toolbox – Flashcard
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length of hip precautions (according to handout)
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6 wks
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posterior hip precautions
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1. no bending hips >90 degrees 2. no crossing legs 3. no turning feet/knees inward (keep feet straight ahead)
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anterior hip precautions
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1. no hip extension past neutral (basically movin' your butt) 2. no turning feet/knees outward (keep feet straight ahead)
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global hip precautions
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anterior + posterior
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what kind of toilet seat would be appropriate for someone with global hip precautions?
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raised
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should ct. with h/p lean forward when getting up?
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no
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should ct. with h/p have knees raised above hips when seated?
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no
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no turning feet INWARD - anterior or posterior h/p?
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posterior
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sternal precautions (4-6 wks)
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1. don't lift more than 5-10 lbs 2. avoid asynchronous movements between 2 sides of chest 3. no shoulder flexion (lifting arm over head) past 90 degrees 4. brace chest when coughing or sneezing 5. no driving for at least 4 wks
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should a person with s/p drive 2 wks after surgery?
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no (at least 4 wks)
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spine precautions length
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8 - 12 wks
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spine precautions (cervical)
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1. no neck movements 2. no lifting more than 8-10 lbs. 3. no twisting neck and back
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type of precautions where ct. shouldn't lift more than 5-10 lbs.
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sternal, pacemaker
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spine precautions (thoracic)
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1. no bending hips past 90 degrees 2. no lifting more than 8-10 lbs. 3. no twisting back 4. no lying on stomach
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spine precautions (lumbar)
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1. no bending hips past 90 degrees 2. no lifting more than 8-10 lbs 3. no twisting back
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no twisting back
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thoracic ; lumbar
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no lifting more than 8-10 lbs.
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thoracic, cervical, lumbar (all spine) ; abdominal
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pacemaker precautions (4 wks)
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1. no shoulder flexion ; abduction past 90 on affected side 2. no excessive stretching or activity on affected side 3. no lifting more than 5-10 lbs. w/ arm on affected side 4. avoid MRIs and strong magnetic waves
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shoulder precautions (6-8 wks)
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1. no extension of operative shoulder past neutral 2. no shoulder active ROM 3. no external rotation past 30 degrees in scaption 4. no lifting or supporting body weight on operative side 5. wear sling at all times 6. do not sleep on affected shoulder for at least 6 wks
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do not rotate arm external past 30 degrees ins caption
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shoulder precautions
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abdominal precautions
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1. do not lift more than 8-10 limbs 2. no bending hips past 90 degrees 3. no twisting trunk 4. logroll to get out of bed
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no bending hips past 90 degrees
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thoracic, lumbar, abdominal
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WBAT
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weight bearing as tolerated (pt allowed to put as much weight as they can tolerate on affected extremity)
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PWB
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partial weight bearing (up to 50%) on operative extremity
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TDWB/TTWB
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touchdown/toe-touch weight bearing (pt not allowed to bear weight on operative extremity but can touch toe to maintain balance)
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NWB
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non-weight bearing
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the occupational profile is a type of OT _____
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evaluation
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most important elements from chart review
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1. basic personal info (name, DOB, etc.) 2. dx, HPI, PMH 3. physician orders
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physical orders
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1. have they ordered OT? 2. activity restrictions or precautions? 3. code status (DNR, DNI, Full Code)
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full code
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opposite of DNR ; DNI
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1st step in eval. in medical setting
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chart review
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other important info for chart review
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1. nursing and other disciplines' notes (PT etc.) 2. restraints (enclosure, seatbelt, mittens) 3. lab & test results (more important in acute settings)
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interview formats
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1. structured 2. semi-structured 3. unstructured
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structured interview
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1. quantitative 2. consistent 3. diff. responses can be attributed to diffs. among interviewees 4. predetermined probes 5. standardized recording of responses
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3 parts of interview
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1. intro 2. body 3. closing
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introduction to ct.
