Mark Klimek Lecture 4 - Crutches & Psychosis
What is the difference between a non-psychotic person and a psychotic person?
- A non-psychotic person has insight (knows they're sick and that it's messing them up) and is reality based (they see reality the same way as you). Use good therapeutic communication with them. - A psychotic person has no insight and is not reality based. Use unique, specific strategies with them.
Swing Through
- For two braces extremities (Amputees) - For non-weight bearing
When dealing with a patient experiencing delusions, hallucinations, or illusions, first ask yourself, "What is their problem?" (What are the different problems that could be going on?)
- Functional psychosis - Psychosis of Dementia - Psychotic Delirium
3 Types of Delusions
- Paranoid/Persecutory - Grandiose - Somatic
Psychosis of Dementia
- People with Alzheimer's, Wernicke's, Organic Brain Syndrome, and Dementia. - Those person has a brain destruction problem and cannot learn reality.
What are the different types of functional psychosis?
- Schziophrenia - Schzioaffected (mood disorder thought process) - Major Depression - Mania
How do you deal with a patient with Psychotic Delirium?
1. Acknowledge feelings 2. Reassure them of safety and temporariness
How do you deal with a person with psychosis of Dementia?
1. Acknowledge feelings 2. Redirect - get them to express the fixation that they are expressing inappropriately to appropriately
With a functional psychosis the patient has the potential to learn reality. How can you teach reality to a functional psychotic?
1. Acknowledge feelings Ex: "I can see you're angry" 2. Present reality a. Positive - what is reality b. Negative - what is not reality 3. Set a limit 4. Enforce the limit Ex: Ending the conversation, do not use punishment
5 Types of Hallucinations
1. Auditory *most common* (hearing) *most common = "harm yourself" 2. Visual *2nd* (seeing) 3. Tactile *3rd* (feeling) 4. Gustatory (tasting) 5. Olfactory (smelling)
What are the different types of loosening of association?
1. Flight of ideas 2. Word salad 3. Neologisms
2 Point Gait
1: Move one crutch and opposite foot together 2: Move other crutch and other foot together *Remember: 2 points together for a 2 point gait* - Used for minor weakness on both legs
3 Point Gait
1: Move two crutches and bad leg together 2: Move good foot *Remember: 3 point is called 3 point because 3 points touch down at once*
4 Point Gait
1: One crutch 2: Opposite foot 3: Other crutch 4: Other foot - Nothing moves together and everything is really weak
Which gait would you use for bilateral total knee replacement, 3 weeks post-op?
2 Point Gait
Which gait would you use for early stages of rheumatoid arthritis?
2 Point Gait
How do you measure crutches for a person?
2 to 3 fingerwidths below anterior axillary fold to a point lateral to and slightly in front of foot
Which gait would you use for first day post-op right knee replacement, weight bearing allowed?
3 Point Gait
When the handgrip of a crutch is properly in place the elbow flexion should be?
30 degrees
Which gait would you use for advanced stages of amyotrophic lateral sclerosis?
4 Point Gait
Which gait would you use for bilateral total knee replacement, first day post-op, weight bearing allowed?
4 Point Gait
Delusion
A false, fixed belief, idea, or thought. There is no sensory component.
Hallucination
A false, fixed sensory experience
Use 2 point for...
A mild problem
Illusion
A misinterpretation of reality. It is a sensory experience.
Use 4 point for...
A severe problem
Only psychotic people have...
Delusions, hallucinations, and/or illusions
Reality orientation is appropriate for...
Dementia patients
What is a big NO when it comes to walkers?
Do not tie belongings to the front of the walker. If they must, have them tied to the sides.
Somatic Delusion
False, fixed belief about a body part
Paranoid or Persecutory Delusion
False, fixed belief that people are out to harm them
Grandiose Delusion
False, fixed belief that you are superior
During your interview a client stares at the wall and says look I see a bomb.
Hallucination
What is the correct way to get up from a chair using a walker?
Hold onto chair, stand up, then grab walker.
During your interview the client looks at the fire extinguisher on the wall and says look I see a bomb
Illusion
Neologisms
Making up new words
Use the odd numbered gait (3) when...
One leg is odd
Advance cane with the...
Opposite side for a wide base of support.
What is the correct way to use a walker?
Pick it up, set it down, and walk to it.
Flight of ideas
Stringing phrases together (loosely associated phrases; tangentiality)
Which gait would you use for left above the knee amputation?
Swing Through
Which gait would you use for left hip replacement, second day post-op, non-weight bearing?
Swing Through
Psychotic Delirium
Temporary, episodic, secondary, dramatic, sudden onset of loss of reality due to chemical imbalance (UTI, Thyroid imbalance, electrolyte imbalance)
Use the even numbered gaits (2 & 4) when...
The weakness is evenly distributed (bilateral)
If they mention axilla or a landmark on the foot...
They are wrong instructions
Functional Psychosis
They can function in every day life. They can have a family, marriage, relationship, job, Can live alone, pay their bills, pay their taxes, and take care of themselves.
Word Salad
Throwing words together
Hold cane on the...
Unaffected side (strong side).
Which foot leads when going up and down stairs on crutches?
Up with the good and down with the bad. The crutches always move with the bad leg.
Narrowed self-concept
When a (functional) PSYCHOTIC refuses to change their clothes or leave the room. *Don't make a psychotic do something they don't want to do*
What is the difference between illusions and hallucinations?
With illusions there is a referent in reality (something to which they can refer to).
Ideas of reference
You think everyone is talking about you
