Occupational Therapy (OT) Precautions – Flashcards

(1) Check weight bearing status (WBAT, TDNWB, 50%, NWB, etc) (2) Be aware of nerve block

- No extension - no adduction - no excessive abduction - no external rotation

-No flexion >90 -No adduction -No internal rotation. -Use abduction wedge in bed

No active abduction

- brace as prescribed (TLSO, LSO, Jewitt) - No BLT (bending, lifting >10, twisting) - log roll: NO BRIDGING.

- sling per MD orders - Pillow under arm to prevent extension (protect anterior capsule and subscapularis) - No PROM, pendulums and AAROM only - No resistive internal rotation, external rotation to neutral only

- no trapeze, avoid pulling on bedrails - Resting heart rate change is often 1st sign of trouble

o RHR >100 o BP >180/100 o SBP increase >40, decrease >20 with activity o DBP increase/decrease >20 with activity o Symptomatic orthostatic changes o Uncontrolled CHF o Unstable angina o New change in rate/ regularity of pulse

20 BPM increase with activity, avoid val salva, no lifting >10-15lbs

30 BPM increase with activity, avoid val salva, no lifting > 10-15lbs

- no lifting >10-15lbs - cough pillow - no driving - no BUE Sh. Ext.

clarify shoulder ROM restrictions, otherwise assume: - NO flexion/abduction >90 - no horizontal abduction - no driving, use seat belt, avoid airbags

-no flexion/abduction >90 -no extension/ horizontal abduction >neutral -no lifting >10-15lbs X 6 weeks - NO iPOD earbugs hanging around chest area. (?)

♣ Homan's sign- pain in popiteal area with dorsiflexion/ knee extended ♣ Prevention- ambulation, sequential compression devices, TED stockings, elevate ♣ Medical treatment: - TPA administration for acute CVA/TIA (usually therapeutic in 24 hrs) o IV heparin (usually therapeutic in 24-48 hours) o Lovenox (usually therapeutic in 3-5 hours) o Coumadin (INR should be in therapeutic range <6) o Inferior vena cava filter

♣ Check activity orders! ♣ Hold for vasospasms ♣ Check with nursing if pt has Bolt, EVD, CVVH, femoral catheter, any lines you don't recognize or if any lines need to be clamped before mobility

Post Autograft- NO ROM 3-5 days (usually immobilized in splint)

- Standard- foam/gel in/out of rooms, glove PRN - Contact- gown, glove ♣ Airborne/ droplet- respirator mask (N95) ♣ RED trash bags for biohazard only

♣ Turn every 2 hours ♣ Use proper seating: ROHO, tilt in space WC ♣ Turn off feeding tube when lowering head of bed 30

♣ Discuss out of normal range lab values with nursing/MD - Considerations with Mobilization/ Activity - WBC <5,000 with fever (indicates risk or presence of infection) - HCT <25 (Low H&H symptoms inc. weakness, - HGB <8 fatigue, tachycardia, DOE, monitor vitals!) - Platelets =6, 2-3 norm range (High= risk for bleeding, Low= risk for clotting) Also consider PT, PTT - Cardiac Enzymes: CK, Tropnonin -K+ 5.5 (Symptoms range, can be serious- arrhythmia, cardiac arrest) -Na+ 160 (Altered MS, apathy, tachycardia, can be serious) - Cl- 115 (weakness, breathing changes) - Ca++ 14 (confusion, weakness, nausea, fatigue) - Mg++ 3.0 (confusion, weakness, hallucinations) -Glucose 250 -Albumin <1.5 (Decreased skin integrity/ wound healing)