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1. intro self w/ name & role 2. validate ct.'s name ; pronunciation 3. clarify OT role in 2-3 sentences 4. explain purpose of interview and check ct's understanding 5. establish time frame 6. social comments to break the ice
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closing
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1. state how much time remains when interview end is close 2. summarize basic content while letting ct. correct 3. clarify next steps including who gets the info 4. ask if any q's 5. thank ct.
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COPM works best when ct over __ years old
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7
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COPM is designed to used ____ lifespan and is not ____ specific
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across/dx
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COPM is ____ structured
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semi
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3 areas of COPM
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self-care, productivity, leisure
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strengths of COPM
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1. psychometrically valid 2. manual and easy scoring 3. built-in reassessment 4. ct.-centered 5. allows caregiver input
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OPHI-II
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occupational performance hx interview v. 2
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OPHI-II
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1. assess occupational identity, competence, and impact of OT behavior settings 2. average length 45 mins 3. semi-structured, scales for rating information, includes Life History Narrative (qualitative data)
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OPHI-II themes
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Occupational Roles "Have you worked in the past?" Daily Routine "Describe a typical day" Occupational Behavior Settings "Tell me about where you live" Activity / Occupational Choices "When you run into obstacles, how do you handle it?" Critical Life Events "What do you consider your biggest success in life?"
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where not to use OPHI-II
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short-term tx settings (acute care with less than 3 visits or short term inpatient psych)
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systolic blood pressure
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pressure in artery when heart contracts ; pumps blood throughout body (peak, top #)
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diastolic BP
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pressure in artery when heart is at rest
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healthy BP parameters for normal healthy adult
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90/60 to ;120/80 mmHg
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healthy BP parameters for older adult
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;140/90
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normal HR for healthy adult
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60-100 BPM
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normal temp for healthy adult
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97.8 - 99.1 degrees Fahrenheit or 36.6 - 37.3 degrees celsius
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normal O2 saturation for healthy adult
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95-100%
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normal resp. rate for healthy adult
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12-18 breaths per min
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what can you do to help pt with high or low blood pressure?
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1. get pt lying or sitting down
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what can you do to help pt with high BP?
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have them lay down
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help pt with low BP?
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get them to lay down, elevate feet, drink fluids
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sx of low BP
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dizziness, nausea, BLURRED VISION (this is how to tell low BP apart from other conditions with similar sx)
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purpose of initial eval.
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paints a clear picture, functional status, strengths, impairments for OT to address
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what info needs to be gained about ct during eval?
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DOB, name, name of agency, PMH, HPI, dx's, precautions, indications
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Levels of FIM
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7 - independent 6 - modified independent 5 - supervision 4 - minimal assist (75% ct. effort) 3 - moderate assist (50-74% ct. effort) 2 - maximal assist (25 - 49% ct. effort) 1 - total assist (<25% ct. effort)
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which transfer should you not use for ct with hip precautions?
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dependent - causes them to bend more than 90 degrees
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FIM levels that are independent (no helper)
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6-7
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FIM levels that are modified dependent
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3-5
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fim levels that are complete dependent
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1-3
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9/13 Frost, 2012 [BB] "Patient Handling Methods Taught in Occupational Therapy Curricula "
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- most students taught traditional manual patient handling (TMHP) instead of safe patient handling (SHP) - educators unaware of risks of TMHP, shaped by attitudes and perceived behavioral control - as educators become more aware of evidence, they will shift towards SHP
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Drucker 2003 - "Develop Disagreement Rather Than Consensus"
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- don't make consensus until you have disagreement - disagreement provides alternatives - understand the alternatives - understand why disagree - know both sides of the issue
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3 perspectives for activity analysis
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- contributions of person or actor - effects of physical environment on performance - implications of social environment
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principles of activity analysis
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- goal-directed - have meaning to ct. in relation to social roles - prevent or reverse dysfunction - require physical ; mental participation of ct. at "just right" level of challenge - develop skill to enhance performance in life roles - relates to ct.'s interests - adaptable, gradable, age appropriate
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therapeutic approaches of activity analysis
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1. biomechanical 2. sensorimotor
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biomechanical approach of activity analysis
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- used in lower motor neuron and orthopedic dys. - improvements in strength, ROM, muscle endurance are goals - focused on activity/occupation, but approach is on biomechanical ct. factors
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sensorimotor approach
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- used in upper motor neuron disorders such as cererbral palsy, stroke, head injury - focused on sensory perception of ct. and movement patterns - consider effect of activity on balance, posture, muscle tone, facilitation/inhibition of abnormal reflexes and movements
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stereognosis
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object identification w/o vision
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proprioception
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knowledge of joint position in space
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saccadic eye movements
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smooth visual scanning (sans jerky movements such as when someone is reading a book)
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organized scanning
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visual scanning in organized way (looking for right word in a puzzle)
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visual agnosia
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ability to verbally identify an object w/ visual input
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high muscle tone
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stiff, spastic, hard to stretch out
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low muscle tone
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loose, looks weak
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what should you wear when entering a ct with TB's special (negative pressure) room?
