Foundations PT Midterm Study Guide PDF

1. Interviews framework/ std precautions body mechanics cultural competency a. Core frameworks that guide clinical practice i. patient centered care 1. patient is a member of the healthcare team 2. family caregivers community are impo...

1. Interviews framework/ std precautions body mechanics cultural competency a. Core frameworks that guide clinical practice i. patient centered care 1. patient is a member of the healthcare team 2. family caregivers community are important to the POC 3. patient centered care is at the HEART of all we do ii. task oriented approach 1. identify ways to engage the person and work towards the air goals 2. analyze the functional task to break down complex movements into manageable parts 3. assess the impacts of the environment(s) where the task will be performed iii. the movement system 1. nervous system 2. integumentary system 3. pulmonary 4. endocrine 5. musculoskeletal 6. cardiovascular iv. AMAP/ANAP 1. facilitate independence even at the most dependent level 2. HAVE THE PATIENT DO AS MUCH AS POSSIBLE, AS NORMALLY AS POSSIBLE (AMAP/ANAP) 3. builds a framework for increasing independence v. control centrally, direct distally 1. guarding during STS and gait 2. assisting with rolling a patient in bed 3. encourage patient to lean forward in sitting before standing up 4. NOSE OVER TOES vi. stability and mobility 1. stability precedes mobility 2. must be able to maintain stability in a position before attracting mobility in the same position 3. inverse relationship btw stability and mobility for functional task b. discuss the importance of standard precautions for infection control and to prevent patient harm in PT practice i. research indicates healthcare providers clean their hands LESS THAN HALF OF THE TIME they should ii. 5 moments for hand hygiene 1. before touching pt 2. before clean/aseptic procedure 3. after body fluid exposure risk 4. after touching pt 5. after touching pt surroundings c. describe the purposes of an initial interview with the patient i. establish trusting therapeutic alliance ii. determine unique aspect of every patient iii. determine pt understanding of PT iv. determine pt understanding of condition v. determine if condition has changed since referral written vi. search for clues to possible underlying causes vii. screen for falls viii. screen for pain ix. listen for red flags x. tailoring the exam xi. formulate an early hypotheses d. list and provide examples of the content included in an initial patient interview i. Introduce yourself - name and pronouns ii. verify pt identity 2 ways 1. name 2. DOB 3. purpose of treatment 4. referral source iii. obtain consent iv. Interview pt; be alert for cultural differences - norms or traditions v. have they fallen recently vi. establish pt understanding 1. conditions 2. barriers and goals 3. impairments/activity participation levels vii. obtain informed consent for exam and Rx after describing risk viii. encourage pt to ask questions e. demonstrate appropriate screening for falls history in the patient interview i. How ii. show me where iii. what have you done iv. contacting your PCP f. discuss culturally competent strategies for patient care i. pt with certain ethnic, religious or other cultural group may have strong preference or concerns ii. embarrassment caused by body exposure iii. taboos related to garment selection or garment removal iv. preferred person to discuss health info v. variation from to person to person may be significant vi. 4 C’s of Culture 1. call 2. caused 3. cope  4. concerns g. describe the role of the patient interview in planning for the end of an episode of patient care i. D/C BEGINS WITH INITIAL PT INTERVIEW ii. living environment 1. tell me about your home 2. stairs a. to enter b. Within 3. what floor is the bedroom 4. what other floors do you need to access 5. are their handrails ? Which side as you go up 6. what type of flooring do you have a. do you have any rugs 7. safety equipment ? Shower chairs? 