weeks after surgery* -The surgically replaced hip should not be ___ or ___, flexed more than ___, or extended beyond neutral flexion-extension. Do not cross the ankle of the surgically affected extremity ___ the opposite extremity, pull on the surgically affected extremity, or allow the patient to lie on the surgically replaced hip. Maintain the surgical extremity in abduction when moving into a side-lying position and during side lying, require the patient to sit in a semireclining position, and require the patient to maintain the surgically affected extremity in abduction when moving from side to side; if an abduction pillow is available, apply it after the patient returns to bed

adducted or rotated 90 degrees over

Risk Factors: A patient who is at risk for the development of pressure ulcers should be identified at ___, the risk factors should be documented, and a prevention program should be initiated promptly.

admission

Allergic Reactions: An ___ occurs when one's immune system overreacts to a specific substance, known as an allergen. A caregiver may experience a reaction to the latex in gloves or the chemicals in hand cleansers. An ___ is a consequence other than the one for which the medication was intended and which frequently has an adverse effect on another organ. Some examples of adverse effects are nausea, muscle ache, vomiting, visual disturbance, drowsiness, abdominal discomfort, intestinal cramping, diarrhea, and headache. You should differentiate between these two!

allergic reaction adverse effect

•Bed mobility ●Side to side -start at ___ or ___ and move him, then to ___ and move him, then to ___ and moves him -depending on size of patient, may need to be on side of the patient that you're moving him or her too- if you have a bigger patient, move the patient ___

ankles or knees hips shoulder towards you

Continued: 4.Pain physiology, motivational interviewing >1.Reassess ___ and ___ >2.Treatment: stress management, graded activity, improving self efficacy >3.Patient beliefs can be a strong predictor of ___ >4.___ is so important

attitudes and beliefs disability Education

Rationale Against Professional: -May have personal and professional identity reduced, may lose professional ___ -Reduces personal decision making -Is a ___ process -Causes separation from professionals, peers, and colleagues -Interprofessional collaboration may not be a value of the profession; professional becomes reluctant to participate

autonomy time-consuming

Two measurements to the nearest 0.25 inch should be made at the site, and the ___ is used as the reporting value. A skin-marking pencil can be used to mark the level or location at the base of the tape of the circumferential measurement. Accuracy and reliability of the measurements are enhanced when the same person performs the measurements, a tension gauge is used, the patient is in the same position, measurements are made at the same time of day, and the same tape measure is used.

average of the two measurements

Three-One-Point Gait Pattern (Modified Three-point/Partial weight-bearing) •Requires the use of ___ AD or ___ •Pattern description: walker, crutches, or canes are advanced simultaneously with the ___ LE, then the full WB LE is advanced while the pt distributes BW onto the AD and partially bears weight onto ___ LE •For example: AD and PWB LE advance simultaneously, then FWB LE steps through the aids •Pattern is used when pt has full WB on one LE and ___ on opposite LE •More stable than three-one-point gait pattern, requires less strength and less energy expenditure but is slower

bilateral walker PWB impaired PWB

Four point: •A -> Four-Point Gait Pattern •Requires the use of ___ aids/AD •Pattern description: alternate and reciprocal forward movement of the AD and the patient's opposite LE •For example: Right crutch then left foot; left crutch, then right foot •It is a very ___ pattern and the the safest pattern in crowded areas •Low energy expenditure •Used when patient requires ___ stability or balance

bilateral ambulation slow, stable maximal

Two Point: •Requires the use of ___ AD •Pattern description: simultaneous, ___ forward placement of the AD and the patient's opposite LE •For example: right crutch AND left foot; left crutch AND right foot •Less stable but ___ than the four-point gait pattern •Low energy expenditure •Requires coordination between patient's UE and opposite LE to move simultaneously

bilateral ambulation aids/AD reciprocal faster

Half-kneeling lift: >Object moved close to ___ before the flexed lower extremity assists with raising the body as the lifter continues to stand >Can be used for objects of ___ >Can be used for those with decreased ___- helps using powerdrivers in legs and gluts

body uneven weight arm strength

Primary Risk Factors Associated with Pressure Ulcers: • Pressure on tissue overlying ___, especially the sacrum, heels, greater trochanters, vertebral spinous processes, and ischial tuberosities • Shear and friction forces applied to the skin • Inadequate or improper nutrition or fluid intake • Insensate body areas, especially those that are not sensitive to pressure • Persistent ___, which leads to skin irritation, maceration, or breakdown • Metabolic or systemic disorders or diseases, especially diabetes • Persons with reduced mobility and ___ • Persistent use of tobacco products

bony prominences incontinence contracture

Patient and Family Education: The caregiver has the responsibility to educate the patient and family about the treatment program and activities, but patient ___ must be respected and the patient's permission must be obtained before sharing information with the family.

confidentiality

Body Mechanics: •Value- ___ primarily so we can be more efficient, reduce stress and strain, promote effective efficient and safe movements, maintain balance, proper respiratory and cardiopulmonary function

conserve energy

The disease-specific precautions are divided into three designations of precautions based on the route of transmission: ___, ___, and ___ • ___: Microorganisms are transferred directly from one infected person to another or indirectly when the transfer of an infectious agent is through an object, medical equipment, furniture surface, or person. Some diseases that can be transmitted by contact are herpes simplex virus, S. aureus, vancomycin-resistant Enterococcus, and C. difficile.

contact (direct or indirect), droplet, and airborne Contact

Protective Isolation: •For patients whose condition or disease causes a high risk of becoming infected through ___ •Burns, wounds, compromised immune system, systemic infection/sepsis

contact with another person

Lacerations: •Prevent ___ of the wound and control the bleeding, arterial wound need more pressure because more bleeding •Wash hands, apply gloves •Apply clean/sterile towel to wound •___ if excessive blood flow •Clean if able with antiseptic or water •Place clean towel or sterile dressing, pressure if needed •Calm and reassure -Arterial - apply pressure to site or major artery ___

contamination Elevate above heart proximal

Burns: •Prevent wound ___ •Relieve or reduce pain, prevent shock •Remove cause of burn, obtain assistance •Remove ___ and Cut away or ___ near site of burn that is not part of the wound- don't remove clothing on the wound •Apply clean or sterile dressing over wound •If caused by chemical, use lots of ___ to wash wound; make sure water runs directly off •Observe for shock, respiratory distress, etc •Arrange for transport to medical facility

contamination jewelry remove clothing water

Continued: •Existing ___- if flexed, need to set them in extension •Condition of skin •Presence of cuts, burns, abrasions •Body type •Psychological status •What extent is patient capable of being responsible for his/her care?

contractures

Open- ended questions >Example >Promote ___ Closed- ended questions >Example >Answer with ___ or ___ usually -Helps understand patient and client better

conversation "yes" or "no"

Factors affecting pulse: Age- Persons older than 65 years may exhibit a ___ pulse rate, whereas young persons (adolescents and younger) usually exhibit an ___ rate Gender- Male pulse rates are usually slightly ___ than female rates Environmental temperature-The pulse rate tends to ___ with high temperature and decrease with low temperature

decreased increased lower increase

Externally Powered: •Propelled by ___ system •Various controls to operate chair: •Joystick •Chin piece •Mouth stick •Etc.

deep-cycle battery

The following conditions are indicators of an improperly applied bandage: • If the color of the segment ___ to the bandage becomes excessively red, blue, or pale, the bandage is usually too tight and is constricting the local circulation. • If the patient reports pain, numbness, tingling, or a burning sensation in the segment distal to the bandage, the bandage is usually too tight and is affecting local neural receptors.

distal

Continued: Apply one restraint strap over the lower thighs (just proximal to the patellae) and one strap across the mid or upper thorax; a towel may be placed beneath each strap for protection and comfort, and the strap buckles should be positioned so they do not contact the patient. Note that when the lower strap is applied over the ___ rather than directly over the patellae, pressure to the patellae can be avoided. If desired, a third strap can be applied over the abdomen or pelvis.

distal thigh

Body Mechanics: •Helps inform you on your patient's mobility and a safe transfer technique •To be performed prior to moving the patient because want to know what they are able to ___ and how ___ they are

do and how strong they are

Immediate postoperative goals are: • Successful wound healing • Control of ___ and shaping of the residual limb • Prevention of ___ (e.g., hip flexion, abduction and external rotation for the AK and BK amputations, and knee flexion for the BK amputation) • Patient and family education concerning limb care, skin care, and residual limb and body positioning • Control of postoperative pain (both phantom limb pain and real pain) • Achieving ___ in activities of daily living and mobility with and without a prosthesis • Education concerning daily inspection of the residual limb, the process of fitting of a prosthetic limb, and functional outcome

edema joint contractures independence

Confirmation of the Fit of an Assistive Device: Each aid should be evaluated for fit with the patient standing with the head ___, shoulders relaxed and ___, trunk erect, pelvis level, knees ___ slightly, and feet (foot) flat.

erect level flexed

>___- Redness of the skin caused by congestion of the capillaries in the lower layers of the skin. >___- A dry scab; devitalized tissue. >___- A fluid with a high composition of protein and cellular debris that has escaped from blood vessels and is deposited in tissues or on tissue surfaces. >___- Any granular material on the surface of a tissue, membrane, or organ.

erythema Eschar Exudate Granulation

A decision regarding the appropriate transfer or activity to be performed will need to be made on the basis of four general parameters: • Your ___ • The available ___ • Information from the ___ and/or ___ • The ___ of treatment

evaluation written information patient and/or family members goals

Common Hospital Emergency Codes: • Code red = ___ • Code blue = ___ • Code orange = ___ • Code gray = ___ • Code silver = ___ • Amber alert = ___ • External triage = ___ • Internal triage = ___ • Rapid response team = rapid response team • Code name clear = to clear a code

fire heart or respiratory arrest hazardous material spill or release combative person person with weapon/hostage situation infant and child abduction external disaster internal emergency

Continued: A ___ is rarely used with small children because the caregiver usually can have full control of the child by placing the hands in guarding positions on the chest or waist.

gait belt

PARALLEL BARS • Position the patient so he or she is standing erect between the bars. • Adjust the height of the bar (rail) so it is level with the ___ or ___ with the upper extremity by the side. • Observe the angle of elbow flexion when the patient grasps the bars; it should be approximately 20 to 25 degrees. • Adjust the width of the bars, if possible, to provide approximately ___ to ___ of space between each of the patient's hips and the bar.

greater trochanter or even with the wrist crease 2 to 4 inches

Rising from the Floor to Standing: >When rising from the floor to standing, if the patient is NWB on one lower extremity and uses bilateral axillary crutches, he or she turns so the hands and the foot of the strongest lower extremity are on the floor and assumes a ___ position with that one lower extremity. The hip of the weaker lower extremity is extended and externally rotated. The crutches are positioned within easy reach, and the patient pushes to a standing position using the ___ and ___

half-kneeling strongest lower extremity and the upper extremities

Continued: •Seat Width •Place ___, held vertically, between greater trochanter/hip/thigh and armrest panels •Hand should be in slight contact with user and armrest panel or hand rims •Both hands should be used, one on each side

hand

Standing with Forearm Crutches (see Fig. 9-22) • The patient establishes balance and uses the right hand to grasp the ___ of one crutch. The crutch is positioned lateral and anterior to the right foot. The crutch is positioned similarly on the ___ • When each crutch is positioned, the forearm cuff is applied alternately to each forearm, unless the patient has reached through the cuff to grasp the handpiece.

handpiece opposite side

The most distal part of the extremity should be higher than the ___; this position can be achieved with the use of pillows or bolsters.

heart

Armrest too ___: •Problems propelling due to difficulty reaching over armrests •Difficulty performing standing transfer due to poor functional position of UE for pushing •Postural deviations when resting on armrests •Limited use of armrests causing discomfort, decreased trunk stability, and fatigue

high

Back too ___: •Difficulty propelling due to difficulty using arms comfortably •Excessive irritation of skin over inferior angles of scapulae •Difficulty with balance as trunk may be inclined forward Back too ___: •Decreased trunk stability or postural deviations

high low

Improper Fit: >Seat too ___: •Insufficient trunk support due to back upholstery being too low •Difficulty positioning knees under table or desk •Difficulty propelling WC due to difficulty reaching rims •Poor posture when forearms rest on armrests >Set too ___: •Difficulty performing standing or lateral swing transfer because COG is lower •Improper weight distribution while person is seated

high low

Manually Operated Lift: A manual mechanical lift uses a ___ system to raise and lower the patient. A manually operated lever is used to control the fluid in the cylinder. When the valve is closed and the lever is "pumped," the fluid compresses and the arm with the spreader bar is raised. When the valve is opened, pressure in the cylinder is released and the arm and spreader bar are ___. The patient's weight and the amount the valve is opened determine the rate of descent of the patient.

hydraulic fluid lowered

Volumetric Measurements • Expose the area to be assessed, seat the patient to assess the foot/ankle, and have the patient sit or stand to assess the hand/wrist. Inform the patient about the procedure and obtain the volumeter and a calibrated container. • Fill the volumeter to overflowing with tepid water. When water no longer drips from the spout, place the calibrated container beneath the spout; be certain both containers are on a firm, level surface. • Instruct the patient to slowly and carefully ___ with the hand open and the fingers relaxed, until the fingers touch the bottom of the container. With the foot/ankle, have the patient slowly immerse the foot until it just touches the bottom of the container. Instruct the patient to leave the body part immersed, without ___, until water no longer drips from the spout. (Note: When using a volumeter with a bar, instruct the patient to immerse his or her hand so the bar separates the third and fourth digits.)

immerse the hand/wrist movement

Balance Lost Forward: • Move directly ___ the patient, but maintain a wide stance. • Use one hand to gently but firmly push on the patient's shoulder or chest and on the gait belt; you may prefer to hold firmly to the handrail and the gait belt and move your body toward the patient's ___. Instruct the patient to look up and straighten the trunk or release the aid(s) and grasp the handrail. • Help the patient regain a balanced position or sit on a step

in front of chest

Continued: • The patient grasps the chair armrests ___ (A). This position provides the greatest stability and allows the patient to use his or her upper and lower extremities most effectively to stand. • To rise, the patient leans the trunk forward, simultaneously pushes down with the upper extremities and the strongest lower extremity, and stands. • When standing, the patient reaches one hand at a time to grasp the handpieces on the walker and establishes balance before ambulating.

in front of the hips

Proliferative Phase: The proliferative phase overlaps the ___ phase with granulation, angiogenesis to reestablish capillary buds, contraction, and epithelialization of the wound site.

inflammatory

Inflammatory Phase: The inflammatory process is the body's ___ to injury or trauma, and it begins immediately after injury or trauma. -The inflammatory process consists of at least three stages: • ___, ___, ___

initial local defense response Vascular, Exudate, Reparative

Components of a Differential Diagnosis: Two primary methods are used to gather information and data: (1) observation and ___ and (2) specific ___ and ___. To gain the most from the patient's response, use active listening skills to determine what the patient has actually told you. At the same time, look for ___ signs of discomfort (e.g., grimaces, frowns, and position changes), respiratory difficulties (e.g., rapid breathing, shallow breaths, and accessory muscle use), and decreased mental function (e.g., slow response, lack of eye contact, "flat" affect, and drowsiness).

interviews tests and measures nonverbal

Continued: Pillow behind back Good seat cushion to relieve pressure on ___ Wheelchair should not reach into ___ Feet are supported in neutral position and not left dangling in ___

ishial tuberosity popliteal fossa plantar flexion

Previously used linen should never be reapplied to a patient or used for any other patient until it has been ___.

laundered

Stress: •The experience of anticipating or encountering adversity in one's goal-related efforts •Stress is linked to: -6 ___ (heart disease, accidents, cancer, liver disease, lung disease, suicide) -___ from work -Increased medical expenses -Loss of ___ -Cognitive impairment -Depression -Aggression -Relational ___

leading causes of death Absenteeism productivity conflicts

•May be dependent, but patient should be participating as much as possible even if only ___. •Bed mobility ●Rolling ●Up and down positioning in the bed ●Supine-> Sit •Important to reduce the risk of developing ___ •When assisting a patient with mobility activities, use body mechanics and your environment to your advantage

mentally pressure ulcers

Standards of ___ differ among individuals and cultures, and thus each patient should be draped to limit exposure of any body area that, when uncovered, is considered by the person to be immodest.

modesty

Continued: • Provide temporary clothing or linen to protect ___ and provide ___. • Specifically ___ how you want the patient to apply linen items, a gown, a robe, or exercise clothing to cover (drape) the body; provide privacy while the patient is disrobing and dressing. • Instruct the patient to inform you when he or she is positioned and draped, or confirm that the patient is ___ before you enter the cubicle.

modesty and provide warmth describe clothed or draped

Stress and coping: •Stress is unavoidable •Not all stress is ___ -The way you perceive stress can change its ___ -Two attitudes towards stress •Stress is ___ attitude -Primary motivation is to avoid or manage the stress to prevent debilitating outcomes •Ex. Denial, avoidance, self blame, behavioral disengagement, distraction

negative effect on you physically debilitating

Three-Person Dependent: Bed to Stretcher: It is used when ___ can be used, in an emergency, when mechanical equipment is not available, and when the patient cannot sit or stand. The two stronger and taller of the three persons should be positioned at the patient's ___, ___, and ___. The third person is positioned to control the lower extremities. One person becomes the leader (usually the person at the patient's head) to instruct and give commands to the lifters.

no other type of transfer head, shoulders, and pelvis

Continued: The patient pushes up from the bed, stands, and grasps the hand grips on the walker while you maintain control of the safety belt and shoulder. You may guard or stabilize the patient's ___ so it does not slide as the person rises. The patient maintains balance and takes time to accommodate to standing before ambulating. The patient ambulates using a three-one pattern.

normal foot

Body mechanics: -•Bend at knees and hip -•Move in ___ at a time (Do not rotate and extend simultaneously) -•Pivot -•Keep COM over BOS -•Stand close to the patient to reduce lever arm -•Straddle patient's knees and feet to prevent buckling

one direction

Ascending and Descending Stairs Using a Handrail: >Bilateral Canes -To ascend or descend stairs using a handrail and bilateral canes, the patient holds both canes in ___ and uses the other on the handrail. An alternative method is to hold a cane in each hand, grasp the handrail and one cane simultaneously, and use the other cane as described for a curb. The cane held simultaneously with the handrail is held parallel to the direction of the handrail. The lower extremities are used in the same way as described for a curb.

one hand

Continued: If you plan to roll the patient toward the right, place the left lower extremity ___ the right lower extremity, place the left upper extremity on the ___, and place the right upper extremity in straight abduction. Roll the patient toward you by pulling gently on the left posterior scapula (shoulder) and the left posterior pelvis. Do not pull on the upper or lower extremity to initiate the roll, because you will not be able to properly control or initiate movement of the trunk and the extremity may be injured.

over chest

Overhead lift: >To place objects on an ___ >Put you at increased risk for muscle ___ >It can be difficult to maintain ___ during the lift >If possible, ___ this lift >Only use this lift when absolutely necessary

overhead shelf strain balance avoid

Rationale Against Client/ Patient: -Process may ___ the patient -May not produce better quality care -May not result in best decisions because of professional role conflicts -Likely to be more ___ (e.g., time, money, and effort) -May reduce the one-on-one relationship between the patient and individual professionals

overwhelm costly

Results of screening and how to determine what transfer technique to use with a patient -___- you're doing all the work -___- they are helping you as much as they can

passive (dependent) transfer active transfer

To create a ___, first cover the entire foot with an underwrap, such as Omnifix or Cover-Roll stretch, to protect the skin. This wrap is an excellent choice for acute plantar fasciitis. An orthotic should be made for a person with chronic plantar fasciitis to support the arch. Appropriate foot exercises also should be initiated.

plantar fasciitis wrap

Allergic Reactions: Type I - immediate reaction due to ___, ___, ___, ___ Type II - seen after an ___ Type III - cascade of reactions in the body that destroys tissues; ___ and ___ Type IV - Delayed reaction mediated by immune-specific T cells (contact dermatitis - ____)

pollen, food, insect stings, animal dander organ transplant when the body rejects the donor organ glomerulonephritis and lupus poision ivy

Processes of Healing: First-intention healing occurs in wounds whose edges are closely related or whose edges have been approximated by sutures, staples, Steri-Strips, or other similar means. First-intention healing is the ___ and most ___ method of healing. Second-intention healing occurs in wounds with large surface areas or retracted edges or in wounds in which a large amount of tissue has been lost.

preferred effective

Medication Errors: The primary types of medical errors result from errors in medication ___ or ___, surgical procedures, diagnostic or laboratory report inaccuracies, and practice mistakes.

prescriptions or regimens

Draping: If access legs, put sheet between patient's legs to cover any ___ areas

private

Compromised Patients: When a pt experiences adverse reaction to treatment [unusual vitals, vertigo, syncope, nausea, or vomiting] pt should be ___ by physician prior to resuming treatment If something changes in their status, you are with them most of the time, you need to ___

re-evaluated report it

5 step approach 1.Self ___ 2.Assessment of ___ and ___ in patients with chronic musculoskeletal pain 3.Clinical reasoning including ___ 4.Education 5.Therapy Patient specific

reflection attitudes and beliefs reconceptualizations

These stages can be described as being progressive: stage I becomes stage II and stage II becomes stage III; however, the stages cannot be described ___. That is, as a stage III ulcer heals, it does not revert to stage II; instead, as a stage III wound heals, it continues to be classified as stage III, but the percentage of the wound that has healed is reported or a measurement and description of the open area of the wound are used to indicate the improvement or healing of the wound.