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N-95 mask
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standard precautions (infection)
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assume everyone has something we don't want to catch
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PPE
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personal protective equipment (to protect from infection)
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3 types of spread we are preventing
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1. airborne pathogens (tuberculosis) 2. blood borne pathogens (hepatitits) 3. multi-drug resistant bacteria
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ex's of blood borne pathogens
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1. hep B 2. hep C 3. HIV
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if someone is in a special negative pressure room, they probably have
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TB
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risk of blood borne pathogen spread can be increased or decreased based on level of _____ in person's blood
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virus
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most common airborne pathogens
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1. TB 2. active varicella/chickenpox 3. disseminated herpes zoster (varicella) 4. rubeola (measles) 5. smallpox 6. monkey pox 7. SARS 8. avian influenza
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most common droplet pathogens
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1. influenza 2. pertussis, diphtheria 3. invasive neisseria meningitis
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what are MDROs?
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multi-drug resistant bacteria - resistant to more than 1 antibiotic
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most common MDROs
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MRSA, VRE, C-Diff
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MRSA and C-Diff can live on surfaces for up to (or longer than in case of C-Diff) ___ days
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80
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isolation precautions
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- prevents spread of MDROS and other highly infectious pathogens - requires use of PPE (usually gown and gloves) - most common for contact and droplet (flu)
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neutropenic precautions
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patient has weakened immune system and must wear mask outside of room to protect themselves (vs. protecting other ppl)
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an OT walks out of room and down hall still wearing gloves and gown. what's wrong?
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they did not remove PPE before exiting ct's room
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a person with very low WBC count (neutropenia) would require ____ precautions
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neutropenic
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gloves still should be worn for pt. ______ outside of room
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contact
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everything you take into room with you, you should be able to _____
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sanitize w/ antimicrobial wipes
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should you use antimicrobial wipes on skin?
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not unless you are a masochist
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what song should you hum to help remember how long to wash your hands (20 secs)?
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happy birthday
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what song should you sing to instantly make friends?
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wannabe by spice girls
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how long should you wash hands?
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20 secs
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what should you always do after contact with C-Diff?
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wash hands w/ warm water
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when putting on PPE, does donning gloves or donning gown come first?
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gown, then gloves
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removing PPE, gloves or gown first?
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gloves, then gown
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what to do after removing gloves?
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wash hands
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example of hip adduction
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turning legs inward (don't do for h/p)
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length of time h/p observed
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6 wks (in time for post-ortho follow-up)
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movement precautions for global hip precautions
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1. no external or internal hip rotation 2. no hip extension 3. no hip adduction (crossing legs) 4. no hip flexion past 40 degrees
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no BLT's for spine precautions
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B: bending L: lifting more than 8-10 lbs. T: twisting back & neck
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no lifting more than ____ lbs on affected side for pacemaker precautions
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5-10
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common conditions - cerebral palsy
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group of neuro. disorders that appear in early infancy or early childhood. permanently affect balance, body movement, muscle coordination. characterized by muscle tone abnormalities, reflex abnormalities, atypical posture, delayed motor development, atypical motor performance.