regressively

Continued: Pressure sores/decubitus: Terms: Blanchable, Ischemia, Maceration, Necrosis, Shear, Bony Prominences Effect on patient: delays or limits ___ potential; raises hospital ___ and ___; leaves an area of skin more susceptible to further breakdown; may be ___ Occurs mainly over bony prominences; can occur within ___ to ___ Causes: poor positioning, long-term low pressure or short-term high pressure, poor nutrition, skin tolerance, shearing forces

rehab costs time painful 20 minutes to one hour

Rationale: Persons who review claims and make ___ and treatment-related decisions focus on indicators of functional outcomes of treatment contained in the caregiver's documentation. Therefore the caregiver must be aware of the need to provide accurate, current, function-oriented documentation. In addition, the use of function-oriented, objective, and measurable data in the documentation process will result in the greatest likelihood of obtaining a favorable reimbursement response to submitted claims and gaining approval to continue treatment from the ___.

reimbursement third-party payer

Continued: •Spasticity -many conditions have this as a symptoms -prevent communication between brain and muscles, causing them not to ___ -spasms resemble charlie horse, and can cause many problems with tendons and muscles (___) which affects mobility of joint -you cannot fight it as a PT •Burns and graft sites -avoid any shear forces around these areas •___- weakness on one side of the body due to a stroke -can have a ___ dislocation

relax contracture Hemiplegia humoral head

Continued: • The patient lowers into the chair slowly and then positions the body back in the chair. • Note: If the chair does not have arms, the patient can be taught to ___ the cane, allowing it to fall sideward to the floor, and to reach to the chair seat or the back of the chair with the free upper extremity to help lower the body into the chair. For each of these activities, the patient should be instructed to lock the wheelchair, elevate the footplates or swing away the front rigging, and position the caster wheels forward before standing.

release

Restraints are recommended for ___ use only and should not be used to hinder or restrain the patient for several hours. What is one major restraint you need to be sure to avoid?

short-term don't leave all four bed rails up

Entry Corrections: The following standard procedures should be followed when correcting a note in a handwritten medical record: • Draw a ___ through the inaccurate information, but be certain the material remains legible. • Date and initial the correction, and add a note in the margin stating why the correction was ___. • Enter the corrected statement in the chronologic sequence of the record, and be certain it is clear which entry the correction replaces. • Use ___ for all corrections and entries.

single line necessary black ink

Recumbent, Dependent Lift: The recumbent, dependent transfer is used with patients who are physically unable to assist with the transfer and are unable to be placed in a ___. One, two, or three persons or special equipment are required to lift and move the patient from one surface to a second surface.

sitting position

Unstageable -Full-thickness tissue loss in which the base of the ulcer is covered by ___ (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the wound bed Further description: Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined; stable (dry, adherent, intact without erythema or fluctuation) eschar on the heels serves as "the body's natural (biological) cover" and should not be removed

slough

Cardiopulmonary disease- Both the condition of the heart and the peripheral vascular system and their ability to function normally affect the pulse rate; for example, a patient with hypertension may exhibit a ___ (lower) pulse rate, whereas a patient with hypotension may exhibit a ___ (higher) pulse rate to compensate for the higher or lower blood pressure Physical conditioning- Persons who perform frequent, sustained, vigorous aerobic exercise will exhibit a ___ than normal pulse rate

slower faster lower

Common cause of back problems: -Not usually one massive event, it is usually ___ of trauma and a final straw

small episodes

Proper positioning is important for the following reasons: • It prevents ___, ___, and ___. • It provides patient comfort. • It provides support and stability for the trunk and extremities. • It provides ___ and ___ to areas to be treated. • It promotes efficient function of patient's body systems. • It relieves excessive, prolonged ___ on soft tissue, bony prominences, and circulatory and neurologic structures.

soft-tissue injury, pressure, and joint contracture access and exposure pressure

Prep for Ambulation: Screening Considerations: •Never perform resistance to an extremity that is NWB, TTWB, or PWB-> surgeon doesn't want ___ here •Never apply resistance to a joint or segment that has just undergone ___.

stress surgery

Sliding board: -___ side toward sliding board -count down for patient Stand pivot: -position feet as far as you can and scoot butt to the ___ -don't rotate back but pivot feet Squat pivot: -scoot to edge of chair- if almost completely dependent, have them wrap around your waist and grab over their shoulder to the back of their gait belt

stronger edge of the chair

Three-One-Point Pattern: To move backward in a three-one-point pattern, instruct the patient to step back with the ___ while maintaining the crutches in front of, or even with, the less functional lower extremity. The patient then steps back with the crutches and the less functional lower extremity to place them in line with the normal foot.

stronger lower extremity

Information about the patient and the plan of care is contained in the status notes, which are written in the SOAP format: stands for ___, ___, ___, ___. The POMR has four phases: 1. Formation of a ___ (current and past information about the patient) 2. Development of a specific, current ___ (problems to be treated by various practitioners) 3. Identification of a specific ___ (developed by each caregiver) 4. Assessment of treatment plan ___

subjective, objective, assessment, and plan database problem list treatment plan effectiveness

The following basic principle should be followed: Maintain the record so that, if all the persons originally treating a patient were to disappear, the next group of practitioners could immediately continue to provide the best quality treatment by using only ___.

the information from the record

Descending a curb: >Unilateral curb -the patient simultaneously steps down with ___ and ___ while flexing the stronger lower extremity. The patient lowers his or her body with the strongest lower extremity and steps down after the cane and opposite lower extremity have been placed on the lower surface

the weaker lower extremity and cane

Medical Errors in Allied Health Fields: Errors in diagnosis by the caregiver can occur when the examination is not ___ enough. If the therapist determines an incorrect cause of the pain, therapy may not be ___ and would lead to an unsatisfactory outcome.

thorough effective

Dressings: >___ (e.g., Bioclusive, Tegaderm, and OpSite) -Dressing of choice for stages I and II wounds with blister formation over bony prominences; resists shear; may be applied to heels prophylactically; self-adherent and allows wound to be observed; may be used for autolytic debridement; do not use on draining or infected wounds

transparent file

Most experts agree that the primary core deep stabilizing muscles are the ___ and ___. Body mechanics can be described as the use of one's body to produce motion that is safe, energy conserving, anatomically and physiologically efficient, and maintains body balance and control. Patients should be taught to breathe normally when performing physical activity and avoid the potentially adverse effects of the ___.

transversus abdominis and the lumbar multifidus Valsalva phenomenon or maneuver

Technique for Ascent and Descent of Stairs with Assistive Aids: -For descriptive purposes, assume the right lower extremity (RLE) is the affected or weaker lower extremity when a single cane is used and when non-weight-bearing and partial- weight-bearing crutch patterns are used. Caution: Whenever a fixed handrail is available, the person should ___ for security and stability

use it

Ascending a curb: >Standard Walker -If the curb is low (4 inches or less), the patient places the ___ and ___ onto the curb and elevates the body while simultaneously raising the weaker lower extremity onto the curb (Fig. 9-38). If the curb is of standard height (6 to 8 inches), the patient turns so the ___ is toward the curb and the walker is in front of the body. The patient places the ___ onto the curb and elevates the body while simultaneously lifting the ___ and ___ onto the curb.

walker and the stronger lower extremity back stronger lower extremity walker and other lower extremity

Biopsychosocial Model: Biological- pretty black and white reason as to the "___" pain is happening So much more that goes into an injury experience -what is the one thing that biological, social, and psychological have in common?

why health

Wound Care: Wound healing is promoted through ___ and maintenance debridement by the removal of yellow slough, fibrin, tissue exudates, and bacteria.

wound cleansing

Burns: When treating a person with a burn, the objectives are to prevent ___, relieve or reduce ___, and prevent ___.

wound contamination pain shock

Walkers: Setup ●Handgrip should be level with patient's ___, ___, or ___ ●Feet of walker should be resting on floor or even with heels. ●Hips and knees should be straight ●Shoes should be worn

wrist crease, ulnar styloid process, or greater trochanter

Axillary Crutches: Setup: ●Middle bar at pt's ___ ●Adjust ht as needed ●Crutches should rest on the ___ NOT in the axilla

wrist crease/ulnar styloid rib cage

Head and Trunk: >prone position ___, ___, ___, ___, ___

-Forehead -Lateral ear -Tip of acromion process -Sternum -Anterosuperior iliac spine

LE: >side-lying extremity (lowermost extremity) ___, ___, ___, ___

-Greater trochanter of femur -Medial and lateral condyles of femur -Malleolus of fibula and tibia -Fifth metatarsa

Head and trunk: >Sitting position: ___, ___

-Ischial tuberosities -Scapular and vertebral spinous processes (if leaning against back of chair); sacrum if the patient is slouched

UE: >side-lying position (lowermost extremity): ___, ___ >side-lying position (uppermost extremity): -___

-Lateral head of humerus -Medial or lateral epicondyle of humerus humerus?

LE: >side-lying position (uppermost extremity): ___, ___ >sitting position: ___, ___, ___

-Medial condyle of femur -Malleolus of tibia -Greater trochanter -Popliteal fossa -Posterior calcaneus if resting against a hard surface

Upper extremity: >supine position ___, ___ >prone position ___, ___

-Medial epicondyle of humerus -Olecranon process -anterior head of humerus -clavicle

UE: >sitting position: ___, ___

-Medial epicondyle of humerus -Olecranon process (if resting on a hard surface)

Bony Prominences that May Cause Pressure Injuries: Head and Trunk: >supine position -___, ___, ___, ___, ___

-Occipital tuberosity -Spine of scapula -Inferior angle of scapula -Vertebral spinous processes -Posterioriliac crest Sacrum

LE: >prone position: ___, ___, ___

-Patella -Ridge of tibia -Dorsum of foot

LE: >supine position: ___, ___

-Posterior calcaneus -Greater trochanter, head of fibula, and lateral malleolus with excessive external rotation of the hip

Abnormal BP Responses: •Systolic rapidly increases with activity •Systolic does not increase with activity •Systolic increases or decreases when activity plateaus •Systolic rapidly declines as activity declines •Systolic does not decline with activity decline •Systolic declines below baseline at termination of activity •Systolic declines before intensity of activity decreases •Diastolic increases more than 10 - 15 mmHg during activity

.

Abnormal Responses Exhibited by the Pulse: • The pulse rate slowly increases during active exercise. • The pulse rate does not increase during active exercise. • The pulse rate continues to increase or decreases as the intensity of exercise or activity plateaus. • The pulse rate slowly declines as the intensity of the exercise or activity declines and terminates. • The pulse rate does not decline as the intensity of the exercise or activity declines. • The pulse rate declines during the exercise before the intensity of the exercise or activity declines. • The increased pulse rate or the amount of the increase exceeds the level expected to occur during the exercise period. • The rhythm of the pulse becomes irregular during or after exercise or activity

.

Balance Lost to One Side, Away from You: • Use the gait belt to pull the patient toward you; use your other hand to control the trunk or grasp the handrail. • Help the patient regain a balanced position or, if that is not possible, lower the patient to the steps or move the body toward the handrail.

.

Barriers to Communication: Distance Environment Time available Language Interpretation of communication Cultural, gender, or age differences

.

Bony Prominences: Prone: •Head and Trunk: ●Forehead, ●Lateral ear, ●Tip of acromion process, ●Sternum, ●ASIS •Upper extremity: ●Anterior head of humerus •Lower extremity: ●Patella, ●Ridge of tibia, ●Dorsum of foot

.

Bony Prominences: Side-lying: •Head and trunk: •Lateral ear, •Lateral ribs, •Lateral acromion process •Upper extremity: •Lateral head of humerus, •Medial or lateral epicondyle of humerus •Lower extremity: •Greater trochanter of femur, •Medial and lateral condyles of femur, Malleolus of fibula and tibia

.

Bony Prominences: Sitting: >Head and trunk: •Ischial tuberosities, Scapular •Vertebral spinous processes (if leaning against back of chair) >Upper extremity: •Medial epicondyle of humerus (if resting on a hard surface)

.

Bony Prominences: Supine: >Head and trunk: •Occipital tuberosity, •Spine of scapula, •Inferior angle of scapula, •Vertebral spinous processes, •Posterior iliac crest • Sacrum >Upper extremity: •Medial epicondyle of humerus >Lower extremity: •Posterior calcaneus, •Greater trochanter, • head of fibula, • lateral malleolus with excessive hip external rotation

.

Car Transfers: •Be creative •Be practical •Think and plan! ●Super duty F-350 vs Mazda Miata ●Front seat or back seat?

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Confirmation of Fit: the following parameters should be measured: • Seat height • Leg length • Seat depth • Seat width • Back height • Armrest height

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Continued: >Prone (Caution: This position is not well tolerated for 2 h for older adults; a change at 30 min often will need to be made; in addition, this position is not appropriate for persons with breathing problems) -Body is well aligned, Have pillows and towel rolls readily available so that as the patient is rolled from a side-lying to a prone position, a pillow is under the abdomen to put the back in neutral or slight flexion, patellae are protected or bridged, the dorsum of the feet are protected or lifted, and ankles are not too far plantar flexed; the feet may hang off the end of the support surface if the patient is not in danger of injury

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Descending a curb: >Bilateral Crutches. Three-One-Point Pattern -To descend a curb using bilateral crutches with a three-one- point pattern, the same procedure described previously for use with bilateral canes can be taught.

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Documentation: >Include: Primary and treatment diagnosis Physicians orders Barriers to treatment Patient consent to treatment Plan of care -Goals, treatments, frequency, duration, discharge Risk vs. benefit of treatment

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EXTRINSIC FACTORS • Pressure applied to soft tissue that overlies a bony prominence • Shear force applied to the skin, especially to the heels and sacrum • Maceration of the skin caused by body waste, perspiration, or skin-to-skin contact (i.e., skin folds) • Infection • Reduced activity leading to prolonged immobility INTRINSIC FACTORS • General health of the patient • Condition of the skin • Body build and composition • Nutritional status • Hydration status • Distance between the edges of the wound • Location of the wound • Adequacy of blood flow to the wound

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Effective body mechanics depends on the stability of a person's BOS, maintenance of the VGL within the BOS, foot and body positions in relation to an object, and the use of short lever arms when lifting, reaching, or carrying.

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Factors Affecting BP: •Age •Physical Activity •Emotional Status •Medications •Size and condition of arteries •Arm position •Muscle contraction •Blood volume •Cardiac output •Site of measurement

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Functional abilities and performance of daily tasks- guidelines: Bed mobility, positional changes, and transfers Personal care and hygiene Application, removal, adjustment, and use of assistive devices or equipment Ambulation and mobility activities with and without the use of assistive devices or equipment

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Heat Exhaustion: Sins and symptoms: Diaphoretic, nausea, headache, shallow/rapid breathing, weak/rapid pulse, pale, temperature normal or slightly elevated, exhaustion, collapse, unconscious, pupils norma Cramping in legs and trunk

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Hyperglycemia: Onset: gradual, skin: flushed, dry, behavior: drowsy, fatigued,confused, breath: fruity odor, breathing: deep, labored, short, vomiting: resent, tongue: dry, hunger: absent, thirst: increased, Glucose in urine: large amounts, shakiness: absent, sweating: absent, tingling in mough: absent, visual disturbances: blurred vision, headache: present

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The following breathing retraining exercises often are used: • Breathing exercises (diaphragmatic, pursed lip, segmental) • Incentive spirometry • Paced breathing techniques • Glossopharyngeal breathing • Sustained maximal inspiration and inspiratory hold techniques • Respiratory muscle strength and endurance exercises The following therapeutic exercise programs with or without oxygen support may be used: • Relaxation training • Posture correction • Manual stretching of the thorax • Chest mobilization • Exercise techniques to improve and maintain ROM of the chest and shoulders (e.g., after a thoracotomy) • Strength and coordination of the trunk and extremities • Exercise endurance training • Energy conservation techniques • Instruction in home care programs • Patient and family education

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Transfers: Preparation •Review medical record, interview, objectives •Precautions (post-op, ROM, wt bearing, etc.) •Prepare patient, environment, self, others ●Draping ●Removing clutter •Get necessary equipment/assistance ●Slideboard, walker, crutches, wheelchair ●Tech, nursing, other therapists •Explain activity •Levels of transfer surfaces should be as level as possible ●How can you use a difference in height to your pt's advantage?

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Types of lifts: Deep Squat Power Straight Leg Golfer's Half Kneeling Traditional Stoop

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Using her system (with other terms that are used in parentheses), the stance subphases are initial contact (heel strike), loading response, midstance (foot flat), terminal stance (heel off), and preswing (toe off). The swing subphases are initial swing (acceleration), midswing, and terminal swing (deceleration).

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Why Assistive Devices? >To compensate for impairments: °Balance °Strength °Uncoordinated movements °Pain (DL or SL) °Amputation (with or without prosthetic) °Altered stability °To improve functional mobility °Enhance body functions °Assist with fracture healing

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•4-point: Involves sequence of 4 moments of contact with the floor to complete the cycle, ex. Animal with four legs

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•Stand Pivot ●Dependent, Assisted, Standby, Independent •Sitting transfer/Squat pivot/Scoot ●Dependent, Assisted, Standby, Independent •Lift ●Dependent sitting, Dependent Recumbent

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PPE (personal protective equipment): DONNING: what order?? ___ REMOVAL: what order?? ___ KNOW THE ORDER OF STEPS

1. hand hygiene, 2. Gown, 3. Mask, 4. Goggles/face shield, Gloves 1. gloves, 2. goggles, 3. gown, 4. mask, 5. hand hygiene

When a person has been lying on his or her ear, that ear should not be used for measurement until it has been exposed to the air for ___ to ___ so the ear canal temperature can become stable. A temperature differential may exist between the person's left and right ear, and so the should be used for all measurements.

2 to 3 minutes same ear

Depending on the severity of edema, CDT may need to be performed for ___ to ___ weeks, three to five times per week, before a patient achieves normal or near-normal girth and can be fitted for a compression garment. MLD often is followed by intermittent vasopneumatic compression pumping.

2 to 8

Hemiplegic WC: •Seat lowered approx.. ___ to allow better use of LEs •Lower seat may make ___ more difficult

2" standing transfers

Continued: •Seat Depth •___ between front edge of seat and user's popliteal fold with palm horizontal to seat with hand held parallel to floor •Pt should be positioned all the way back in the chair with posterior pelvis in contact with back upholstery

2-3 fingers

Confirmation of Fit: •Seat Height/Leg Length •___ easily under thigh, with hand held parallel to floor, from edge of seat to depth of approx. ___ •Bottom of footrest should be at least ___ from floor

2-3 fingers 2" 2"

Continued: ●You may apply resistance to a joint distal or proximal as long as there are no ___ (e.g. rectus femoris, gastroc, biceps etc.) •Caution when applying resistance to a painful joint •Assess PROM (passive ROM) and AROM (active POM), unless contraindicated by the surgery or MD order ●**Check your chart and/or referral script!**

2-joint muscles

Continued: Modified four-point -weight bearing status- ___, ___ -walking aid- ___ or ___

modified two-point, FWB One crutch or one cane

Continued: ___ - nausea, muscle ache, vomiting, visual disturbance, drowsiness, abdominal discomfort, intestinal cramping, diarrhea and headache

Adverse effects

___- Movement away from an axis or from the median plane of the body; movement of a body part away from the middle of the body. ___- Movement toward an axis or toward the median plane of the body; movement of a body part toward the middle of the body. ___- To become pale. ___- Pertaining to or affected with coma; a state of unconsciousness

Abduction Adduction Blanch Comatose

>Pt can sit with/without UE support, has good UE strength, but poor LE strength-> ___ transfer: Sliding Board, Squat Pivot, Scoot >Performs all sitting test, good strength-> Active Transfer: ___

Active Stand Pivot

Wheelchair types: >Type will depend on: •Body function •___ limitations •Size and weight •Expected ___ •___ for change >Additional Components: •Headrest •Lateral trunk support panels •Seat pan or cushion •Back panel •Armrest trough with adjustments •LE supports

Activity use Prognosis

>___- Absence of oxygen in the tissues. >___- The pulse that is found when a stethoscope is placed on the chest wall over the apex of the heart; also may be found by palpation. >___- The absence of breathing. >___- Variation from the normal rhythm. >___- Listening for sounds produced within the body by using the unaided ear or a stethoscope

Anoxia Apical pulse Apnea Arrhythmia Auscultation

>___- The measurement or quantification of a variable or the placement of a value on something (note that assessment should not be confused with examination or evaluation). >___- The person who is treating or working with the patient; examples are the therapist, therapist assistant, aide, or family member. >___- The exchange of information through verbal (oral), written, or nonverbal (visual) means. >___- Written or printed matter conveying authoritative information, records, or evidence. >___- The use of an electrical current to assist with the diagnosis of a patient's condition.

Assessment Caregiver Communication Documentation Electrodiagnostic tests

___: •Absence of microorganisms that produce disease; the prevention of infection by maintaining a sterile condition >___ - designed to keep pathogens confined to a specific area, object, or person à may involve isolation >___ - used to exclude all microorganisms before they can enter surgical wound or contaminate a sterile field before or during surgery

Asepsis Medical Surgical

>___- The disintegration of cells or tissues by the enzymes of the body or cellular components in wound fluid. >___- Gravity-assisted bronchial drainage with techniques for secretion removal and breathing techniques. >___- The removal of devitalized tissues from or adjacent to a traumatic or infected lesion to expose healthy tissue. >___- Denotes amputations that are caused or acquired from poor vascular status of a limb (i.e., ischemia). >___- Healing by the growth of epithelium over a denuded surface

Autolysis Chest physical therapy (CPT) Debridement Dysvascular amputation Epithelialization

___: >use -Used for persons who need less stability or support than is provided by parallel bars or a walker; they allow greater selection of gait patterns and ambulation speed and provide stability and support >characteristics -Most crutches are composed of wood or aluminum and can be easily adjusted for proper fit; they can be stored and transported and can be used in narrow or crowded areas or for stairs Types include standard (adjustable and nonadjustable), offset, and triceps (elbow extension) (see Fig. 9-1, B) >disadvantages -Are less ___ than a walker Can cause injury to ___ if used or measured improperly Require good standing balance Elderly patients may feel insecure with them Functional ___ of the upper extremities and trunk muscles is required

Axillary crutches stable axillary vessels and nerves strength

Standing and Sitting with a Cane: This approach positions the cane in the proper hand, widens the patient's ___, and allows some weight shift from the weaker lower extremity onto the ___ when it is used during the weight-bearing (stance) phase of the gait pattern.

BOS cane

-___ >Use to absorb heavy drainage, but will require a secondary dressing to cover the wound (Kaltostat, Algosteril); calcium alginates may be used on infected wounds or for filling in the cavity of deep wounds

Calcium alginates

Transmission: ▫___ Precautions ●Hands, Gloves, Gown, Private or shared room, Dedicated Equipment ▫___ Precautions ●Hands, Mask, Private room, Transport with mask ●Meningitis, Flu, Streptcoccal pharyngitis, Pneumonia ▫___ Precautions ●Hands, Mask N-95 respirator, Private room negative air flow, Door closed, Transport with mask ●Measles, Varicella, TB

Contact Droplet Airborne

Continued: >___- Pt performs transfer but may require your hand on them for safety or balance. **If you are ___ the patient it is AT LEAST contact guard assist** >___- Pt requires small amount of physical assist; Pt performs at least 75% - 99% of the work, PT performs at most 25% of the work

Contact Guard Assist- CGA touching Minimal Assist- Min A

___- Pt performs transfer but may require your hand on them for safety or balance. **If you are touching the patient it is AT LEAST contact guard assist** ___- Pt requires small amount of physical assist; Pt performs at least 75% - 99% of the work, PT performs at most 25% of the work

Contact Guard AssistCGA Minimal Assist (MinA)

Heat Exhaustion: •Heat Exhaustion ▫___ the person down, place in comfortable ___, ___ or ___ clothing ▫Obtain help as needed ▫Counteract the effects of dehydration, sponge forehead and neck with cold compress or ice bag, water or electrolytes ▫Observe for ___ ▫Request transport to medical facility if no relief of S/S

Cool position loosen or remove shock

-___ (e.g., Polyderm, Lyofoam, Mepilex, and Allevyn) >Used for heavily exudative wounds (especially during the inflammatory phase after debridement and desloughing when exudate is at its peak), deep cavity wounds, and weeping ulcers such as venous stasis ulcers; is very absorbent and can be left on for 3-4 days

Foam dressings

• ___: Microorganisms are transferred by direct or indirect contact, but in contrast to contact transmission, respiratory droplets carrying infectious pathogens transmit infection when they travel a short distance directly from the respiratory tract of the infected individual to the mouth, conjunctivae, or nasal mucosa of the recipient. Droplet transmission necessitates that the caregiver wear a mask or face shield (Fig. 2-4). Respiratory droplets may be transmitted during a sneeze, cough, or talking. Some examples of diseases or conditions spread through droplet transmission are strep throat, meningitis, pneumonia, influenza, the common cold, pertussis (whooping cough), smallpox, and mumps.

Droplet

Infection control: •Air •___ (cough or sneeze) •___ (skin, equipment, mat pads, instruments - needles, scalpels, thermometers, eating utensils, linens, body fluids - blood, semen, saliva, and vaginal secretions) •Microorganisms must have a ___: break in skin barrier, mucous membranes, mouth, nose, ears, and genitourinary tract

Droplets of water Direct contact portal of entry

___ (Tennis Elbow) Wrap: To wrap the extremity of a patient with epicondylitis, place an underwrap (i.e., a thin, porous polyurethane foam) around the wrist to prevent the tape from adhering to the underlying skin. Distract the wrist by having the patient hold the elbow at the side with the elbow bent to ___, and gently pull the wrist and hand away from the forearm. Use athletic tape that is approximately ___ to ___ inch wide. Place the tape just distal to the radial head and ulnar stylus.

Epicondylitis 90 degrees 0.5 to 0.75

The use of ___ helps determine the effectiveness of the caregiver's interventions or outcome measures. Outcome measures help determine the difference the treatment has made to the patient's functional status, if any.

Evidence-Based Practice (EBP)

WHEELCHAIR TO BED • Help the patient move forward in the chair; maintain control of and support the NWB lower extremity. Position yourself in front of the patient to guard and protect him or her throughout the transfer. • Instruct the patient to stand by pushing with the upper extremities and ___ lower extremity. • Instruct the patient to pivot so that the buttocks are toward the bed. Control and support the NWB lower extremity as the patient sits on the edge of the mattress. • Assist in ___ the NWB lower extremity onto the mattress as the patient lifts the FWB lower extremity.

FWB lifting

>Stage III -___ tissue loss; subcutaneous fat may be visible but bone, tendon, or muscles are not exposed; slough may be present but does not obscure the depth of tissue loss; may include undermining and tunneling Further description: The depth of a stage III pressure ulcer varies by ___; the bridge of the nose, ear, occiput, and malleolus do not have subcutaneous tissue and stage III ulcers can be shallow; in contrast, areas of significant adiposity can develop extremely deep stage III pressure ulcers; bone/tendon is not visible or directly palpable

Full-thickness anatomic location

>Stage IV -___ tissue loss with exposed bone, tendon, or muscle; slough or eschar may be present on some parts of the wound bed; often includes undermining and tunneling Further description: The depth of a stage IV pressure ulcer varies by anatomic location; the bridge of the nose, ear, occiput, and malleolus do not have subcutaneous tissue and these ulcers can be shallow; stage IV ulcers can extend into ___ and/or ___ (e.g., fascia, tendon, or joint capsule), making osteomyelitis possible; exposed bone/tendon is visible or directly palpable

Full-thickness muscle and/or supporting structures

___ of an extremity to serially measure its circumference is a technique used to evaluate the presence of edema or atrophy. Indications for upper extremity measurement include lymphedema; fractures of the humerus (Fig. 11-8, C), radius, or ulna (Fig. 11-8, D); and severe tennis elbow. Use of a plastic or metal anthropometric measuring tape is recommended to obtain these measurements because it does not deteriorate, it is easy to clean, and its calibration marks can be read easily.

Girth measurement

___: •Single most effective way to protect the patient and caregiver from transmission of pathogens •Before and after patient ___ •Before and after contact with wounds, dressings, specimens, bed linen, and protective clothing

Hand Hygeine contact

>___- Paralysis of one side of the body. >___- Homolateral; on the same side. >___- Indicates a position away from the median plane or midline of a body or structure. >___- Related or located toward the midline of a body or structure. >___- The ability to move in an environment with ease and without restriction.

Hemiplegia Ipsilateral Lateral Medial Mobility

Contracture sights: ___, ___, and ___- all VERY common places for contracture: common theme, where devote attention no matter WHAT position they are in

Hip and knee flexors, ankle planter flexors, shoulder adductors

Dependent: •Indications: when patient is unable to help or participate in the transfer ●Severe neurological deficits ●Severe trauma ●Morbidly obese patients who have significant weakness •May require more than 1 person- better to be overprepared than underprepared •___ lift ->they come with a sling under their body; explain what you plan to do, lock breaks on wheelchair, ask patient to lean forward, place sling behind the patient, lean patient back in chair, pull under patient's legs, criss cross legs when attach to hoyer, use the same color straps for both legs and then both arms, make sure front straps on legs are one notch lower than arm straps, have patient criss cross arms over chest, when patient's weight is fully on the table, you can lock lift and take straps off of it

Hoyer

>___ (e.g., Vigilon, ClearSite, and NU-GEL) -Recommended for stages II and III wounds with dressing covering the gel; moist wound bed is maintained; recommended for use on skin tear, cover with rolled absorbent material (Kling); may cause maceration of surrounding healthy tissue; does not protect wound from external soiling; helps clean and debride necrotic tissue

Hydrogel

>___- Abnormally high blood pressure. >___- Abnormally low blood pressure. >___- Pertaining to the groin. >___- The active phase of respiration when the person breathes in; also referred to as inhalation >___- The insertion of a tube into the larynx to maintain an open airway. >___- Sounds heard during auscultatory determination of blood pressure; believed to be produced by the vibratory motion of the arterial wall as the artery suddenly distends when compressed by a pneumatic blood pressure cuff; the origin of the sound may be within the blood passing through the vessel or within the wall itself.

Hypertension Hypotension Hypotension Inspiration Intubation Korotkoff's sounds

>___- The patient can perform a transfer without any type of verbal or manual assistance (Note: In some situations, specific equipment or devices may be used) >___- The patient requires assistance from another person to perform the activity safely in an acceptable time frame; physical assistance, oral or tactile cues, directions, or instructions may be used >___- The patient requires verbal or tactile cues, directions, or instructions from another person positioned close to, but not touching, the person to perform the activity safely and in an acceptable time frame; the assistant may provide protection in case the patient's safety is threatened

Independent Assisted Standby (supervision) assistance

TRANSFER ACTIVITIES Transfers, Wheelchair and Bed >___ -When a significant difference exists in the strength of the extremities, it usually will be easier for the patient to transfer while leading with the stronger extremities. -The caregiver should be at the patient's ___ for protection or assistance when the patient initially attempts any type of independent standing transfer.

Independent Standing Transfer side

Assists: ___- Pt performs transfer safely without physical assist or supervision. Pt performs 100% of the work ___- Pt performs transfer without physical assist. Therapist provides guarding and/or verbal cues for safety or technique

Independent(I) Standby/SupervisionSBA or SPV

Types of assistance: >___- Pt performs transfer safely without physical assist or supervision. Pt performs 100% of the work >___- Pt performs transfer without physical assist. Therapist provides guarding and/or verbal cues for safety or technique

Independent(I) Standby/SupervisionSBA or SPV

___- The insertion of a tube, as into the larynx, to maintain an open airway. ___- A wound produced by the tearing of body tissue, as distinguished from a cut or an incision. ___- A fall in blood pressure associated with dizziness, syncope, and blurred vision that occurs upon standing or when standing motionless in a fixed position.

Intubation Laceration Orthostatic (postural) hypotension

The following areas are at particularly high risk for a seated person: •___ • Scapular and vertebral ___ • ___ processes (elbow) • Medial epicondyles of the humerus if the patient is resting on a hard surface • Back of the ___ if the patient is resting against the seat • The ___ and feet

Ischial tuberosities spinous processes Olecranon knees heels

___- Separation from others. ___- Practices that help reduce the number and spread of microorganisms. ___- A tiny living animal or plant that can cause disease. ___- Pertaining only to infections originating in a hospital. ___- A microorganism that produces disease.

Isolation Medical asepsis Microorganism Nosocomial Pathogen

>___- The sense by which position, weight, and movement are perceived. >___- An orthopedic appliance used to support, align, prevent, or correct deformities or to replace the function of parts of the body (e.g., a brace or splint). >___- A quantifiable or objective means to determine the effectiveness of treatment or performance that is usually expressed in functional terms. >___- A system developed to organize a medical record that uses a common list of patient problems as its base. >___- Perception mediated by proprioceptors or proprioceptive testing; sensation and awareness about the movements and position of body parts or the body.

Kinesthesia Orthosis Outcome measure Problem-oriented medical record (POMR) Proprioception

Continued: E. ___: Only one assistive aid is used. The assistive aid and the opposite lower extremity (foot) advance alternately; the assistive aid is held in the hand opposite the affected lower extremity. One cane or crutch may be used. F. ___: Only one assistive aid is used. The assistive aid and the opposite lower extremity (foot) advance simultaneously; the assistive aid is held in the hand opposite the affected lower extremity. One cane or crutch may be used.

Modified four-point Modified two-point

___ signs: -Assess for grimacing, frown, position changes, and document -Respiratory difficulties -Decreased mental function -Appearance, body movements, body positions, facial expressions, gestures, pantomime, posture, spontaneous response to stress, touch -A lot of people don't ___ in hurting, so look at nonverbal signs- document these to help understand progression of treatment sessions

Nonverbal speak up

>___- A localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure or pressure in combination with shear force and/or friction. >___- A mass of dead tissue in, or cast out from, living tissue; pronounced "sluf." >___- Free from any microorganisms; aseptic.

Pressure ulcer Slough Sterile

___: evaluates, provides plan, determines treatments, assigns tasks establishes goals, periodically evaluates results of treatment ___ performs treatment activities and communicates frequently verbally and in writing with the primary caregiver

Primary giver Assistant

___ Description: This system is based on a list of patient problems, a database, and a series of status (progress) notes designated as the "initial," "interim or ongoing," and "discharge" notes. When all departments or service units of a facility use POMR record keeping, a higher quality of patient care may be anticipated.

Problem-Oriented Medical Record

Types: ●___ ●___- 4 legs ●___- 4 legs ●___ aka ___ Requires overall good strength PROS: ●More functional on stairs and in narrow, confined areas ●Can be stored and transported more easily than crutches or walker CONS: ●Provides limited support because of small BOS (this applies more to single point vs others)

Single point Large based quad cane Small based quad cane Hemi-cane aka hemi-walker

Clinical Pearls: •You will make mistakes •___ down- helps to prevent mistakes, also plan ahead! •Practice makes perfect •___ is highest priority - ask for help!

Slow Patient safety

Support Devices: •___ a segment; restrict ___ of joint; control edema, swelling, or joint effusion ▫Examples: Muslin; Kerlix; Ace, Stockinet

Stabilize motion

Walkers: Types: ●___- four legs ●___- two wheels in front and two legs in back ●___ (4 wheel) PROS: ●Maximal patient stability, support, and mobility ●4 support legs with or without wheels ●Can be adjusted ●Lightweight ●Foldable for storage CONS: ●May be difficult to store or transport ●Difficult or impossible to use on stairs ●Reduces speed ●Difficult to perform normal gait pattern ●Difficult to use in narrow or crowded areas

Standard Rolling rollator

Types of Wheelchairs: >___- Designed for persons who weigh less than 200 lb and for limited use on rough surfaces; not designed for vigorous functional activities >___- Constructed for persons who weigh more than 200 lb or for those who perform vigorous functional activities >___- Designed to be lightweight, may have a rigid or folding frame, and can be made with titanium in a rigid or folding frame; weighs from 12 to 30 lb; benefit is efficiency in propulsion and reduction in cumulative trauma in the upper extremities; weight capacity to 300 lb

Standard adult Heavy-duty adult Ultralight wheelchair

>___- A temporary suspension of consciousness caused by cerebral anemia; fainting. >___- The period when the greatest amount of pressure is exerted on the walls of the arteries during heartbeat; usually indicates the contractile phase of the heartbeat. >___- An abnormally fast heartbeat (i.e., a pulse rate greater than 100 beats/min). >___- Measurement of a person's body temperature, heart and respiration rates, and blood pressure; also referred to as cardinal signs.

Syncope Systole Tachycardia Vital signs

Mobility and Transfer Activities:Special Precautions: •Spinal Precautions: ___ ->is a brace that looks like a corsette with straps --> to put on, have patient turn on ___, tuck as much as can and roll patient to ___, fasten straps loosely and pull straps under armpits- upper straps DO NOT go over ___, tighten straps bottom to top while rotating sides

TLSO (thoracic lumbar sacral orthosis) side opposite side shoulders

Peripheral Venous and Arterial Circulation Tests: >___ -Used to assess the function of the valves of the saphenous vein With the patient standing, the caregiver palpates a proximal segment of the saphenous vein with the fingers of one hand, then uses the fingers of the other hand to tap (percuss) a distal segment of the vein. A fluid movement will be sensed by the fingers on the proximal segment during percussion if the valves are not functioning properly. Test both lower extremities and compare the results

Venous sufficiency tests Percussion test

COMMUNICATION: Instructions and information can be presented to the patient verbally or nonverbally and with various audiovisual methods. ___ is the most prevalent style used. The tone, volume, and inflection of your voice can detract from or add to your message. Observation of the patient's reaction to the message will help you determine whether the person understands it, has questions, or is puzzled.

Verbal communication

___: >use -Used when maximal patient stability and support are required >characteristics -Various styles are available, and most have four support legs or feet; some may have two or four wheels, and most can be adjusted for proper fit. Most walkers are lightweight, and some can be folded for storage. Types include ___, ___, ___ (which are wider, support more weight, and are either adjustable or nonadjustable), ___, ___, ___, ___, or ___ ("hemiplegic") (see Fig. 9-1, A) >disadvantages -May be difficult to store or transport. Difficult or impossible to use on stairs. Reduces the ___ of ambulation. May be difficult to perform a normal gait pattern. Can be difficult to use in narrow or crowded areas

Walkers standard, child, bariatric reciprocal, stairclimbing, wheeled, folding, and one-handed speed

-___ >Use on stages II and IV wounds for debridement; slough and necrotic tissue adhere to dressing and are removed with dressing; this dressing is the most widely used and probably the most controversial, because research shows disruption of angiogenesis by dressing removal and increased risk of infection because of the need for frequent dressing changes

Wet to dry

Movement from the Bed to a Walker: Before allowing the patient to stand, measure and adjust the walker for the patient. Instruct the patient to move to the edge of the bed using the upper extremities and the normal lower extremity to elevate the body. You should help control the surgical hip and its lower extremity in slight ___ as the patient pivots and positions the lower extremities over the edge of bed. Instruct the patient to place the normal foot on the floor as you assist in lowering the surgical lower extremity to the floor. The patient maintains the trunk in a semireclining position by resting on the extended upper extremities, which are placed posterior to the hips.

abduction

Continued: • The primary caregiver should use a turning schedule, and other caregivers who intervene to provide treatment should adhere to the turning schedule after treatment has been performed. • Ideally, patients should be comfortable in whatever position they are placed. This rule may depend on the patient's problem and diagnosis. Some patient conditions (such as burns to the axilla) do not allow the patient to assume a position of comfort. In the case of burns to the axilla, the most therapeutic position is to have the patient in shoulder ___, which usually is not a position of comfort. The position of comfort is often the position of ___.

abduction contracture

Communicating with a Person with an Impairment: It is more important to emphasize the person's ___ rather than his or her impairment.

abilities

Patient First Language: "The ACL tear will be here at 3:00" "The head injury will be in OT first" Get in a habit of using patient-first! Focus on ___ instead of ___ Focus on the positive ABILITY rather than disability Avoid words such as ___, ___, ___ "He is confined to a wheelchair" (DON"T) vs. "He is mobile within the community with a wheelchair" (DO)

ability disability confined, victim, afflicted

Power Lift: In a power lift, only a half squat is performed so the hips remain ___ the level of the knees. The lifter's feet are parallel to each other and remain behind the object, with the upper extremities parallel to each other.

above

Continued: • Repeat this process based on the patient's ability to tolerate and accommodate becoming more erect, continue to measure and log the vital signs and tolerance time, and decrease elevation of the table when it is apparent a given elevation is not tolerated. (Caution: Signs and symptoms of intolerance to being upright include syncope, tachycardia or hypotension, facial pallor or flushing, excessive perspiration, complaints of nausea or dizziness, or sensory or color changes in the lower extremities. Be observant for signs and symptoms of autonomic hyperreflexia and postural [orthostatic] hypotension.) (Refer to Chapter 12 for information about these conditions.) Note that several sessions may be required for the patient to ___ to an upright position.

adapt

Hemiplegia: When the patient's upper extremity is involved, the following positions should be avoided: prolonged shoulder ___ and ___ rotation; elbow ___; forearm ___ or ___; wrist, finger, or thumb flexion; and finger and thumb ___. These positions are most likely to lead to soft-tissue contractures caused by muscle spasticity, reduced function of the opposing muscles, and lack of active motion.

adduction internal flexion supination or pronation adduction

Continued: For a patient who has undergone a total hip replacement, motion of the affected limb must be restricted to avoid excessive hip ___, ___, and ___ Prevention of hip flexion beyond ___ degrees is most important when getting the patient out of bed or placing him or her in a chair

adduction, rotation, and flexion 90

TAPING STRATEGIES: Some examples of an ___ are the epicondylitis wrap (adhesive tape) and the plantar fasciitis wrap.

adhesive nonstretch tape

Hemiplegia: -Pulling on the involved or weakened extremities should be avoided to control or move the patient; this precaution is particularly important for the ___ because the muscles will not provide adequate support to the joint as a result of the effects of paralysis. Many patients will experience pain or discomfort when they lie on or roll over the involved shoulder

affected shoulder

Fractures: •Protect fracture site and avoid further injury •Prevent shock, reduce pain, prevent wound contamination if open •Do NOT try to ___ •Obtain info about injury (cause, location, pain, restriction of motion) •Get help if needed •Observe site or position of extremity •Examine patient's general appearance/condition •Monitor blood pressure and pulse •Avoid movement or activity to the injured site

align

Fractures: When treating a person with a fracture, the objectives are to protect the fracture site and avoid further injury to it, prevent shock, reduce pain, and prevent wound contamination if the bone ends have penetrated the skin. Emergency care should not include any attempt to ___

align the fracture segments or "set" the fracture.