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multiple sclerosis
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potentially disabling disease of brain & spinal cord where immune system attacks protective myelin sheath that covers nerve fibers, causing communication prob's between brain and rest of body. sx: optic neuritis, sensory disturbances, urinary incontinence, muscle weakness, fatigue.
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ex's of sx of acquired brain injury
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- seizures - hydrocephalus - cognitive impairment
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Parkinson's disease
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progressive disorder of nervous system that affects movement (resting tremor, muscle rigidity, bradykinesia)
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SBA
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stand by assistance
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what occupations are typical for school-aged children (5 and up)?
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1. developing "student" role 2. developing social role 3. expressing complex emotions and ideas (guilt, anger) 4. developing unique identity 5. exploring athletic skill
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biggest challenge of school age children
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keeping their attention! need to be creative, use environment and sensory input
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occupations of preschool children (3-5 yrs)
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1. preschool skills 2. ADLs like dressing, toileting 3. expressing ideas 4. expanding play skills 5. expanding social circles
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occupations of infants/toddlers
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1. expressing self and communicating needs 2. problem solving 3. social bonding 4. learning thru exploring 5. eating ; drinking new foods 6. using tools 7. bowel movements 8. pre-dressing
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what should you do when a ct with sternal precautions starts coughing?
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give them pillow to hug to chest
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posterior hip precautions - don't turn knee inward or outward?
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inward
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posterior h/p - should you allow knees to touch?
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no
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anterior h/p - should you lean or twist towards your affected side?
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no
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for what patients should you use a dependent transfer?
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- spinal cord injuries - no LE function - limited trunk control - no UE strength - limited UE/LE/trunk function
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for what patients should you use an assist or independent (sliding board transfer)?
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LE paralysis and sufficient UE strength
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for what patients should you use a stand/step transfer (rocking)?
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hemiparesis when target surface does not allow adjacent WC position
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for what patients should you use a stand/pivot transfer?
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hemiparesis target surface allows adjacent WC position
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normal HR
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60 - 100 BPM
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resp. rate
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12-18 BPM
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temp
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97.8 - 99.1 degrees Fahrenheit or 36.3 - 37.3 celsius
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pre-hypertension
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120/80 and >
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hypotension
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<90/60
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where in a SOAP should you put assessment RESULTS sans interpretations (ROM, muscle grades, sensory information)?
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O
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in activity analysis, how is strength graded?
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- decrease or increase in resistance
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how can activity be graded?
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- strength - ROM - endurance/tolerance - perceptual/cognitive/social skills - selection of activity - simulated or enabling activity (changing ct. environment to better stimulate interest)
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adapting equipment to have long handles would be an example of ____ grading
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ROM
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changing plane of movement from gravity eliminated
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strength grading
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confabulation
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ppl make up info out of memory impairment or embarrassment
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TLSO
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thoracolumbosacral orthosis
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LSO
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lumbosacral orthosis
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CARE (documentation)
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C - Clarity A - Accuracy R - Relevance E - Exceptions
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signs of high BP
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dizziness, headaches, nosebleeds, blurred vision
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signs of low BP
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dizziness, nausea, feeling faint, rapid shallow breathing, orthostasis
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sx of low O2
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shortness of breath/difficulty breathing, fatigue, mental confusion, tingling fingers, dizziness
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signs of cardiac distress
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chest pain, tightness, burning radiating to jaw and neck, shortness of breath, nausea, cold & clammy sweat (diaphresis)
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if ct. hyperventilating...
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cue ct. to slow breathing, pursed lip breathe, do not use paper bag if previous cardiac history
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blood glucose
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80-125
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low blood glucose sx
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diaphoresis, confusion, blurred vision, dizziness
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high blood glucose can mean
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diabetes, stroke, heart attack
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spinal precautions length
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8-12 wks
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sternal precautions length
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4-6 wks
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lengths of precautions
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hip: 6 spinal: 8-12 sternal: 4-6 shoulder arthroplasty: sling to be worn 4-6 wks, do not sleep on affected shoulder for at least 6 wks