The ideal alignment requires that the line rests as follows: slightly ___ to the lateral malleolus; slightly ___ to a midline through the knee; through the greater trochanter; ___ through the trunk (through the bodies of the lumbar vertebrae); through the shoulder joint; through the bodies of the cervical vertebrae; and through the ___ of the ear.

anterior anterior midway lobe

Allergic reactions can be classified as mild, moderate, or severe. In most instances, a person with a mild or moderate reaction exhibits several signs and symptoms that usually are not life threatening. Therefore an initial treatment is the use of an ___ (e.g., diphenhydramine), which is contained in many over-the-counter medications used to control nasal and sinus congestion.

antihistamine

Standing and Sitting with a Walker: Alternative Methods. An alternative method for standing is to instruct the patient to preposition the body and feet as described previously and place one hand on one hand grip of the walker and the other hand on the chair armrest in front of the hips An alternative method for sitting is to instruct the patient to reach one hand to the ___ while the other hand remains on the ___. This method offers less stability than the previously described method because the walker is not as secure as the chair.

armrest walker hand grip

___- To go or move upward. ___- A rounded projection on a bone. ___- The metal bar on a door that disengages the door latch when it is pushed. ___- To go down; to proceed from a higher level to a lower level. ___- Pertaining to the femur (thigh bone).

ascend Condyle Crash bar Descend Femoral

Some transfers may be described according to the number of persons required to assist the patient (such as "plus 1" or "plus 2"); however, most descriptions indicate whether the patient requires ___ or can function ___. All caregivers in the same facility should use the same terminology when describing the transfer, and a consensus should be reached regarding the ___ that will be used

assistance, independently terminology

Forearm crutches: aka lofstrand or canadian crutches: -When stability and support of axillary crutch are not required but need more stability than a cane PROS: ●Eliminate danger of injury to ___ ●More functional on stairs and in narrow, confined areas ●Easy to store and transport ●Forearm cuff retains crutch on forearm when reaching CONS ●Less stable and supporting than axillary, walker, or parallel bars ●Require functional standing balance and functional UE strength ●Cuff can make difficult to remove ●Elderly patients may feel insecure

axillary area

Persons in the occupations of physical and occupational therapy are at high risk for injury, especially to the ___. Proper use of body mechanics and core stabilization will conserve ___, reduce ___ and ___ on body structures, reduce the possibility of personal injury, and produce safe movements of the spine. the core of the body relates to the musculature and structures within the lumbo-pelvichip complex.

back energy stress and strain

Standing, Dependent Pivot: The patient is elevated to a standing position, usually from a bed, plinth, toilet seat, or wheelchair, and is pivoted so his or her ___ is toward the object to which the person is lowered. You may be required to lift the patient to a standing position, ___ the knees and hips for the pivot, and help the patient to sit.

back stabilize

Return to a Sitting Position • The patient approaches the chair forward and pivots toward the right until his or her ___ is toward the chair. • The patient steps back until the edge of the chair seat contacts the posterior thigh of the right lower extremity. • The crutches are removed from the axillae; the patient holds the handpieces with the left hand to widen the base of support and increase stability. The crutches are positioned to the side and held ___.

back vertically

Standard Doors: -The patient uses the same positions and techniques previously described for a door that opens away from or toward the person. However, the patient will need to open the door only wide enough for the crutches, canes, or walker and the patient to move through the doorway. The patient will need to turn to close the door and then move sideward or backward after the door has been closed to resume the gait pattern and direction. -When the door opens toward the patient, it may be necessary to ___ while opening the door, especially if the door cannot be approached at an angle toward or facing the opening edge of the door.

back up

Continued: For patients who are NWB, PWB, or have weak lower extremities, it may be easier to ascend the curb in the ___ position; FWB patients or patients with good strength but poor balance may want to ascend the curb facing ___ to avoid the turning maneuver.

backward forward

AMBULATION FUNCTIONAL ACTIVITIES: Before a patient can be fully independent, he or she must be taught how to move ___ and ___, to turn to the left and to the right, and to perform a 180-degree arc. You should not assume that each patient is able to perform these activities without being taught how to do so. Failure to teach the patient these activities may result in decreased independence or an increased risk of injury for the patient.

backward and sideward

•Walker- if regular curb, go down with bad, up with walker first and then good leg; if curb really high, go up ___ and use ___ to push body up the increased height of the curb

backwards triceps

PREAMBULATION DEVICES Parallel Bars: Parallel bars can be used for ___ training, to teach specific ___ patterns, and to provide ___ while measuring an assistive device. The bars should be adjusted so their width permits the hips and trunk to pass through them with clearance on both sides and the height is at the level of the ___ when the patient stands erect. Each bar should be adjusted to provide ___ to ___ degrees of elbow flexion when the patient stands erect and grasps the bars approximately ___ inches anterior to the hips. Each bar should be approximately ___ inches wider than the patient's greater trochanters when he or she is centered between the bars.

balance gait support greater trochanters 20 to 25 6 inches 2 inches

Guarding During Gait Training on Curbs, Stairs, and Ramps: When ascending or descending stairs or a ramp, initially teach the patient to stop and gain ___ on each step before progressing to the next step to avoid building momentum. Patients who gain too much ___ may be at risk for a fall. Guarding from either the front or back can provide safety for the patient, but most patients have a greater sense of security when someone is in front of them as they descend from an elevation. If a handrail is not available when ascending an elevation, it is recommended that two persons guard the patient. One person is positioned in front of or slightly to one side of the patient, and another person is positioned behind or to the side of the patient.

balance momentum

•All assistive devices are designed with the purpose of increasing a person's___, reduce weight bearing, and permit mobility. >A patient may begin with an AD requiring maximal stability with limited mobility before progressing to a more ___ that allows more mobility.

base of support (BOS) unstable

BACKWARD FALL: • The patient releases the crutches and quickly flips them to the side; the crutches must not fall to the floor ___ the body. • The patient tucks the chin toward the chest and reaches forward with both upper extremities. • A semiflexed trunk position is maintained so the buttocks and trunk contact the floor before the ___ • If no serious injury has occurred, the crutches are gathered in preparation for standing using one of the techniques presented in this chapter.

behind back of the head

Continued: In general... ●stand ___ the patient on the way up and ___ the patient on the way down ●stand to the side of the ___ LE ●Patient should get as close to the step or curb prior to initiating ascent or descent ●Going upstairs: Lead with the ___ ●Going downstairs: Lead with the ___ (good people go to heaven and bad people go to hell) ●With a walker, ascend a curb ___ (depending on height of it)

behind in front of weaker unaffected leg affected leg backwards

ASCENDING A CURB, STAIR, OR RAMP: GUARDING THE PATIENT FROM THE BACK: • Position yourself ___ and slightly to the side of the patient in the area where there is the least protection for the patient. • If a handrail is used, position yourself to the ___. If a handrail is not used, position yourself to the side at which the greatest ___ or potential for injury exists in case the patient's balance is disturbed. (Note: Many caregivers prefer initially to be positioned to the patient's weakest side or the side of the least functional extremity.)

behind side opposite it danger

Biopsychosocial Model: Previously biomedical model Therapist ___ vs patient ___ Chronic pain >Poor compliance, less treatment adherence, poorer outcomes

beliefs interpretation

Return to Bed: Adjust the bed so it is slightly ___ the patient's buttock. the surgical lower extremity should remain slightly forward of the opposite lower extremity. The patient reaches back to the mattress and shifts the body weight onto the normal lower extremity while allowing the surgical lower extremity to slide forward. The patient sits on the edge of the bed in a semireclining position as you control the surgical hip and lower extremity.

below

Deep Squat Lift: A deep squat is performed to position the hips ___ the level of the knees. The lifter's feet straddle the object, with the upper extremities parallel to each other. The lifter grasps the opposite sides, the handles, or the underside of the object. The lifter's trunk is maintained in a vertical position, and the lumbar spine remains in ___ with an anterior pelvic tilt (inclination)

below lordosis

Lift Techniques: >Deep Squat Lift -Position hips ___ level of knees -Feet straddle object, with UE parallel to each other -Grasp opposite sides of object or under object -Trunk remains in ___ position and lumbar lordosis -May have to demonstrate and practice with them

below vertical

Three-One-Point/Partial Weight-Bearing or Modified Three-Point Pattern: The three-one-point/PWB gait pattern requires the use of ___ that will support a significant amount of body weight (canes are not appropriate for this gait pattern) or a walker. It allows the affected lower extremity to function actively while maintaining some weight bearing on it.

bilateral assistive devices

Two-Point Pattern: The two-point gait pattern requires the use of ___. The pattern uses a simultaneous, reciprocal forward placement of the assistive device and the patient's opposite lower extremity. This pattern is relatively stable and can be performed more rapidly than the four-point gait. It requires relatively low energy expenditure and is very similar to a normal gait pattern. However, it also requires coordination by the patient to move one upper extremity and its opposite lower extremity forward simultaneously. With the two-point pattern, the patient can ambulate more rapidly but with less stability than with the four-point pattern.

bilateral assistive devices

Basic Gait Patterns: >Four-Point Pattern -The four-point gait pattern requires the use of ___ devices. The pattern uses an alternate and reciprocal forward movement of the assistive device and the patient's opposite lower extremity. This pattern is very stable and can be performed slowly, and it is the ___ pattern to use in crowded areas.

bilateral assistive devices safest

Three-Point/Non-Weight-Bearing Pattern: The threepoint NWB pattern requires ___ or a ___, but not with bilateral canes because the canes cannot support a significant amount of the body's weight. The patient should be taught to ___ through rather than "swing through" the crutches and to control the movement of the trunk and lower extremities with normally functioning musculature, which will reduce energy expenditure and increase the patient's ___ and ___.

bilateral assistive devices, walker step balance and stability

1."Treatment by PT is a risk factor for long term sick leave in patients with low back pain" >1.Broaden illness beliefs from pure biomedical towards ___ >2.The Pain Attitudes and Beliefs Scale for Physiotherapists 2.Outcome measures can be used to assess patients ___ 3.___ may influence treatment choices, patient compliance, and progression of physical activity

biopsychosocial beliefs Illness perceptions

If an item has been autoclaved, be certain that ___ or ___ lines appear on the tape used to seal the package. These colored lines indicate that the item has been sterilized and is considered sterile. A 1-inch border along the edges of the field is considered to be nonsterile. Avoid placing any sterile item within ___ of the outer edge of the field, and do not touch this area with sterile gloves or other sterile objects.

black or green 1 inch

Pulse Oximetry: A pulse oximeter measures the level of ___ saturation, monitors pulse rate, and calculates HR. The normal blood oxygen saturation reading at or near sea level is between ___ and ___%. Hypoxemia is suspected if readings fall below ___%. In general, oximeters accurately measure oxygen saturation between ___ and ___% regardless of the type of oximeter used

blood oxygen 95% and 100 90 70% and 100

Intermittent Compression Pump: • Explain the procedure to the patient and obtain consent, measure the patient's ___ to ensure that pneumatic pressure does not exceed diastolic pressure, and examine the extremity. • Position and drape the patient, expose the extremity, and apply a tubular stockinette and the sleeve to the extremity. • The extremity should be level with or elevated above the ___. • Adjust the controls of the unit as necessary (i.e., pressure and inflation-to-deflation ratio) and turn on the unit. The patient can be instructed to actively contract muscles during deflation cycles.

blood pressure heart

Definition: ___: Use of the body - producing motion that is safe, efficient, and maintains balance and control

body mechanics

Dependent or Assisted Mobility Activities: To move a supine or prone patient, you should move individual ___ to reduce the effort required and to provide greater control.

body segments

Girth Measurements LOWER EXTREMITY • Explain the procedure, expose the extremity, and position the patient standing on a level surface so the extremity is relaxed. • Use a plastic or metal anthropometric measuring tape with well-defined, easily visible calibrations. • Palpate and mark the ___ (e.g., the lateral malleolus) to be used as the base for the distance measurement site on the extremity; position the free end of the tape on the mark and extend it along the extremity. • Use a skin-marking pencil to mark the site at which the measurements are to be made (i.e., the area of greatest edema or atrophy).

bony landmark

Pressure Ulcers: Frequent changes in the patient's position, proper and adequate nutrition, and the relief of pressure or reduction in pressure on the soft tissue that overlies ___ are all methods of pressure ulcer prevention.

bony prominences

patients who are in bed for a prolonged time. The greatest pressure is placed on the tissues that cover ___. Intervention to reduce pressure over bony prominences is of foremost importance.

bony prominences

Assessing BP: •Proper size cuff (p57) •Sit quietly 1 - 2 min. •Expose antecubital space •Place center of bladder over the medial arm (so it will occlude the ___) •Place stethoscope diaphragm over the ___ (where you feel the pulse) •Inflate the cuff to 15 - 20mmHG > occlusion pressure •Slowly deflate the cuff while listening for Korotkoff's sounds •Read the pressure at the ___ sound and the pressure when the sound becomes ___

brachial artery brachial artery initial absent

Bad gait patterns are hard to ___ so try to form good gait habits with assistive devices to easier to handle when move them away

break

Assisted Standing Transfer: >Stand Pivot •Indications •Patients who are stronger on one side than the other- other knee may want to ___ •CVA •For patients post CVA: guard or block the ___ extremity •Post op patients with wt bearing restrictions •For post op patients: Guard the ___ extremity •___ transfer is NOT advised

buckle affected unaffected Dependent stand pivot

Forearm Crutches: The length of the crutch can be measured as for the ___ (see the next section) to determine the height of the handpiece with the patient supine or standing (Fig. 9-4, A). The top of the forearm cuff should be located approximately ___ to ___ to the olecranon process when the patient grasps the handpiece with the cuff applied to the forearm and the wrist in neutral flexion-extension

cane 1 to 1.5 inches distal

CHEST PHYSICAL THERAPY: Also called ___ is an intervention process concerned with the examination, evaluation, and treatment of patients of all ages with acute and chronic lung conditions.

cardiopulmonary physical therapy, CPT

Shock: •Identify and reduce or remove the ___ when possible •Prevent or reduce the extent of the physiological state of shock •S/S: ▫Pale, moist, cool skin; ___ and irregular breathing; ___ pupils; weak, ___ pulse; diaphoresis; dizziness or nausea; syncope -Place pt ___ with head slightly lower than LE's, control bleeding Cool compress to head

cause shallow dilated rapid supine

Before you attempt to lift, pull, reach for, or carry an object, the following two actions are required to use proper body mechanics: • Position yourself so your ___ and the object's ___ are as close as possible. • Increase your ___.

center of gravity (COG) COG base of support (BOS)

Falling Techniques: >Falling Backward -Instruct the patient to release the crutches (or other aid), flex the trunk, and bring the chin to the ___ while reaching forward (Fig. 9-52). Using this method, the force of the fall will be absorbed by the buttocks and back, and the head will be protected. It is not recommended that the patient be taught to ___ with the upper extremities for protection.

chest reach backward

Carrying Activities: When carrying an object, hold it ___ to your body; the best positions are ___ or ___. If you carry an object in one hand (e.g., a suitcase or a briefcase), alternate carrying it in one hand and then the other; do not twist your back when moving the object from one hand to the other; stoop to lift it from the floor. Balance the load whenever possible. Some bulky or heavy objects can be carried on your ___, especially if you must carry them for a substantial distance.

close in front of your body at the level of your waist or on your back shoulders

Continued: • If the exposed distal segment feels ___ to the touch when compared with the similar, opposite segment, the bandage is usually too tight proximally and is constricting the flow of arterial blood to the area. • If edema develops in the segment distal to the bandage, the bandage is usually too tight and is constricting the local lymphatic and venous circulation. • If the bandage changes ___, it is usually too loose.

cold position

Remodeling Phase: -The remodeling phase overlaps the proliferative phase and is characterized by the organization of the ___ into a more definitive and finite pattern. The remodeling phase can last from ___ to ___.

collagen tissue 3 weeks to 2 years

Complete (or Complex) Decongestive Therapy Objectives: • Enhance lymph drainage through the use of manual lymph drainage techniques. • Control and reduce edema through ___. • Use an intermittent vasopneumatic compression device as an adjunct to manual lymph drainage. • Reduce or eliminate infections; educate the patient about techniques for meticulous skin and nail care. • Increase function and enhance lymphatic flow through a gentle, individualized ___. • Establish a maintenance program of therapy that will preserve the extremity improvements obtained from complete (or complex) decongestive therapy. • Teach the patient to manage symptoms independently.

compression bandaging exercise program

PROFESSIONAL COLLABORATION: Another concept used in patient care is professional teamwork or, more specifically, ___. The cotreatment approach to patient care depends on the cooperation, collaboration, and coordination of the activities performed by the two caregivers to maximize the effectiveness of patient care.

cotreatment

Planning for Positioning: Precautions: •Avoid clothing or linen folds beneath patient- don't want ___ in their skin so they don't get ___ •Observe skin color over ___ before, during, and after treatment •Protect bony prominences from excessive and prolonged ___

creases bed sores bony prominences pressure

Descending a curb: >Three-Point Pattern -to descend a curb using bilateral crutches with a three-point pattern, the patient places the ___ down onto the lower surface by slightly ___ the strongest hip and knee. The PWB lower extremity is positioned in front of the patient and over the edge of the curb. The patient steps down using the strongest lower extremity after the crutches and PWB extremity are resting on the lower surface

crutches flexing

Continued: • Periodically monitor the patient during the treatment session, and provide the patient with a call device or bell that can be used during treatment. Lower the pressure or stop treatment if the patient reports tingling, numbness, or severe pain or can feel his or her pulse. • To conclude the treatment, turn off the unit when the sleeve is ____. (Note: If the sleeve is inflated, detach the inflation hose(s) from the sleeve and deflate it.) Remove the sleeve and discard the stockinette. • Examine the extremity, measure the ___ Fig. 11-15 (girth), and document your activities and findings.

deflated circumference

The Privacy Rule allows patients access to their individual health care-related information and control over the use of that information. individually identifiable information includes (1) ___ data that relates to the individual's past, present, or future physical or mental health condition; (2) the provision of ___ to the individual; or (3) the past, present, or future ___ for the provision of health care to the individual. Individually identifiable health information includes many common identifiers such as name, address, date of birth, and Social Security number.

demographic health care payment

Standing, Dependent Pivot: A standing pivot should not be attempted with a ___ patient unless the patient is small and the caregiver has sufficient strength for the maneuver. A safety belt or transfer sling placed under the ___ should be applied before any sitting or standing transfer is attempted, particularly during the early treatment sessions.

dependent buttocks

Wound Classification: A burn is caused when the skin contracts in response to dry heat (fire), moist heat (steam or scalding water), chemicals, electricity, or radiation. A burn may be described according to the ___ of the wound, for example, ___ (first degree), ___ (second degree), or ___ (third degree).

depth superficial partial thickness/deep partial thickness full thickness

PRINCIPLES OF DOCUMENTATION: The following areas also should be considered for therapy documentation: 1. The patient's primary and treatment ___ 2. Physician's ___ 3. The patient's barriers to treatment and their resolution 4. The patient's consent to treatment 5. The ___, which includes goals, interventions, proposed frequency and duration, and discharge 6. Short-term and long-term ___ 7. Risk or benefit of treatment

diagnosis orders plan of care goals

Prone: Towel under ankle so they're supported and in ___ Pillow under hips Arms ___ for comfort Head in ___ through a face cut out

dorsi-flexed flexed neutral

Continued: •Initial contact, loading response, midstance, terminal stance, preswing, initial swing, midswing, and terminal swing •One key concept or observation of the gait cycle is that there is a brief period when both feet are in contact with the ground and that "time" is termed ___ •How ___ a person walks affects the length of time they remain in double limb support, i.e. the faster a person walks the less amount of time they are in DLS

double limb support fast

Continued: The patient may use the crash bar as a support when stepping through the door. The patient must be instructed to push ___ rather than outward on the bar while moving through the doorway to avoid opening the door too wide and affecting the BOS.

downward

Important considerations: •Discuss and educate the patient on the need to remove clothing if needed •Allow the patient to ___ and provide adequate amount of linen or gowns to do so. •Understand and respect cultural or religious differences •CLEAN LINEN ONLY! •Use a private room or privacy screens when available

drape themselves

Transferring to the Floor from Crutches: -If the patient is NWB on one lower extremity and uses bilateral axillary crutches, both crutches are ___ and balance is maintained briefly on the strongest lower extremity. The patient lowers the body using the strongest lower extremity until his or her hands contact the floor

dropped to the floor

Intermittent Vasopneumatic Compression Devices: -Intermittent compression through the use of a vasopneumatic compression pump and sleeve is a method of treatment for chronic or acute ___ or ___ and venous insufficiency.

edema swelling

Sitting, Independent: If the patient is going to move to the right, the right hand is placed on the ___ and the left hand is placed on the ___ or ___, depending on the patient's strength, size, and skill. The patient pushes with the upper extremities to elevate the body and swings the buttocks onto the edge of the bed by moving the head quickly to the left and pushing toward the right with the left arm simultaneously, then repositions the hands and moves farther onto the bed.

edge of the bed armrest on the seat of the chair or on the back of the chair

Elastic Bandage: •Multiple usage until ___ gone •Can be washed and dried flat •Provides limited support and protection •Effective temporary method to control or reduce ___ or ___ >Make sure they don't lose ___ in limbs or if they go ___, etc.

elasticity swelling or edema feeling cold

Preventive Interventions: Relief of pressure can be accomplished by ___ the area from the pressure source (e.g., using a pillow beneath the calf to elevate the heel slightly from the mattress when the person is supine), changing the patient's ___ frequently so an area is not in prolonged contact with a source of pressure (i.e., using a turning or positioning schedule to relieve weight bearing on a specific bony prominence), positioning the patient so an area is not in contact with a source of pressure (i.e., positioning the patient in a partial side-lying position with the use of pillows or foam wedges so he or she does not rest directly on the lowermost greater trochanter), and by separating ___.

elevating position bony prominences

Continued: •Stress is ___ attitude -Primary motivation is to accept and utilize stress towards achieving successful outcomes •Ex. Positive reframing, acceptance, planning, emotional support, active coping

enhancing

Continued: -Mechanical debridement (typically a nonselective form of debridement) can be performed through pressure irrigation (i.e., pulsed lavage), the removal of dressings (wet to dry dressings), hydrotherapy, electrical stimulation, a combination of hydrotherapy and ultrasonography, and the use of dextranomers. -Chemical debridement can be performed with the use of ___.

enzymes

When the upper layer of the ___ is affected, the burn is superficial (first degree); when the deep layer of the epidermis and the ___ are involved, the burn becomes a partial-thickness (second-degree) wound; and when the epidermis, dermis, and ___ (fat or bone) are involved, the burn becomes a full-thickness (third degree) wound.

epidermis dermis subcutaneous tissues

Assessment of Body Temperature: It is suggested that a normal or baseline temperature be established for a person before the need arises to measure the temperature during an illness, especially when the patient is an infant or a toddler. A person whose body temperature is elevated before treatment should not be asked to ___. The cause of the abnormal temperature should be determined before exercise is begun.

exercise

Avoid asking the patient, "Do you understand the instructions?" Most patients will answer "yes" when asked such a question, even if they have not understood the instructions. Instead, ask the patient to ___ to verify what he or she understands.

explain the procedure to you

DRAPING: The primary reasons to appropriately drape or clothe a patient are to ___; address ___ concerns; maintain a comfortable body temperature; and protect the skin and clothing from becoming soiled or damaged A patient's cultural, religious, or personal preferences may affect the caregiver's ability to drape the patient to expose sufficient areas of the skin or body parts for treatment.

expose or free an area to be treated modesty

Full-Length Cast or Knee Immobilizer: -To ascend stairs or a curb while wearing a full-length cast or knee immobilizer, the patient should ___ and ___ the hip so the toes clear the stair lip or riser or the front of the curb when stepping up. The immobilized extremity will trail the body as the patient steps up. -To descend stairs or a curb while wearing a full-length cast or knee immobilizer, the patient partially ___ the hip so the heel clears the stair tread or curb. The immobilized lower extremity remains in front of the patient and leads the body when he or she steps down.

extend externally rotate flexes

Supine: Pillow underneath knee- ___ Towel under ankle, slightly ___ Pillow under head to support ___ Arms comfortable at sides

extended dorsi-flexed occipital protuberance

Ascending or Descending Ramps, Inclines, or Hills: -The patient should advance the aid and the stronger lower extremity before advancing the weaker lower extremity; a shorter stride may be necessary. With a below-knee cast, that extremity should be ___ at the hip and ___ at the knee when ascending. The patient advances the weaker lower extremity and assistive device before advancing the stronger lower extremity using a short stride. -Patients with a full-length cast or knee immobilizer will need to partially flex the hip to clear the foot and lead with the immobilized extremity. -With a below-knee cast, the hip and knee should be partially ___, with the foot positioned in front of the body to clear the foot; alternatively, the hip should be partially flexed and the knee extended to clear the foot.

extended flexed flexed

Orthopedic Surgical Conditions: For a patient who has had a total knee replacement, it is important to keep the affected knee in ___. When the patient is not undergoing treatment with a continuous passive motion machine, the knee should be placed in full extension (with no pillow) and in a ___ position at the hips.

extension neutral

>___- The chair is propelled by a deep-cycle battery system, and various types of controls are used to operate the chair (e.g., a joystick, a chin piece, or a mouth stick) >___- A low-profile, fixed frame, lightweight (15-24 lb) chair with features such as a low back, canted rear wheels, fixed or adjustable axles, and fixed or adjustable seat and backrest; it can be bought or customized for various sports activities

externally powered reclining

Move to a Prone Position, Patient Supine: The arm over which the patient will roll should be positioned in one of two ways: (1) close along the side with the shoulder ___ rotated, the elbow ___, the palm ___, and the hand tucked under the ___, or (2) with the shoulder ___ so the arm rests next to the ear with the elbow ___. The other contralateral upper extremity remains by the side.

externally, straight, up, pelvis flexed, straight

Continued: >Stages II and III -Granulation/nondraining -Granulation/draining ->Maintain moist wound bed; protect surrounding tissue; observe for infection; absorb ___ (only IF draining)

exudate

Continued: • Help the patient stand on the FWB lower extremity; assist in controlling or supporting the NWB lower extremity. • Instruct the patient to reach for and grasp the ___ of the wheelchair and pivot on the FWB foot to position the hips in preparation to sit. • Instruct the patient to use the upper extremities and FWB lower extremity to slowly lower the body into the chair; maintain control and support of the NWB lower extremity. • Position the NWB lower extremity on an elevated leg rest as necessary; place the other foot on the foot plate. • Position the patient for safety and comfort and remove the safety belt.

far armrest

A one-arm-drive chair may be used for independent propulsion when the user has only one functional upper extremity and no functional lower extremities. Two hand rims are attached to the same wheel. The outer, larger rim propels the ___ wheel and the inner, smaller rim propels the ___ wheel.

far-drive near-drive

Unilateral Cane: -the patient holds the cane and the handrail simultaneously or hangs the cane on the forearm ___ from the handrail, on the belt, or in a pocket and either uses the strong hand to grasp the handrail or grasps the handrail with one hand and uses the cane in the other hand as described for ascending and descending a curb. The lower extremities are used in the same way as described for ascending and descending a curb.

farthest

Guidelines for Lifting Activities: Stoop or squat to lift any object below the level of your hips. • Widen your ___ to increase your base of support and improve your balance and stability. • Move close to the object before you lift; keep the object ___ to your body as you lift or carry it. • Maintain the lumbar curve in your lower back as you lift; do not ___ your lower back.

feet close flatten

Assessment of Pain: In many hospital environments, patient pain is considered the ___. Ask the patient to describe the pain, because words can provide valuable clues to the cause. For example, patients who describe their pain as "burning" or "tingling" are likely to have a ___ cause of pain, particularly if associated with subjective numbness, loss of sensation, and weakness.

fifth vital sign neuropathic

Continued: •Stabilize •If open, cover with sterile dressing •If suspect spinal fracture, place patient on ___ and maintain head and neck in neutral: ___ if needed (need at least 3 persons to keep the spine in neutral) ▫Evaluate level of neurological sensation and function ▫Evaluate patient for signs of shock, bleeding, and other injury ▫Obtain qualified medical assistance to transport •Request transport to medical facility

firm flat board logroll

Continued: • To measure each of the circumferences of the extremity, apply the measuring tape around the extremity so it contacts the skin firmly and lies ___ but without causing an excessive indentation in the soft tissue. Use consistent pressure as you apply the tape at each mark, and apply the tape so each measurement is parallel to the one above and below. • Palpate and mark the ulnar stylus of the wrist to be used as the base for the series of measurement sites on the extremity. Take a circumferential measurement at the wrist.

flat

Continued: • Measure and document the distance from the bony landmark to the circumferential measurement sites. • For the circumference measurement, apply the tape around the extremity so it contacts the skin firmly and lies ___, but without causing an excessive indentation in the soft tissue; use consistent pressure and a tension gauge, if possible, as you apply the tape. • Record the results for the circumference and the distance from the landmark to the base of the tape; document your activity and report significant findings. • Measure the ___ for comparison.

flat contralateral limb

Side-to-Side Movement, Patient Supine: To have a supine patient perform a side-to-side movement, instruct the patient to do the following: (1) ___ his or her hips and knees and place the feet ___ on the bed or mat; (2) position one upper extremity next to the ___; and (3) ___ the other upper extremity approximately 4 inches from the trunk.

flex flat trunk abduct

Downward Movement, Patient Supine: To have a supine patient perform a downward movement, instruct the patient to partially ___ his or her hips and knees to position the feet flat on the bed or mat; the heels should be 8 to 12 inches distal to the buttocks. The upper extremities should be positioned next to the trunk with the elbows flexed and the shoulders (scapulae) depressed. The patient elevates the pelvis using the lower extremities and elevates the upper trunk by simultaneously pushing into the bed or mat with the elbows and the back of the head, and then he or she moves downward by pulling with the ___, simultaneously pushing up with the shoulders (scapulae) and pulling downward with the elbows or forearms.

flex lower extremities

Upward Movement, Patient Supine: To have a supine patient perform an upward movement, instruct the patient to fully ___ the hips and knees, position the feet flat on the bed or mat with the heels close to the buttocks, and position the upper extremities with the elbows flexed and next to the trunk with the shoulders (scapulae) pulled up toward the ears. The patient elevates the ___ using the lower extremities and elevates the upper trunk by simultaneously pushing into the bed or mat with the elbows and the back of the head, and then he or she moves upward by pushing with the lower extremities and depressing the shoulders.

flex pelvis

One-Leg Stance Lift ("Golfer's Lift"): The one-leg stance lift can be used for light objects that can be lifted easily with one upper extremity. The lifter faces the object, with the body weight shifted onto the forward lower extremity. To pick up the object, the weight-bearing lower extremity is partially ___ at the hip and knee while the non-weight-bearing lower extremity is extended to counterbalance the forward movement of the trunk (Fig. 4-5). The lifter picks up the object in a manner similar to the way a golfer removes a golf ball from the cup and returns to an upright position.

flexed

Straight Leg Lift: In a straight leg lift, the lifter's knees are only slightly ___ or may be fully ___. The lower extremities are either parallel to each other or straddle the object, and the upper extremities are either parallel to each other or grasp the opposite sides of the object. The trunk may be positioned either vertically or horizontally, and the lumbar spine remains in lordosis

flexed extended

Continued: Floor to Wheelchair.: To move from the floor to a wheelchair, the patient sits on the right hip facing the locked wheelchair with its caster wheels positioned forward. The lower extremities should be ___ at the hips and knees. The patient reaches to the back of the seat or the armrest and pulls up to a kneeling position. The patient moves to a ___ position with the right foot forward and flat on the floor, and he or she kneels on the left knee. The patient places the right upper extremity on the near armrest or on the seat of the chair and uses the right extremities to push to a partial or full standing position. The patient reaches for the far armrest with the right upper extremity and pivots on the right lower extremity so the back is toward the chair, then lowers into the chair using the right extremities.

flexed half-kneeling

Lift Techniques: Straight leg lift >Knees are only slightly ___ >Lower extremities are either parallel to each other or straddle object, and upper extremities are parallel to each other or grasp object on opposite sides >Trunk in vertical or horizontal, lumbar spine in ___

flexed lordosis

Side-Lying Position: Both of the patient's lower extremities should be ___ at the hip and knee. The uppermost lower extremity should be supported on ___ and positioned slightly forward of the lowermost extremity. One or two pillows should be used to support the patient's head. A folded pillow placed at the patient's ___ is used to support the uppermost upper extremity and to prevent the patient from rolling forward.

flexed one or two pillows chest

Move to a Sitting Position, Patient Supine: To move a supine patient to a sitting position, move the patient close to one edge of the bed or mat (using the length of the patient's thigh as a guide to where the patient's buttocks should be) and roll the patient to a side-lying position with the lower extremities partially ___. Elevate the trunk by lifting under the shoulders or by instructing the patient to push up using either or both upper extremities. Pivot the lower extremities over the side of the bed or mat as the trunk is ___. If the patient is not able to control the lower extremities to put them on the floor, you may need to assist or guide the lower extremities to prevent pain or injury. Do not allow the patient to sit unattended or unsupported. This method is recommended for patients who have a lower back condition that might be aggravated by trunk flexion or for patients who have functional use of only one upper and lower extremity

flexed raised

Bariatric Patient: A dependent transfer can be performed when a bariatric patient is transferred and no mechanical equipment is available. With the patient supine, roll the patient to a side-lying position and place a ___ next to the body from midchest to midthighs. Roll the patient to the opposite side, extending the sheet under the body. Help the patient to a sitting position by moving the legs over the edge of the mat and using the sheet to get the patient to an upright position. Both caregivers brace the patient's knees with their ___ and use the sheet in a cradlelike fashion to help the patient stand.

folded sheet knees

Precautions for patient positioning: • Avoid clothing or linen ___ beneath the patient. • Observe ___ over bony prominences before, during, and after treatment. • Protect bony prominences from excessive and prolonged ___. • Use additional caution when positioning patients who are mentally incompetent or confused, comatose, very young or elderly, paralyzed, or lacking normal circulation or sensation.

folds skin color pressure

Precautions for ambulation activites: • Ensure that the patient wears appropriate ___; do not allow the patient to ambulate while wearing loose-fitting shoes or slippers or when barefoot. These conditions can lead to patient insecurity and injury. • Monitor the patient's physiological responses to ambulation frequently and evaluate vital signs, general appearance, and mental alertness during the activity. Compare your findings with normal values to determine the patient's reaction to the activity.

footwear

Continued: When Balance Is Lost Backward • Push ___ on the pelvis and trunk to help the patient regain a balanced position. • If the patient is unable to maintain an upright position, assist him or her to the floor or a chair.

forward

Elevator Access: -Patients should be taught to enter and leave the elevator in a ___ position whenever possible.

forward

Mobility and Transfer Activities: Special Precautions: •Spinal Precautions -avoid bending ___ more than 90 degrees -avoid lifting more than ___ -avoid twisting your ___ -> ___ should move with your nose

forward 10 pounds trunk toes

Sitting, Assisted: The transfer board is positioned under the patient's thigh, in front of the drive wheel, so it extends from the wheelchair seat to the bed. Do not place the transfer board just under the buttocks, which can result in the patient sliding ___ in the process of the transfer. The board needs to be under the ___.

forward off the transfer board thighs

>Back height • A proper fit for a standard seat back will allow you to place ___ between the top of the back upholstery and the floor of the user's axilla. • The inferior angles of the scapulae should be positioned approximately ___ above the back upholstery when the user sits with an erect posture (E)

four fingers, with your hand held vertically, one fingerbreadth

SOAP notes should indicate and clearly reflect the patient's condition and subsequent changes in condition, and they should be written ___ so that information is reported promptly and regularly.

frequently

Anticipate the need for an assistant and, if necessary, have someone available before attempting the initial transfer. You must determine the best position to use to protect the patient. To prevent injury to the patient as the result of a fall, it is usually best to be in ___ of and slightly to ___ of the patient when he or she stands.

front one side

Cane: -Rise to a Standing Position • Position the cane on the right side of the chair; a footed cane is placed slightly to the ___ and ___ of the right armrest, and a standard cane is hooked onto the front portion of the armrest. • The patient moves toward the front of the chair seat and positions the right foot slightly posterior to the left. The patient places his or her hands on the armrests in front of the hips to be able to push with them to lift the body from the chair. • To rise, the patient leans the ___ forward and pushes strongly with the right upper and lower extremities; if they are capable of providing assistance, the left extremities can be used as well.

front and side trunk

Patient with One Non-Weight-Bearing Lower Extremity, Standing Transfer- BED TO WHEELCHAIR: • Position the wheelchair at an angle on the side next to the hip of the ___ lower extremity, facing the foot of the bed; lock the chair and swing away the front rigging or elevate the footplates. • Help the patient move to the edge of the mattress and sit up; apply a safety belt or sling. • Position yourself ___ of the patient to guard and protect him or her; assist in moving the ___ extremity to the edge of the mattress. (Caution: Avoid excessive hip flexion and adduction if the patient has had a total hip replacement.)

full weight-bearing (FWB) in front non-weightbearing (NWB)

At the end of treatment: Note: Depending on the ___ of the caregiver and the patient and the area or areas of the patient to be exposed for treatment, it may be necessary for the caregiver to ask another person to help the patient with undressing, positioning, draping, and redressing to protect modesty.

gender

•Crutches- up with ___ followed by crutches, on the way down lead with the ___ and ___

good crutches and the affected leg

Stair and Curb Navigation: •Cane- ___ up first and cane follows, PT ___ him •On way down, ___ first and then bad leg down first, PT ___ patient

good leg behind cane in front of

Downing: After wash hands- ___ is the first thing you PUT ON, Tie gown, After gown is ___ (press middle tab so fits to nose, then put on goggles (if glasses use a face shield), Last use gloves that are ___, pull gloves up over the edge of the gown

gown mask latex free

The following techniques may be used for airway clearance: • Positioning for ___ drainage • Chest percussion, vibration, and shaking • Rib springing • Cough training, stimulation, and assistance • Forced expiratory technique (huff) • Airway suctioning • Oxygen, bronchodilator, and humidity therapy used in conjunction with CPT treatments

gravity

Postural Age-related Changes: >The disks between the spinal segments become less resilient and give in more readily to external forces, such as ___ and ___ >Muscles become less ___ >Compression and deterioration of the spine, commonly seen in individuals with osteoporosis, cause an increased flexed, or bent forward, posture. >Lifestyles usually become more ___

gravity and body weight flexible sedentary

Principles and Concepts: Use of ___ and ___ to your advantage COG (center of gravity- is at ___ level) Personal Vertical Gravity Line (VGL) Object or Patient - added weight- this changes it BOS

gravity and/or friction second sacral

It is important to select and apply techniques that will, in some situations, reduce the adverse effects of ___ and ___

gravity or friction

Handpiece Height: With the patient supine, measure from the ___, ___, or ___ with the arm by the side and the elbow extended to the heel of the shoe; hold the tape next to the side of the lower extremity. Use this value to position the handpiece by measuring up from the rubber tip of the crutch to the handpiece.

greater trochanter, from the wrist crease, or from the ulnar styloid process

Canes: The hand grip of the cane should be placed at the level of the patient's ___, ___, or ___ with the arm straight along the side. Place the cane parallel to the femur and tibia with the foot (tip) of the cane on the floor or at the bottom of the heel of the shoe (Fig. 9-5). A tape measure can be used to determine the distance from the patient's greater trochanter to the heel with the hip and knee straight, which determines the length of the cane when the patient is supine.

greater trochanter, the wrist crease, or the ulnar styloid process

Canes: •Setup ●Handgrip should be placed at level of patient's ___, ___, or ___ with arm straight at side ●The handle of cane is facing away from the patient until ___, then turn handle to wear it faces the patient

greater trochanter, wrist crease, or ulnar styloid process fix the height

Curbs and Stairs: Two approaches are used to ascend and descend multiple steps (stairs): (1) with the use of a ___ (banister) and (2) ___ the use of a handrail. It is usually desirable to initiate stair activities with the patient using a handrail to provide maximum stability and a sense of security.

handrail without

Supine Position: A small pillow or a cervical roll may be placed under the patient's ___. A small pillow, rolled towels, or a small bolster can be placed in the ___ spaces (i.e., behind the knees) to relieve lumbar lordosis and promote comfort. Because having an item behind the knees encourages hip and knee flexion and may contribute to lower extremity contractures of the iliopsoas (hip flexor) and hamstring (knee flexor) muscles, this position should not be maintained for a prolonged period. A small, rolled towel or small bolster may be placed under the patient's ___ to relieve pressure to the calcaneus (heel), but knee hyperextension should be avoided.

head popliteal ankles

Heat-Related Illnesses: When treating a person with a heat-related illness, the objectives are to remove or reduce the cause of the illness and return the individual to a state of normal homeostasis. The two primary forms of heat-related illness are heat exhaustion and heat stroke. Of the two, ___ poses the least threat to life, whereas ___ is considered a medical emergency because it can be life threatening.

heat exhaustion heat stroke

These events could result in the rupture of a cerebral vessel or a cerebrovascular accident, which could lead to death. This phenomenon is most likely to occur when the patient is performing ___, ___, or ___ but can occur at any time during active or resistive exercise

heavy lifting, pushing, or pulling

Dependent: •Indications: when patient is unable to ___ ●Severe neurological deficits ●Severe trauma ●Morbidly obese patients who have significant weakness •May require more than 1 person •Hoyer lift

help or participate in the transfer

Floor to Wheelchair Forward Push-up: The patient moves to the front of the chair and places one hand on the armrest or on the seat. The patient grasps the armrest or the seat of the chair and pushes down on the chair to a ___ position and maintains balance. The patient grasps both armrests or places one hand on the seat of the chair and one hand on the armrest and then performs a push-up to elevate the hips above the ___. At the peak of the lift, the patient pivots so one hip is over the seat and moves the hand to allow one hip onto the chair. The patient repositions the hands on the armrests and performs a push-up to position the body in the chair.

high kneeling seat level

Factors Affecting Respiration: Age- Both very young patients (infant to 3 years) and elderly patients (≥65 years) tend to have ___ respiration rates Physical activity- The rate and depth of respiration ___ during exercise. Emotional status- The rate and depth of respiration ___ during episodes of high stress, anxiety, or emotion (e.g., anger or fear) Air quality Impurities in the atmosphere may cause the respiration rate to increase or decrease, depending on the effects of various components of the person's pulmonary system Altitude High altitudes cause the respiration rate to ___ until a person is acclimated Disease- Disease that affects various components of the pulmonary system usually increases the respiratory rate and also may affect the depth of respiration

higher increase increase increase

Transtibial Amputation: Prolonged ___ and ___ should be avoided for the patient with a transtibial amputation. The RL should not be elevated on a pillow while the patient is supine for more than a few minutes of each hour. If the RL is elevated, the knee should be maintained in extension. The amount and length of time the patient is permitted to sit should be limited to no more than 40 minutes of each hour. Lying in the prone position periodically is recommended.

hip and knee flexion

Patient with a Total Hip Replacement Assisted Standing Transfer: Each surgeon will have instructions or preferences for the amount of weight bearing allowed, the movement or activities to be permitted, and the alignment of the trunk in relation to the surgically replaced hip. Most of the precautions or contraindications are designed to reduce the possibility of ___ during the first 10 to 14 days of postoperative care.

hip dislocation

Transfemoral Amputation: Prolonged ___ should be avoided for a patient with a transfemoral amputation. The residual limb (RL) should not be elevated on a pillow while the patient is supine for more than a few minutes of each hour. The amount and length of time the patient is permitted to sit should be limited to no more than 40 minutes of each hour. In addition, it may not be possible to fit the patient with a prosthesis if ___ occur.

hip flexion contractures

Continued: Obtain ___ of previous medical/surgical interventions, particularly related to major body systems Obtain history of major family medical and surgical events, such as evidence of cancer, hypertension, coronary artery disease, other heart-related conditions, arthritis, and diabetes Obtain a history of social health/habits (current and past), employment or work, living environment, and lifestyle, such as use of tobacco, alcohol, controlled substances, and sexual activities

history

Return to a Sitting Position • The patient approaches the chair and pivots toward the chair, leading with the right upper extremities, until the right side is nearest the chair. • The footed cane is placed in front and to the side of the right armrest; a standard cane is ___ onto the armrest. • The patient reaches for the near armrest with the right hand and then, if he or she is able to do so, grasps the far armrest with the left hand and continues to turn until the back is toward the chair seat.

hooked

Continued: To conclude a treatment session, gradually return the patient to a ___ position, observe the patient measure and log the vital signs, and observe and palpate the lower extremities for edema or circulatory responses (i.e., pedal pulses, color, and temperature). • Document your activities and findings.

horizontal

Peripheral Vascular Conditions: -When peripheral vascular disease problems are diagnosed early enough, they can be treated with use of a ___ -For most patients, prompt medical care and management of any condition that affects the peripheral venous or arterial circulation will be necessary to prevent a serious complication.

hyperbaric chamber

Introduce yourself by your name and title, shake hands, make eye contact Red flags: •Age older than 50 years •History of ___ or cancer •Report of bowel or bladder dysfunction •Intractable night pain •Numbness and tingling in extremities •Numbness and tingling in groin area •Weight loss/gain •Recent infections •Fever/chills

immunosuppression

Guidelines for Communicating with Persons with Disabilities: • Interact directly with the person with the ___. • ___ or ___ to communicate with a person in a wheelchair; position yourself in front and at eye level. • Avoid leaning or sitting on a person's wheelchair; use care when handling assistive aids.

impairment Stoop or squat

PULSE: The pulse is an ___ measure of the contraction of the ___ of the heart and indicates the rate at which the heart is beating. It is defined as the movement of blood in an artery, which can be palpated at various sites of the body or measured through auscultation over the apex of the heart with a stethoscope.

indirect left ventricle

RESPIRATION (PULMONARY VENTILATION): One respiration comprises one ___ and ___. Depending on the source used, the accepted normal range for respiration at rest is ___ to ___ respirations per minute (breaths/min) for adults and 30 to 50 breaths/min for infants. Resting values above ___ breaths/min or below ___ breaths/min are considered abnormal for adults.

inhalation and one exhalation 12 to 18 20 10

balance, and body mechanics change with different ___

injuries

Seizures: •Protect the person from ___ •Protect modesty or privacy •Place in safe location and position •Do not ___ or ___ •Obtain help as needed •Monitor rate and quality of respiration •Assist with keeping ___ patent ▫DO NOT put objects in ___ •When convulsions subside, turn head to side or roll on side •Allow rest and privacy once convulsions ___ •Patient should be evaluated by physician if cause not known

injury restrain or restrict airway mouth cease

Why is positioning important?: •Prevent ___, ___ and ___ •Provide patient ___ •Provide support and stability of trunk and extremities •Provide access and exposure to treated areas •Promote efficient function of body systems •Relieve excessive, prolonged pressure

injury, pressure, and joint contracture comfort

INTERPROFESSIONAL COLLABORATION: To be successful, ___ requires the team members to meet collectively and periodically to solve problems and reach decisions about management of the patient. Collaboration, coordination, and communication are important factors used by the team to help the patient effectively fulfill goals or needs

interprofessional collaboration

Crutches: -Rise to a Standing Position • The patient moves toward the front of the chair seat and places the right foot approximately 6 to 8 inches forward. If the knee of the most affected lower extremity cannot be flexed, the patient should be taught to slide the heel forward before attempting to stand, or the caregiver can support the lower extremity as the patient stands (A). • The handpieces of both crutches are grasped in the left hand and are positioned vertically slightly in front and to the side of the chair; the right hand holds the armrest (B). • To rise, the patient ___ and pushes with both hands and right lower extremity (C).

leans the trunk forward

DESCENDING A CURB, STAIR, OR RAMP: GUARDING THE PATIENT FROM THE BACK: • Follow the general considerations listed previously in this procedure. • Stand behind and to the side of the patient in the area where there is the ___. • Place one foot on the step on which the patient stands; place the other foot on the step above. • Grasp the gait belt with one hand and the handrail, if one is available, with your opposite hand. Descend one step with each foot after the patient has descended one step. • Teach the patient to stop and gain ___ on each step before progressing to the next step.

least protection normal balance

Sideward Movement: To move to the right, instruct the patient to position the ___ next to the outside of the left foot and the right aid approximately 6 to 8 inches away from the right foot. The patient steps sideward to the right and ___ the aids to sidestep again.

left assistive device repositions

Continued: If the patient is going to move to the left, the ___ is placed on the board 4 to 6 inches from the left thigh and the right hand is placed next to the right thigh. the patient performs a push-up with the upper extremities to elevate the body and begins to move toward the bed by quickly moving the head to the left and pushing toward the right with the left arm simultaneously.

left hand

Move to a Supine Position, Patient Prone: To move a prone patient to the supine position, first move the patient close to one edge of the bed or mat. If the patient is going to roll toward the right side, cross the ___ over the ___. Position the right upper extremity close to the side with the elbow straight, the palm up, and the hand tucked under the pelvis; alternately, the right shoulder can be flexed and the arm can be positioned close to the patient's ear, with the other upper extremity placed next to the patient's side. Stand on the far side of the table and roll the patient ___ you to a side-lying position.

left leg over the right leg toward

The caregiver and any assistants should use proper body mechanics: • Lift with your ___ and avoid ___ • Avoid trunk ___ and ___ • Position your center of gravity (COG) as close to the patient's ___ as possible • Increase your ___ (BOS) (lower your COG and maintain your vertical gravity line within your BOS) • Continue to instruct the patient and those assisting with the transfer by using short statements; it may be possible to incorporate some patient teaching while the activity is performed.

legs, twisting flexion and rotation COG base of support

The date and time of dressing changes should be documented. The patient should be instructed about the ___ the bandage should remain in place, when it should be routinely removed (e.g., for bathing, for exercise, or if it becomes wet), and how long the wound can be ___ before the bandage is reapplied.

length of time free of the bandage

Principles for Proper Posture: Maintain the normal anterior and posterior curves of the spine for proper balance and alignment. • Stand and sit with your body erect so the shoulders and pelvis (hips) are ___; avoid slouching or "___" positions. • Stand with your ankles, knees, hips, and shoulders aligned; keep your head over your body, not in front of the shoulders. • Stand with your abdominal wall flat, your head in neutral, your shoulders level, your chin parallel to the floor and slightly tucked, and your body weight evenly placed on each leg. Keep your knees slightly flexed and maintain lumbar lordosis.

level round back

Continued: • Remove the calibrated container before the patient lifts the foot or hand from the water so any water that would drip from the body part does not drip into the calibrated container. Dry the patient's foot or hand. • Place the calibrated container on a firm, ___, and position yourself to read the scale at eye level. • Record the results, document your activities, and report significant findings. • Repeat the procedure for the uninvolved extremity for comparison.

level surface

Because lymphedema is a ___, patients must be responsible for meticulous skin care and must follow precautions, perform self-massage, apply compression bandages or garments, and perform remedial exercises to ensure that CDT will have long-term success

lifelong condition

•Tests in Sitting: ●Push up- off bed of wheelchair, don't have to come all the way up; just get their bottom off to see if they can ___

lift their body weight

Rationale for lordosis: Reduces mechanical stress to ___ and ___ (discs) Better stability- not directing discs ___ which would lead to greater risk of disc herniation Better use of power muscles

ligaments and IVD posteriorly

ADVANCE HEALTH CARE DIRECTIVES: An Advance Health Care Directive, also known as a "___," is a set of instructions to give an appointed individual the right to make decisions concerning the health care actions to be taken when a person is no longer able to make decisions because of ___ or ___. Because this form of will was to be used while an individual was still living but unable to make decisions, it was called a "living will."

living will illness or incapacity.

Forearm crutches (also referred to as ___ or ___ crutches) >use -Used when the stability and support of an axillary crutch are not ___, but when more stability and support than can be provided by a cane are needed; they eliminate the danger of injury to axillary vessels and nerves and are more ___ on stairs and in narrow, confined areas >characteristics -They are easy to store and transport, and the forearm cuff retains the crutch on the forearm when the patient reaches for an object Types include aluminum or wood, adjustable, and nonadjustable (see Fig. 9-1, B) >disadvantages -Provide less ___ and ___ than axillary crutches, a walker, or parallel bars. Require functional standing balance and functional upper body and upper extremity strength for many gait patterns Forearm cuff can make it difficult to remove the crutch Elderly patients may feel ___ with them

lofstrand or canadian required functional stability and support insecure

Spinal cord injury: -For a patient with a recent spinal cord injury, the injury site may be protected by an external appliance (e.g., a brace, plaster or plastic body jacket, or halo device), internal fixation (e.g., bone graft, metal rods, or wires), or a combination of the two methods. ___ the person when turning. Protective positioning or restraints will be required when this patient is in a side-lying position or sits without a back support.

logroll

Continued: MOVEMENT FROM THE FLOOR TO STANDING • The patient starts in the prone position and pushes to his or her hands and knees or ___ to a side-lying position. • If the patient is on all fours, he or she moves to a half-kneeling position, then to standing; a firm object may be used for assistance. • If the patient is lying on his or her side, he or she pushes to a side-sitting position, moves to a handsand-knees position, and then performs the movements listed in the previous step.

logrolls

Short-term (interim) goals -Preparatory component of ___. Lead-in activity for long-term goal Sequential activities that produce cumulative effect Support and promote functional outcome Long-term (terminal) goal -Evolves from ___. Describes maximal performance or desired outcome. Describes functional outcome as a necessary component. Should be revised or modified based on the patient's progress and performance

long-term goal short-term goals

Footplates too ___: •Increased pressure on distal posterior aspect of thigh •Decreased function of the UE when propelling chair •Unsafe mobility due to lack of sufficient clearance of footplate Footplates too ___: •Increased pressure on the ischial tuberosities •Difficulty positioning chair beneath table/desk •Decreased trunk stability caused by lack of support by posterior thighs

low high

Continued: The patient pushes with the upper extremity to raise the trunk and maintains this position by resting on the elbow and forearm of the lowermost upper extremity, then elevates the trunk fully by pushing with both upper extremities to a side-sitting position (Fig. 8-10, B). The lower extremities can be pivoted simultaneously over the edge of the bed or mat (Fig. 8-10, C). This technique is beneficial for the patient with ___ dysfunction or pain because less stress is directed to the ___ by avoiding rotation and flexion.

low back lumbar spine

Mechanical equipment: When a heavy or dependent patient needs to be lifted or transported, the safest and most effective device to use is a ___ or ___. Either of these devices can lift a patient who weighs up to ___ lb, depending on the specifications for the lift.

manual (hydraulic) or an electrical (battery powered) mechanical lift 450

Test and measures- guidelines: Muscle strength and endurance using ___ or ___ methods Joint motion and range using a ___; measured actively and passively Joint integrity; test actively and passively using manual or mechanical methods Sensory functions- Protective reactions to pain, temperature, and pressure Discriminatory reactions such as kinesthesia, proprioception, stereognosis, two-point discrimination, touch, and feel (e.g., temperature, shape, and texture) Reflex responses related to tissue stretch, posture, and gross and fine motor skills Automatic reactions such as righting, equilibrium, and synergies

manual or mechanical goniometer

An object's COG is located where the ___ of an object is located; it is the heaviest area to move or the most difficult to adjust to a new position. The COG of a standing person is located approximately at the level of the ___ in the center of the pelvis.

mass second sacral segment

Sitting, Dependent Lift: In a sitting, dependent lift, one, two, or three persons may be required to lift and move the patient from one surface to a second surface. A ___ may be used instead of multiple persons. If a mechanical lift is used, only one caregiver is usually needed to perform the transfer

mechanical lift

Dressings: The purposes of the dressing are to protect the wound, assist the healing process, reduce infection or contamination of the wound, and remove exudates and toxic waste when the dressing is removed. Dressings can be used to add ___ in very dry wounds or to remove and ___ moisture in wounds with large amounts of exudate.

moisture absorb

EMERGENCY CARE: Although the role of the caregiver may be to provide immediate initial aid, the caregiver should make an effort to obtain immediate assistance from the ___ available, such as a physician, a nurse, an emergency medical technician, a rapid response team, or other medical personnel.

most qualified individual

Continued: Review information about four major body systems: ___ (gross range of motion, gross symmetry, gross strength, weight and height); ___ (gross coordinated movement; motor control; motor learning; communication ability; consciousness; expected behavioral responses; orientation to place, time, and person; educational needs and barriers); ___ (texture, skin color, presence of scar formation and integrity); and ___ (blood pressure, edema, heart rate and respiratory rate)

musculoskeletal neuromuscular integumentary cardiovascular/pulmonary

Continued: The aid is held in the upper extremity ___ to the lower extremity that requires protection, which widens the BOS and assists in shifting the patient's COG away from the protected lower extremity.

opposite

Continued: -The patient should be discouraged from holding onto the caregiver during transfers, but if the patient insists or is in the habit of doing so, he or she can hold your middle or upper back with the upper extremities. (Caution: Do not allow the patient to hold you around your ___. You must use proper body mechanics to prevent undue strain on your back.) -Instruct the patient using terms such as ___ or ___. Instruct the patient to move his or her head forward and shift his or her weight forward, if possible, so as to unload the weight from the backside to begin the transfer. As you lift on the safety belt or sling, simultaneously straighten your lower extremities and stabilize the patient's knees by pushing in and forward with your knees.

neck "ready, stand" or "one, two, three, stand."

These sounds are characterized by their pitch, qualities (harshness or loudness), intensity, and duration of the inspiratory and expiratory phases: • Normal breath sounds are classified as tracheal, bronchial, bronchovesicular, or vesicular and depend on the area of the chest being examined. • Tracheal breath sounds are best heard in the ___ region and are high pitched, harsh, hollow, and loud. • Bronchial breath sounds are loud, tubular, less-harsh sounds that are best heard over the ___. These sounds are abnormal if heard in the peripheral lung fields and represent consolidation in a lobe.

neck manubrium of the sternum

Debridement: The removal of ___ from the wound allows the wound to heal more effectively. Debridement can be performed with sharp instruments (i.e., a scalpel or scissors), mechanically, chemically, or with autolysis. Sharp debridement with use of a scalpel or scissors to remove thick adherent eschar and other devitalized tissue is the most rapid method. Surgical or sharp debridement often is performed by a physician when a large amount of necrotic tissue is present (>___%).

necrotic tissue 70

Sidelying: Pillow between legs and knees, support malleousus and knees Pillow underneath armpit Pillow under head -___ alignment

neutral

Checklist of Nonverbal Pain Indicators*: Behavior (with movement and at rest) 1. Vocal complaints: ___ (sighs, gasps, moans, groans, cries) 2. Facial grimaces/winces (furrowed brow, narrowed eyes, clenched teeth, tightened lips, jaw drop, distorted expressions) 3. Bracing (clutching or holding onto furniture, equipment, or affected area during movement) 4. Restlessness (constant or intermittent shifting of position, rocking, intermittent or constant hand motions, inability to keep still) 5. Rubbing (massaging affected area) 6. Vocal complaints: verbal (words expressing discomfort or pain [e.g., "ouch," "that hurts"]; cursing during movement; exclamations of protest [e.g., "stop," "that's enough"] ) Subtotal scores Total score

nonverbal

Goals of Wound Management Dependent on Wound Stage and Appearance: >Stage I: -appearance- Erythema that does ___ when pressure is applied -goals- Remove, relieve pressure, keep area clean; avoid friction and shear forces

not blanch

Doors: >Self-Closing Door -If the door opens away from the patient, the door is approached at an angle so the patient faces the side of the door that will ___. The door is opened with a quick push, and the patient returns the hand from the doorknob or crash bar to the crutch. The door can be opened wider by repeating this procedure as the patient moves through the doorway. The patient must be certain that the final step through the doorway will place the body beyond the closing arc of the door.

open

Continued: • Estimate and describe the type and amount of exudate (e.g., viscosity, color, and consistency). • Describe the ___ associated with the ulcer after it has been rinsed with sterile saline solution. • Observe and report whether edema or induration exists in the tissue surrounding the periphery of the ulcer. • Observe and report whether signs of inflammation are present in the tissue surrounding the ulcer; measure and report the area in which signs appear. • Observe and describe the condition of the skin surrounding the ulcer (e.g., dry, moist, loose, taut, warm, or discolored). • Observe and report any increase in pain in the area

odor

FORWARD FALL: • The patient releases the crutches and quickly flips them to the side; the crutches must not fall to the floor in front of the body. • The patient reaches forward with both upper extremities and turns the head to ___ • When the hands contact the floor, the elbows are bent to absorb some of the force of the fall. • The body is lowered to the floor, and if no serious injury has occurred, the crutches are gathered in preparation for standing using one of the techniques presented in this chapter.

one side

>Stand Pivot -Indications •Patients who are stronger on ___ •CVA ->For patients post CVA: guard or block the ___ -Post op patients with wt bearing restrictions •For post op patients: Guard the ___ •Dependent stand pivot transfer is NOT advised

one side than the other affected extremity unaffected extremity

To reduce the collection of pathogens under the fingernails, nails should be trimmed to less than ___ so they are not visible when the hand is held in front of the face with the palm directed toward the face and the fingertips at eye level.

one-quarter inch

LYMPHEDEMA: The lymph system is a ___ system designed to rid tissues of unwanted material and excess fluid. ___ is the result of a functional overload of the lymphatic system in which lymph volume exceeds transport capabilities, resulting in obstructed lymph flow, swelling, pain, and susceptibility to infection.

one-way drainage Lymphedema

Modified Four-Point Gait Pattern: •Require ___ AD - cane or crutch •Pattern description: similar to that of the regular four-point gait pattern but with ___ •For example: the AD and opposite LE advance ___ •Used in the patient with only one functional UE or only uses one AD •AD used in UE ___ of the impaired LE •Use of one AD widens the patient's BOS and shifts COM away from impaired LE •Sometimes referred to as the "___" gait

only one one AD alternately opposite hemi

Modified Two-Point Gait Pattern •Require ___ AD - cane or crutch •Pattern description: similar to that of the regular two-point gait pattern but with one AD •For example: the AD and the opposite LE advance simultaneously •Used in the patient with only one functional UE or only uses one AD •AD used in UE ___ of the impaired LE •Use of one AD widens the patient's BOS and shifts COM away from impaired LE •Sometimes referred to as the "___" gait

only one opposite hemi

Modified Four-Point or Two-Point Pattern: Modified four-point and two-point gait patterns are appropriate for the reduction of stress on an arthritic hip, for example, but they are not appropriate for a postsurgical patient who needs a true PWB gait. The patterns require ___ and can be used for patients who have only one functional upper extremity or who have a lower extremity medical condition for which less stress is required.

only one assistive device

Standing and Sitting with Axillary Crutches: Placing the crutches ___ to the foot of the stronger lower extremity widens the patient's BOS so when the patient stands, the body's vertical gravity line will be located between the crutches and the strong lower extremity. Alternative Methods: An alternative method for standing is to hold the crutches with the hand on the same side of the body as the stronger lower extremity. This technique narrows the BOS but increases the force the patient is able to use to stand. The ipsilateral upper and lower extremities function simultaneously to lift the patient upward

opposite

Transfers: Principles and Concepts: •******************************************** •Head moves ___ the direction you want the patient to move •One person moves at a time •___- if get head over toes, it gets the weight off of their butt •********************************************

opposite Nose over toes

Two-Point Pattern: To move backward in a two-point pattern, instruct the patient to simultaneously move one assistive device and the ___ backward and then move the opposite aid and lower extremity backward simultaneously. The pattern should be repeated as necessary

opposite lower extremity

Sites used to assess a person's body temperature are the oral cavity, rectum, axilla, ear canal, forehead or temporal lobe, and occasionally the inguinal fold. The most common and convenient location to measure a person's temperature is the ___, but the most accurate measurement of body temperature is obtained from the ___.

oral cavity rectal cavity

PUSHING, PULLING, REACHING, AND CARRYING: The force of the push or pull should be applied ___ to the surface over which the object is to be moved and in the line of the movement desired. This tactic reduces the effect of ___ and moves the object in the proper direction.

parallel friction

Continued: Alternative Method.: -The wheelchair is positioned and locked either ___ to and approximately 2 feet from the head of the bed or facing the center of the bed approximately 3 feet from the side of the bed, with both armrests and the front rigging removed. -The persons performing the lift approach the patient from each ___. Each lifter uses one forearm to cradle the patient's thighs while the other upper extremity crosses the patient's posterior upper trunk and grasps the other lifter's forearm. The patient's upper extremities are placed over each lifter's upper back or shoulders, but not around their necks. One person gives the ___ to lift and the lifters walk forward, away from the chair, carrying the patient (Fig. 8-23). They turn so the patient's back is toward the bed and move backward toward the bed. The patient is seated on the edge of the bed, assisted to a supine position, and centered in the bed.

parallel side command

Two Person Lift Transfer: WHEELCHAIR TO BED • Position the wheelchair ___ to the side and midway between the head and foot of the bed; lock the bed wheels. • Lock the chair and raise the foot plates or swing away front rigging; the armrest nearest to the bed should be removed only if it is higher than the ___. • The taller and stronger person stands ___ the chair. The patient crosses his or her arms over the abdomen, and the person behind the chair reaches through the ___ and grasps either the patient's forearms near the wrists or a safety belt placed firmly below the rib cage (A).

parallel surface of the bed behind axillae

Totally Dependent Patient: Stretcher to Bed or Bed to Stretcher: when the two surfaces are at approximately the same height, position the stretcher (gurney) ___ to and ___ one edge of the bed. If the stretcher has a loose pad, slide it and the patient onto the bed and then remove the pad; if a draw sheet is available, use it to slide the patient from the stretcher onto the bed.

parallel touching

Wound Classification and Staging: If the epidermis and a portion of the dermis are involved, the wound is considered to be a ___ wound and the ulcer is considered to be ___. When the entire dermis and underlying fascia, muscle, tendon, or bone are involved, the wound is considered to be a ___ wound and the ulcer is considered to be ___.

partial-thickness superficial full-thickness deep

Automobile Access: -Frequently, patients will find it more convenient to enter and leave a vehicle from the ___ side to avoid interference from the steering wheel. The transfer can be performed more easily if the car seat is positioned ___ as far as possible to provide greater space for the lower extremities. -The patient with a full-length cast or knee immobilizer may be more comfortable in the back seat because the extremity can be placed on the ___.

passenger back seat

5 "rights" of administering medication: 1. Right ___ 2. Right ___ 3. Right ___ 4. Right ___ 5. Right ___

patient drug time route dose

The interprofessional team approach must be ___ centered rather than ___ centered; team members must therefore be able to provide advice, counsel, and recommendations, based on each member's knowledge and expertise, that will lead to the best outcome for the patient.

patient profession

Collaboration: Interprofessional Collaboration Team effort by multiple professions Collaboration, coordination, and communication Patient centered (interprofessional collaboration is ___- this is our number 1 goal) vs profession centered???? Professional Collaboration PT and PTA

patient centered

Side-to-Side Movement, Patient Supine: position one forearm under the ___ and one forearm under the middle of the back. Gently slide the upper body and head toward you without lifting the upper body. Next, position your forearms under the patient's ___ and just distal to the pelvis; gently slide that body segment toward you. Finally, position your forearms under the ___ and ___ and gently slide them toward you. The force you use to pull and slide the patient should be applied parallel to the surface of the bed or mat to further reduce the energy required.

patient's neck or upper back lower trunk thighs and legs

Continued: • Grasp the gait belt with one hand; be prepared to use your other hand to control the trunk or grasp the handrail when available. If a handrail is not available, guard with your opposite hand placed on the ___. • Use an anteroposterior stance with your outside foot on the step on which the patient is standing and your inside foot on the step below the step on which the patient is standing. • Advance your feet up one step after the patient has advanced one step, but maintain your feet in an anteroposterior position as described. This process is repeated to ascend all the steps.

patient's shoulder

Downward Movement, Patient Supine: Position yourself approximately opposite to the ___ or ___ or ___. Cradle and lift the pelvis slightly before you slide the patient's upper body and head downward. Move the patient approximately 6 to 10 inches and then reposition yourself and the patient's lower extremities if further movement is required. Reposition the patient in the center of the bed or mat.

patient's waist or hips or at the patient's feet

Wheelchair to Floor in a Backward Position: The patient performs a partial push-up to clear the ___ from the seat and then uses the upper extremities to lower onto the knees to a high kneeling position facing the front of the chair. Then the patient lowers to a ___ position or onto all fours and then onto one hip.

pelvis side-sitting

Planning for Positioning: Assess the patient's status: •Medical or surgical condition that requires certain ___; ex. If had a hip replacement, might not be able to position them in certain ways •Level of consciousness •Pain •___ impairment- if can't feel, wont know something is wrong •Impairment of position sense •Motor impairment •Spasticity •Edema •Skin irritation, infection •Bowel/bladder incontinence

positioning Sensory

Mobility Activities: •May be dependent (you're doing 100% of the work), but patient should be participating as much as ___ even if only ___. •Bed mobility ●Rolling ●Up and down positioning in the bed ●Supine <-> Sit

possible mentally

Independent Standing and Sitting with Assistive Aids: >Walker -Rise to a Standing Position • The walker is positioned directly in front of the chair with the open side toward the patient and close enough to be within the patient's reach. • The patient moves the hips forward to the middle or front portion of the chair seat. • The patient positions the foot of the unaffected lower extremity slightly ___ to the foot of the least functional extremity; the feet should be flat on the floor, and the hands should be placed on the front portion of the armrests.

posterior

Moving from Sitting to Standing and Returning to a Sitting Position: To return to a sitting position, the patient needs to be positioned so the chair seat contacts one or both ___. He or she should (1) incline the trunk forward by flexing the spine and neck combined with hip and knee flexion, (2) move the pelvis rearward, (3) grasp the arms of the chair, and (4) flex the hips and knees to lower the body into the chair seat.

posterior thighs

Amputee WC: •Rear wheel axes positioned approx. 2" ___ •___ and compensate for loss of weight of LEs

posteriorly Widen BOS

Posture and Body Control: As caregivers, it is our responsibility to observe a patient's ___ while sitting, standing, and moving, regardless of the patient's diagnosis. Likewise, our posture should be correct when we are treating patients, even when we are seated.

posture

Lymphedema can be ___ (i.e., congenital, usually found in the lower extremities) or ___ (i.e., caused by surgical removal of lymph nodes, tumor invasion of the lymph nodes, injury or infection to the lymph drainage system, or radiation therapy, which can damage the lymph channels). Lymphedema can be found in any part of the body but is usually limited to the ___.

primary secondary extremities

Verbal Communication Effective communication >Determines patient ___ ___- don't use medical jargon, use language that is easy for them to understand ___, ___, ___- all these critical, can either make patient feel better or calm them >Can stimulate or calm a patient with your voice and behavior >If your patient doesn't like you, doesn't know why they're there, or what you're doing, they probably won't ___

rapport lay language Tone, volume, inflection comply

REACHING ACTIVITIES Stand on a footstool or ladder to reach or place an object above your head. Move the object close to you or move close to the object before grasping, lowering, or raising it; be certain you will be able to control the object safely. Hold the object close to your body as you step down from or onto a footstool. Do not simultaneously ___ and ___ your body

reach and twist

Move to a Side-Lying Position, Patient Supine: To have a supine patient move to a side-lying position, first instruct the patient to move to the far side of the bed or mat. To roll toward the right, the patient simultaneously ___ with the left upper extremity and lifts the left lower extremity diagonally over the right lower extremity; he or she then uses head flexion and the abdominal muscles to roll onto the side or uses the left hand to ___ the edge of the mattress, draw sheet, or bed rail to pull to a side-lying position.

reaches across the chest grasp

Reclining WC: •For individuals who need to partially or fully ___ at some time when in chair •May be ___ (approx. 30° from vertical) or ___ •Elevating leg rests and headrest extensions are necessary

recline semireclining fully reclining

Balance Lost Backward: • Pull forward on the gait belt and use your other hand to grasp the handrail. Move closer to the person while maintaining your anteroposterior stance. • Help the patient regain a balanced position or sit on a step, or instruct the patient to ___ the aid(s) and grasp the ___. • If you are unable to maintain the patient in a standing position, instruct the patient to release the crutches and grasp the handrail, or instruct and help the patient to sit on a step.

release handrail

Balance Lost Forward: • Gently and firmly pull back on the gait belt and the trunk or shoulder; if a handrail is available, grasp the gait belt and use your other hand to grasp the handrail. • Move closer to the patient, and maintain your anteroposterior stance as you help the person regain balance and stand erect. • If you are unable to maintain the patient in a standing position, instruct the patient to ___ and reach for the ___; then lower the patient to the stair using the gait belt, or maneuver the patient toward the wall of the stairway.

release the crutches handrail

Continued: Many caregivers find it helpful to have patients ___ to determine their ability to comprehend and retain the information and to estimate preparedness to perform. It is not sufficient to ask, "Do you understand what you are to do?" or "Do you understand the instructions?" because many patients will respond affirmatively even when they do not understand.

repeat the instructions

To empathize, we need to invoke the ___ of the actions associated with the emotions we are witnessing.

representation

Respiratory Rate: •The measure of ___. •Respiration consists of one cycle of ___. •Accepted Norms >Infants: ___ to ___/minute >Adults: ___ to ___/minute

respirations per minute inspiration and expiration 30 - 50 12 - 18

Move to a Supine Position, Patient Prone: To have a prone patient move to a supine position, first instruct the patient to move to one side of the bed or mat. To roll to the right, the patient positions the ___ under the right side or flexes the right shoulder so the upper arm is positioned next to the right ear. The left hand is placed ___ on the bed or mat near the anterior left shoulder; the left hip and knee can be partially flexed or extended. The patient pushes with the left upper extremity, lifts the left lower extremity over the right lower extremity, and moves to a side-lying position.

right upper extremity flat

Low back trauma or discomfort: -Excessive lumbar ___, trunk side bending, and trunk ___ should be avoided. When turning, patients may experience less discomfort if they "___" (i.e., roll the entire body simultaneously) rather than roll segmentally (i.e., rolling the shoulders and upper trunk first, then the pelvis, and then the lower extremities); they also may be more comfortable with the hips and knees partially ___ with a pillow under or between the knees when they are in a supine or side-lying position

rotation flexion logroll flexed

Preambulation Instruction: The goal for most patients will be the ___ and ___ performance of functional activities.

safe and independent

Ambulation with AD's: •ADs allow for ___ ambulation ●Increase BOS ●Redistribute wt within BOS for those not full ___ ●Alter center of gravity

safer wt bearing

Burns: -The primary precaution is to avoid creating a ___ across the surface of the burn wound, graft site, or area from which the graft was taken; ___ creates a shear force, causing friction and disruption of the healing process. The patient should be instructed to elevate the body or extremities when moving an area with a burn to avoid the effect of shear forces

shear force sliding

•Bed mobility ●Scooting up or down in bed -patient bends their knees, help them roll over to one side, tuck a ___ under the patient, have patient roll over to the other side and make sure its completely underneath him; get as close to ____ as possible to lift and move

sheet shoulders

Principles of Proper Body Mechanics • Position yourself close to the object to be moved so you can use ___ lever arms. • Position your center of gravity close to the object's center of gravity to improve ___ of the object. • Roll, push, pull, or slide an object rather than ___ it. • Avoid simultaneous trunk ___ and ___ when lifting or reaching. • Look straight ahead and do not twist or turn your body while lifting.

short control lift flexion and rotation

Upward Movement, Patient Supine: Support the patient's head and upper trunk with your arms, and lift until the inferior angles of the scapulae clear the bed or mat; your chest should be close to the patient's chest so you use ___ arms with your arms. Slide the lower trunk and pelvis upward approximately 6 to 10 inches. To move the patient farther, reposition yourself and the patient's lower extremities and repeat the process.

short lever

PRINCIPLES OF PATIENT EXAMINATION AND EVALUATION: Goals of treatment should be established cooperatively between the patient and the caregiver. These goals usually are designated as interim (or ___) and terminal (or ___). Short-term goals are usually a specific component or lead-in activity for a ___. Goals should be modified or revised depending on the patient's performance and progress. Finally, goals and outcomes should be realistic and attainable for each patient.

short term long term long-term goal

Move to a Prone Position, Patient Supine: To have a supine patient move to a prone position, first instruct the patient to move to one side of the bed or mat. To roll to the right, the patient positions the right upper extremity under the right side of the body or flexes the shoulder so it is positioned next to the right ear and then moves to a ___. If the space is insufficient to roll to a prone position, the patient should reposition his or her body away from the near edge of the bed or mat. As the patient rolls to the prone position, the ___ is used to protect and lower the body. The person then adjusts the position as desired for comfort.

sidelying position left upper extremity

Two-Person Dependent: Chair to Floor: Position the wheelchair parallel to the area on the floor to which the patient is to be transferred. One person stands behind the patient, and another person stands at the side of the lower extremities. The patient is lifted from the chair as described previously, and the lifters move ___ away from the chair. On command, both lifters stoop to lower the patient to the floor.

sideward

Back Dysfunction: MOVEMENT FROM STANDING TO THE FLOOR • The patient places one hand on a firm object and moves to a ___ position, keeping the trunk erect. • The patient briefly kneels on both knees (high kneeling), then moves to ___. • The patient moves the hands forward until he or she is ___ or gently side sits, if this is not painful, and then lowers onto one elbow to a side-lying position. • The patient adjusts his or her body position as desired.

single knee (half-kneeling) all fours (hands and knees) prone

Pressure Ulcer Documentation Guidelines: • Describe the ___ of the ulcer. • Identify the ___ of the ulcer based on the classification system of the National Pressure Ulcer Advisory Panel. • Measure and report the size of the total surface area of the ulcer. • Measure and report the depth of the ulcer. • Determine the evidence or extent of ulcer tunnels or undermined areas; report tissue destruction underlying intact skin along the margins of the ulcer; measure the width and length. • Estimate and describe the percentage of ___ (black, red, and yellow) and the percentage of the ulcer covered with new skin; describe the composition of the ulcer (e.g., granulation, epithelialized tissue).

site or location stage color

Because ___ puts more stress on the back than lying, standing, or walking, it is important to instruct patients about proper sitting techniques when sustained sitting is necessary in their work. Sustained standing or sitting with poor posture can cause ___ and postural fatigue throughout the musculoskeletal system.

sitting kyphosis

Orthostatic Hypotension: ALWAYS be aware of this -a lot of times it happens when they initially go from ___ to ___ -___ from sitting to standing -gait belt on patients- helps to make sure they don't hit the floor

sitting to standing slowly progress

The primary barrier is the ___ when it is intact.

skin

Continued: • The right hand reaches to the armrest, and the patient lowers the hips into the chair using the right upper and lower extremities. If the knee of the least affected lower extremity cannot be flexed, the patient should ___ to sit. • The crutches can be placed on the floor, and the body moves back in the chair.

slide it forward

Types of transfers: -___ •typically used with amputations, spinal cord injuries, and non-weightbearing patients •for a patient to assist they must have good ___ strength and ___ control -___ •Used for patients with some LE strength, someone with hemiparesis -___ •can be used when person is dependent, cannot follow directions, or lack of UE strength

sliding board upper body and trunk stand pivot squat pivot

>Stage II -Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without ___; also may present as an intact or open/ruptured serum-filled blister Further description: Presents as a shiny or dry shallow ulcer without slough or bruising (bruising indicates suspected deep tissue injury); this stage should not be used to describe skin tears, tape burns, perineal dermatitis, maceration, or excoriation

slough

Continued: Movement of a recumbent patient upward, downward, or sideward can be accomplished more easily if a ___ is placed beneath the patient. This item is frequently called a draw sheet; it usually extends from the upper back to the buttocks or midthigh area. Two persons, one on each side of the bed or mat, grasp the sheet or pad and, on command by the leader, they ___ the patient by sliding.

small sheet or linen pad simultaneously move

Continued: If the door opens toward the patient, the patient approaches the opening edge of the door at an angle, facing toward the hinge side of the door. By being positioned at an angle to the door, the patient will be able to open the door a ___ amount than would be necessary if standing directly in front of it. The patient positions the body close to the door, but slightly outside the area needed to open it. The body weight is shifted onto the crutch hand grip farthest from the doorknob or latch, and the hand nearest the doorknob or latch is used to open the door by quickly pulling on the doorknob and then returning the hand from the doorknob to grip the crutch.

smaller

Standing Transfer Into an Automobile >TRANSFER WITH CRUTCHES • Instruct the patient to approach the passenger door at an angle; position yourself to guard the patient by standing behind him or her and to one side. • The patient reaches to open the door, opens it, and shifts the crutches into the hand farthest from the car. • The free hand is positioned on a ___ (e.g., the roof, back of the seat, dashboard, door frame, or window frame with the window completely lowered), and the patient pivots so his or her back is toward the ___.

solid surface of the car car seat

Persons who are visually impaired appreciate knowing who is ___, so you should identify yourself, similar to the way in which you identify yourself when using a telephone. It will be necessary to identify each individual in a group, and each individual should identify himself or herself when speaking. A person who is hearing impaired may need to have ___ (touch, tap) or ___ (hand wave, gesture) cueing from you before you begin speaking. Be patient during the conversation, and wait for confirmation of your feedback before continuing.

speaking tactile visual

BLOOD PRESSURE: A ___ (i.e., a BP cuff) measures BP and is an indirect measurement of the pressure inside an artery caused by blood flow through the artery. Specifically, it is the force exerted by the blood against any unit area of the vessel wall. BP is composed of the systolic and diastolic pressures: • ___ pressure is the BP at the time of contraction of the left ventricle (systole). • ___ pressure is the BP at the time of the rest period of the heart (diastole).

sphygmomanometer Systolic Diastolic

Continued: These terms are better suited for patients who are unable to actively use the muscles of the lower trunk and lower extremities during ambulation and who must "swing" the trunk and lower extremities "to" or "through" the crutches to ambulate. These gait patterns are associated most frequently with patients who have a ___ or a developmental impairment that requires the patient to use the upper extremities to support and provide the force necessary to lift and move the body forward without assistance from the lower extremities.

spinal cord injury

PAPER TAPE METHOD: Upper Extremity: •Explain the procedure, seat the patient, elevate and support the upper extremity, and expose the entire upper extremity from the top of the shoulder to the ends of the fingers. • Apply the ___ along the length of the extremity; apply the paper strips at the specified landmarks (e.g., the elbow and the base of the thumb/ wrist). • Wrap each individual strip around the extremity; keep it flat, in close contact with the skin, perpendicular to the spine, and parallel to the strip above and below. Do not pull the strip so tight that it causes an indentation in the soft tissue. Attach the strip to the spine, and follow the manufacturer's instructions for pleating the spine to ensure that the garment's length will be appropriate.

spine of the measuring tape

Axillary Crutches: •For those who need less ___ or ___ than is provided by parallel bars or walker •Requires good balance, UE strength, and trunk strength •PROS: ●Can use more ___ ●Can increase speed while providing stability and support ●Most composed of wood or aluminum and can be adjusted ●Can be stored and transported ●Can be used in narrow or crowded areas ●Can be used on stairs •CONS: ●Less ___ than walker ●Can cause injury to axillary ___ if used or measured improperly ●Elderly patients may feel insecure

stability, support gait patterns stable vessels and nerves

Pressure Ulcer Assessment Factors: • Identify the wound ___. • Measure the wound ___. • Measure the wound ___. • Observe and describe the tissue at the wound edges. • Examine the wound for areas of tunneling or undermining; measure the length or depth. • Observe and describe the characteristics of any exudate (i.e., viscosity, amount, and color). • Observe and describe the characteristics of any necrotic tissue (i.e., color, adherence, texture, consistency, and amount). • Describe any wound odor. • Observe and describe the characteristics of the surrounding skin (e.g., dry, macerated, color, texture, blistered, edematous, firm, soft, or indurated [edges rolled under "epiboly"]). • Observe and describe the characteristics of wound healing: • Granulation • Epithelialization • Budding • Wound contraction

stage size depth

Descending: -To descend stairs using a handrail and a standard walker, the patient faces the ___ and positions the walker along the side farthest from the handrail with the closed side of the walker next to the body. The front feet of the walker are placed one step below the step on which the patient stands, and the rear feet remain on the step on which the patient is standing -The patient grasps the handrail and the rear hand grip or the midpoint of the horizontal bar of the walker. The weaker lower extremity descends first, which is accomplished by flexing the hip and knee of the strongest lower extremity and lowering the body; then the patient steps down with the strongest lower extremity. The walker is advanced down one step, and the procedure is repeated. The patient descends the final step using the same method described to step from a curb.

stairs

Ascending: -To ascend stairs using a handrail and a standard walker, the patient faces the ___ and positions the walker along the side farthest from the handrail with the closed side of the walker next to the body. The front feet of the walker are placed one step above the step on which the patient stands; the rear feet remain on the step on which the patient stands. The patient grasps the handrail and the front hand grip or the midpoint of the horizontal bar of the walker. the patient steps up with the stronger lower extremity, elevates the body, and then steps up with or lifts the weaker lower extremity. The walker is advanced up one step by the patient, and the procedure is repeated. -The final step at the top of the stair is performed by placing the walker on the ___ and using it for support as the patient steps up, similar to the way one ascends a curb.

stairs upper surface

Normal ambulation can be described as consisting of gait patterns. A normal gait pattern has a swing and a stance phase because during the gait cycle a given foot is either in contact with the ground (___) or is in the air (___). The stance phase comprises approximately ___% of the cycle, and the swing phase comprises approximately ___% of the cycle.

stance swing 60 40

Muscle Activity: The primary phases of gait are the ___ and ___ phase. When a lower extremity is in contact with the floor or other surface (i.e., weight bearing), it is in the ___ phase; when it is not in contact with the floor, it is in the ___ phase.

stance and swing stance swing

Assisted Sitting Transfer: •Sliding board, Scoot, Sit, Squat pivot •Indications ●Unsafe to ___ due to wt bearing precautions, poor balance, large size differences between the therapist and the patient ●SCI, CVA, B LE trauma •___: can help reduce the friction and allow ease for transferring a patient •Your positioning is dependent on the patient's ___

stand Sliding board diagnosis

Two-Person Dependent: Chair to Bed.: The two-person lift transfer can be used when the patient is unable to ___, when the transfer is performed from two surfaces of unequal height, or when the patient is unable to assist with the transfer. This transfer can cause ___ for the persons lifting and should be used only in an emergency or when mechanical equipment is not available.

stand back strain

Balance Lost to One Side, Toward You: • Use one hand or your shoulder to press against the patient's trunk; use your other hand to grasp the gait belt or handrail. • Help the patient regain a balanced position or, if that is not possible, help lower the patient to the ___ or move the body toward the ___.

steps handrail

Application of a Sterile Dressing: -Before applying a dressing, a ___ with the appropriate wound care materials should be established and the caregiver should wear sterile, protective clothing appropriate for the patient's condition. If it is necessary to dry the patient's skin before the dressing is applied, a sterile towel or sterile gauze should be used. The patient should be positioned comfortably so the wound is accessible.

sterile field

Select the appropriate dressing material and apply it directly to the medication base over the wound. Be certain you maintain its sterility as it is applied by handling it with sterile gloves or sterile forceps. Once the initial layer has been applied over the wound, the upper layers of the dressing and the bandage do not need to be applied using ___.

sterile technique

Stoop Lift: When an object rests below the level of the waist but can be reached without squatting, the lifter can ___ to lift. The person partially flexes the hips and knees and maintains the lumbar spine in its normal lordosis. The lifter grasps the object and uses the lower extremities to raise the body and the object.

stoop

Standard Walker: -only for patients who have good balance, trunk control, and extremity ___. -They should be performed only when a handrail is available and when all of the feet of the walker fit on the stair treads when the walker is positioned along the patient's side. -these techniques should be used for emergency situations rather than as routine techniques

strength

Turning Movement: The patient should be taught to turn to the left and to the right regardless of which extremities are weakest or strongest. It is suggested that the patient learn to pivot on the ___ regardless of which lower extremity is weaker, regardless of the direction of the turn, and regardless of the type of gait pattern used.

stronger lower extremity

Ascending a curb: >Bilateral Crutches. Three-One-Point Pattern. -To ascend a curb with bilateral crutches in a three-one-point pattern, the patient places the ___ onto the curb and elevates the body while simultaneously ___ and ___ onto the curb.

stronger lower extremity raising the crutches and the PWB lower extremity

Ascending a Curb: >bilateral canes -To ascend a curb with bilateral canes, the patient places the ___ onto the curb and elevates the body while simultaneously raising the ___ and ___ onto the curb. An alternative technique is to have the patient place the canes onto the step, step up with the strongest lower extremity, then raise the weaker lower extremity onto the curb.

stronger lower extremity weaker lower extremity and both canes

Ascending a curb: >Unilateral Cane -To ascend a curb with a unilateral cane, the patient places the ___ onto the curb and elevates the body onto the curb while simultaneously raising the ___ and ___ onto the curb. An alternative technique is to have the patient place the cane onto the curb simultaneously with the strongest lower extremity, then raise the weakest lower extremity onto the curb

stronger lower extremity weaker lower extremity and cane

Pain: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Response to pain is highly personal and ___; it is whatever the patient says it is and exists wherever and whenever he or she says it does. Self-report of pain is considered the most reliable indicator of pain.

subjective

Evaluation: 1.Gather ___ information 2.___ patient- can learn a lot of info from this 3.___- helps to understand where patient is hurting, see if it reproduces patient's symptoms 4.Tests and measures 5.Cardio/pulmonary functions 6.Mental and cognitive function 7.Review of other reports/tests if available

subjective/objective Observe Palpate

Tilt table: Explain the procedure to the patient and obtain consent; measure the patient's vital signs. • Position the patient ___ on the table and place a rolled towel beneath each ___. If the patient is bilaterally full weight bearing, position the feet flat on the ___ approximately shoulder width apart. The upper extremities may be positioned parallel to the sides of the body, may be placed beneath or remain free from the chest strap, may rest on an over-the-table support, or may be supported by slings attached to the table frame. A pillow under the head will add to the patient's comfort until he or she is elevated to approximately ___ degrees, at which time it may be more comfortable to remove it.

supine knee footboard 75

Adhesive or Athletic Tape: •Used when greater ___ or ___ of a joint is needed than can be provided by Ace •Example: 1st or 2nd Degree sprains of ankle when air cast or gel-filled ___ is not available •Preventative bandage to reduce possibility of sprain •___ to ___ inches •May be ___ or have some capacity to stretch- might loosen up the more you move •Requires ___- too sticky for skin

support or protection splint 1.5 to 2 rigid underwrap

For patients who have not reached the legal age of consent and for those judged to be mentally confused or incompetent to participate in the informed consent decision-making process, it may be necessary to obtain consent from a legally qualified ___, such as a parent, guardian, family member, or court-appointed advocate.

surrogate

Cardiac Arrest/Death: •Maintain cardiopulmonary system at a level sufficient to ___ until person can be transported to medical facility •Call 911, Get AED (if available), Do CPR (ABC) •After 2 cycles of CPR if breathing and pulse are absent, Use AED

sustain life

Patient Communication: •What is wrong with him/her? •How many visits will he/she need? •What do you want him/her to do? •What will you do with him/her? >Wrap up at the end of an evaluation -___ with patient -make sure patient is clear with these questions so they know what to ___ and what you will ___

talk it through expect work on

Korotkoff's Sounds: I - first faint, clear ___ [120] II - ___ or ___ sound III - sounds become crisp and louder IV - distinct and abrupt muffling of the sounds until a soft blowing quality is heard. (initial diastole) V - sounds ___ (second diastolic phase) [80]

tapping sound murmur or swishing disappear

Transfers: Preparation: •GAIT BELT ALWAYS •Thread through the ___ first -put low on patient, tighten, and make sure its secure

teeth

While wearing nonsterile gloves, the caregiver should gently and carefully palpate the tissue in the area of the wound to determine the following: • The ___ of the wound tissue in comparison with that of the tissue away from the wound on the same or another extremity • The ___ of the tissue • The integrity of the wound edges or the area of healing • The condition of the skin (e.g., dry, moist, pliable, or taut) • The sensory response or capacity of the tissue

temperature tone

Blood Pressure: •Indirect measurement of the pressure inside an artery caused by blood flow through ___ >___ - force at the time of left ventricular contraction (systole) >___ - force at the time of rest (diastole) •Measured with a ___ and a ___

the artery Systolic Diastolic sphygmomanometer and a stethoscope

Move to a Sitting Position, Patient Supine: first instruct the patient to move toward one edge of the bed or mat, but leave sufficient space to roll to a side-lying position. The position of the patient on the bed should be about a ___ away from the edge, so that when he or she comes to a sitting position, the thighs will be supported on the bed. The patient rolls to a side-lying position and flexes the hips and knees to maintain this position briefly, then positions the hand of the uppermost upper extremity on the bed or mat at the midchest level.

thigh's length

How to Check Posture: >Stand with your back to a wall, heels about ___ from the wall. Place one hand behind your neck, with the back of the hand against the wall, and the other hand behind your low back with the palm against the wall. >If there is excessive space between your back and the wall, such that you can easily move your hands forward and back more than one inch, some adjustment in your posture may be necessary to restore the ___ of your spine.

three inches normal curves

The patient should not be challenged by a complete flight of stairs (approximately 10 to 12 steps) until a series of ___ to ___ steps or a single curb have been practiced. This method is usually the least desirable and should be used only when the patient is unable to use the other methods described.

three to five

Continued: • Elevate the table to a position ___ by the patient, maintain that position for several minutes, measure and log the vital signs and tolerance time, and inquire about the patient's status (e.g., "Tell me how you feel." "Are you comfortable?"). • When the patient's condition is stable, raise the table to a new elevation, measure and log the vital signs and time, determine the tolerance to the new position, and maintain the position for several minutes

tolerated

Lift Techniques: Power lift >Use the power lift for objects ___ for you to straddle. >Similar to deep squat lift >The object shifts your center of gravity ___, and you must push your buttocks out to compensate

too large forward

An object at arm's length should be brought closer to one's body before being lifted to reduce the ___ produced by long lever arms.

torque

Move to a Side-Lying Position, Patient Supine: Stand facing the patient so you can roll (or turn) him or her ___ you to a side-lying position. When it is absolutely necessary to roll the patient ___ you, be certain he or she is protected from rolling off the bed or mat table.

toward away from

Continued: Stand facing the patient and roll the patient to a sidelying position. Roll the patient ___ and protect the near edge of the bed or mat by placing one of your thighs against it. This maneuver will prevent the patient from rolling off the bed or mat.

toward you

•When documenting be sure to be specific of type of ___ used, ___ level, surfaces, any ___ performed, and if/where you ___ their lower extremities. •EXAMPLE: Patient performed stand pivot transfer from wheelchair to bed with MAX A with stabilization at LLE with verbal cues to initiate stance.

transfer assistance cues blocked

Basic goals of wound care and management: • Protect the wound and surrounding tissue from additional ___ • Provide an optimal environment for wound healing • Reduce ___ on the tissues near the wound • Protect the tissue in the area of the wound from mechanical stress or movement • Reduce the number of ___ in and around the wound • Expedite the healing process • Decrease or reduce the formation of ___

trauma strain pathogenic microorganisms scar tissue

Before the initial treatment of a patient, the caregiver is responsible for informing the person about the proposed ___, alternative ___ that are available, and associated primary known risks. The patient then has the right to consent to or reject the proposed treatment. This process is the process of ___.

treatment treatments informed consent

CONFIRMATION OF FIT: The initial fit of the aid may need to be revised after the patient has ambulated several times. As the patient becomes stronger, more skilled, and more proficient, the initial fit of the aid may no longer be comfortable or efficient. When axillary crutches (as well as forearm crutches) fit properly, the patient's stance should form a triangle of the crutch tips and the patient's foot or feet, called the ___.

tripod position

>Seat depth • Proper fit will allow ___ to be placed between the front edge of the seat and the user's popliteal fold with your palm horizontal to the seat (C) with your hand held parallel to the floor. >Seat width • Proper fit will allow the placement of your hand, held vertically, between the user's greater trochanter, hip, or thigh and the armrest panels with your hand positioned vertically to the seat

two or three fingers

Wheelchair Fit Confirmation: >Seat height and leg length • A proper fit will allow you to place ___ easily under the thigh, with your hand held parallel to the floor, from the front edge of the seat to a depth of approximately ___ (A). • The bottom of the footrest must be at least ___ from the floor with the chair on a level surface when this evaluation is performed (B). • ___ provide adequate distance from the bottom of the footplate to the floor so the chair can be maneuvered easily and safely on most surfaces.

two or three fingers 2 inches 2 inches Two inches

Typically, before a living will is implemented, ___ must verify that the patient is incapable of making medical decisions and that his or her condition is in compliance with the state's living will law. A ___ or ___ is a person appointed by a patient to make decisions on behalf of the patient in the event that the patient is physically unable to make the decision. The services of a lawyer are not needed to fill out an advance directive; the advance directive becomes legally valid as soon as it is signed in front of the required witnesses.

two physicians power of attorney or health care proxy

MEASURING TAPE METHOD FOR THE UPPER EXTREMITY: • Expose the extremity, position the patient so the extremity is relaxed, supported, and elevated, and explain the procedure. If lymphedema is not bilateral, measure the ___ to obtain a baseline for comparison. Use a plastic or metal anthropometric measuring tape with well-defined, easily visible calibrations; it will be helpful if the tape can be locked at any length so it will not retract, but can be lengthened. • Use a tension gauge, if it is available, for circumference pressure.

unaffected contralateral extremity

These garments have the following disadvantages: they can be ___ (although more comfortable materials have become available), putting them on is a ___ (often talc is used on the limb before garment application, but talc should not be used with patients who have known respiratory problems or who are allergic to it), they are unsightly, and they typically last no more than 3 to 6 months.

uncomfortable laborious process

Bilateral Axillary Crutches: -To ascend or descend stairs using a handrail and bilateral axillary crutches, the patient places both crutches ___ farthest from the handrail while holding on to the handpieces, then grasps the handrail with the other hand. Guarding can be done from the side as demonstrated or from the front (downhill from the patient).

under the axilla

You should avoid the use of terms such as "victim," "stricken," and "afflicted" because they tend to indicate an ___ status.

unhealthy

Continued: •Stabilize your equipment ● lock the w/c, stretcher, or bed- DON'T FORGET TO DO THIS •If pt has one-sided involvement, position w/c next to the ___ side. ●With pivot transfer w/c will be slightly ___ to bed to allow for foot to maneuver

uninvolved angled

•Bed mobility ●Rolling ●Supine <->Sit -start with knees and bend them up, roll as a ___, the PT comes under the shoulders and legs to help him come up to a sitting position

unit

Sitting or Lateral Assisted Transfer: This transfer may require the use of a transfer (sliding) board, an overhead bar or frame, overhead straps, or other equipment. These items are used to bridge the space between the two objects or to permit the patient to use the ___ for assistance.

upper extremities

Continued: AMBULATION ON A LEVEL SURFACE • Initially, many caregivers prefer to be positioned to the side of the patient that is ___

weakest or least functional

Tilt Table: A tilt table may benefit persons who need to physiologically acclimate to an ___ position as a result of a variety of conditions, such as prolonged recumbence, disturbance in balance, decreased proprioception, kinesthesia, lower extremity circulation, or generalized weakness. A tilt table is particularly useful because it can be elevated gradually and maintained at any position between horizontal and completely vertical.

upright

Shock: •After symptoms relieved, gradually return to ___ and monitor- continue to monitor throughout esp. when changing position •Request transportation to medical facility

upright position

Orthostatic (Postural) Hypotension: •Reduced ___ from lower extremities •Older adults, spinal cord injuries, hypotension, immobilized or recumbent positions •See Shock Treatment, plus •Prevent by wrapping LEs from feet to groin with Ace; Abdominal binder or corset; Elastic hose; Instruct to perform ___ and ___ if able; slowly accommodate to upright/tilt table- can take different blood pressure readings throughout and monitor what it is at diff degrees-> can tell if making improvements with therapy

venous return ankle pumps and knee to chest

UPPER EXTREMITY • Follow the aforementioned procedure, measuring the distance from a bony landmark (e.g., the ulnar styloid process) to the area where the circumference is to be measured (i.e., the area of greatest edema or atrophy); then measure the circumference. • Document both the distance from the landmark and the circumference. • If a tension gauge is used, be sure to mark the tension that was used around the circumference to permit more accurate detail for following measurements. Note: Because girth measurements are difficult to perform on irregularly shaped areas such as the hand/wrist and foot/ankle, ___ are suggested for those areas.

volumetric measurements

Restraints, Safety Straps: •Unless a patient needs to be restrained for protection or to protect others from harm by the patient, physical or drug restraints are not to be used without the ___ of the patient and a physician's ongoing order •Restraint orders from attending physician ●4 hours for >18 years old ●2 hours for children/adolescents 9-17 years old ●1 hour for children < 9 years old

voluntary consent

Descending a curb: >Standard Walker -To descend a curb with a standard walker, the patient moves to the edge of the curb and places the ___ onto the lower surface while flexing the strongest hip and knee. The weaker lower extremity is positioned ___ the patient and over the edge of the curb. The patient steps between the walker with the weaker lower extremity and then steps down with the strongest lower extremity. The same sequences described for the curb can be repeated to ascend and descend stairs.

walker in front of

Standing, Assisted Pivot: When the patient leads with the weaker extremity and uses the weaker upper extremity to assist with the transfer, proprioception and kinesthesia in those extremities may be improved, and the patient is more likely to sense or feel them in a functional way. The patient should learn to transfer by leading with both the ___ and ___ extremities to increase independence and encourage use of the weaker extremities.

weaker and the stronger

Descending a curb: >Bilateral Canes -To descend a curb with bilateral canes, the patient simultaneously places the ___ and ___ down onto the surface below while slightly ___ the stronger hip and knee. This latter action will help lower the patient's COG as the canes are lowered. The patient lowers the body with the strongest lower extremity and steps down after the canes and the opposite lower extremity have been placed on the lower surface.

weaker lower extremity and both canes flexing

Ascending a curb: >Three-point pattern -To ascend a curb with bilateral crutches in a three-point pattern, the patient places the ___ onto the curb with the ___ held in hip extension and external rotation and knee extension or with the knee flexed. The patient elevates the body using the ___ and simultaneously raises the ___ onto the curb and brings the opposite lower extremity forward.

weight-bearing lower extremity NWB lower extremity strongest lower extremity crutches

Continued: -Elevate the body high enough to clear the ___ and stand the patient to the height necessary to elevate the pelvis above the level of the surface of the bed. Pivot by sliding your feet and the patient toward the bed and lower the patient onto the surface when the buttocks (pelvis) are turned and directed toward the bed. -Set the patient on the edge of the bed. Then help the patient perform sitting activities or help him or her into a supine position.

wheelchair wheel

Seat too ___: •Difficulty propelling due to increased distance from the hand rims •Difficult performing standing or lateral swing transfer •Difficulty moving through narrow hallways or doorways •Postural deviations due to leaning on one side of chair for support Seat too ___: •Difficulty changing position •Excessive pressure on greater trochanters •Difficulty wearing bulky outer garments, orthoses, or braces

wide narrow

Walkers: The appropriate height of a walker can be determined with the patient standing or supine. The hand grip of the walker should be placed level with the patient's ___, ___, or ___, with the walker positioned in front of and along the patient's sides and with the patient's arms straight along the sides. A tape measure can be used to determine the distance from the patient's greater trochanter to the heel, with shoes on and with the hips and knees straight.

wrist crease, ulnar tyloid process, or greater trochanter

Platform attachment: Indications: •Unable to bear weight through ___ and ___ •Severe deformities of wrists or fingers •Below-elbow amputation- someone missing a hand •Unable to extend one or both elbows Cons •Lose use of ___ to elevate and maintain body in swing •Another person may need to apply or remove •Less effective on stairs

wrists and hands triceps

Continued: When Balance Is Lost to One Side, Away from You • Pull on the gait belt to move the patient toward ___. • Help the patient regain a balanced position or help him or her to the floor or a chair.

you

Balance Lost Backward: • Pivot your body sideward toward the patient and maintain a wide stance with your feet. • Use one hand to press forward against the pelvis or trunk, and use your other hand to grasp the gait belt or handrail. • Help the patient regain a balanced position. • If you are unable to maintain the patient in a standing position, instruct the patient to release the crutches and grasp the handrail or lean forward. • Allow the patient to lean against ___ or sit on ___, or maneuver the patient toward the wall of the stairway. Regardless of which technique you use, you must prevent the patient from falling backward and causing both of you to fall down the stairs.

your body your thigh