8. anything in your home make you feel safe/nervous 9. who lives with you h. provide effective feedback on errors in body mechanics in clinical skill performance 2. Guarding for STS transfer and walking a. how to use a gait belt i. provide firm grasping surface ii. protect pt from accidental trauma on skin iii. enables therapist to gradually lower a pt to the floor (if necessary) iv. gait belt 1. supinated (underhand) grip 2. education= feel tight 3. don/doff a. before transfer b. after activity 4. pt lean forward slightly 5. snugly low @ level of COM v. Gait belt contraindications 1. recent colostomy/ileostomy surgery 2. severe respiratory problems 3. recent abdominal chest or back surgery 4. abdominal aneurysm 5. phobia regarding belts b. how to guard a pt during STS transfer including using AD i. stand in stride to one side slightly behind the patient ii. Demonstrate the movement iii. cue pt: scoot forward iv. position feet under pt or slightly behind with full foot contact v. cue to lean trunk forward (nose over toes)  vi. cue to push armrest vii. extend trunk and lower extremities to full standing viii. USING AD DEVICE 1. single point cane a. cue to place cane in hand on armrest b. use BOTH arms to push on the armrest during STS 2. Quad cane a. use BOTH arms to push on the armrest during STS b. then grasp the quad cane ix. where to stand ? 1. always on affected side 2. if non = whatever side they preferred 3. why? a. better control b. can predict and control fall c. how to guard a pt during ambulation on level surfaces i. slightly behind and to weaker side ii. control points 1. pelvis (gait belt) 2. shoulder girdle d. how to prevent or manage a fall during ambu i. Collapsing fall 1. move in close nad attempt to bring COM back over BOS 2. regaining position is not possible and chair is not immediately available, deepen your stride and rest the pt on your forward thigh 3. if thigh not option then carefully lower the pt to the floor ii. angular fall 1. move closer and lift slightly on the gait belt to help the pt regain support 2. if not possible: lower to thigh or floor 3. lower all the way to floor = controlled FALL iii. falling safely 1. prevention a. person (balance, strength, attention) b. task: effective gait training and AD c. environment: uncluttered, lighting 2. minimizes risk of injury a. drop crutches to side b. use UE to break the fall c. turn head to side 3. documentation a. List the purposes of documentation in the health care system i. precise ii. concise  iii. complete iv. legible v. timely b. describe SOAP note documentation within the medical record i. medical record 1. systemic documentation of single pt medical history and care 2. legal document 3. source oriented 4. problem oriented medical record 5. SOAP: patient/client management note c. describe the sections of the SOAP note format and provide an overview of material included in each section i. S = subjective 1. reports made by pt, pt’s family or caregivers 2. details pt’s own perception of condition 3. use quotes 4. should not include extraneous info that is not directly related to pt’s conditions 5. be careful not to pass judgment (pt overreacting) ii. O = objective 1. document pt progress toward functional goals 2. provide details of interventions performed a. location b. frequency c. intensity d. duration e. repetitions 3. be sure to include enough detail regarding specific interventions 4. adequate detail so that the therapist could replicate a. equipment b. position c. pt’s response (change in symptoms) iii. A = assessment 1. analysis of the pt’s progress including reasons why the pt is or is not improving as expected 2. summarize pt progress and discuss factors hindering progress towards goals 3. response to intervention 4. be careful a. not too vague b. “patient tolerated treatment well” is too vague c. must justify need for continued SKILLED therapy iv. P = plan  1. interventions for the upcoming sessions, including any change in intervention strategy 2. be careful not to be too vague a. “continue treatment” is too vague 3. include session length, frequency, duration of plan 4. goals are part of the plan d. barriers to progress i. usually part of the A ii. motivation confidence and compliance are all factors - but those are NOT the barriers iii. lack of motivation iv. lack of confidence v. lack of compliance or inconsistent compliance with program vi. lack of family support 4. positioning and bed mobility a. Describe proper positioning for short term and long term i. long term positioning: sitting 1. increase frequency 2. every 15-20 min 3. may require small lumbar roll 4. 90-90-90 position = (hip flexion, knee flexion, neutral ankle) 5. avoid sacral sitting a. sacrum, ankles, heels 6. support arms a. dont leave arms hanging ii. long term positioning: bed 1. Every 2 hr 2. more frequent depending on medical conditions 3. heels off the surface to minimize pressure 4. promote symmetry and comfort 5. supports arms is mobility is limited or positioning side lying 6. pillow placed lengthwise under the legs 7. add pillow under arms and head b. describe proper and positioning for specific conditions i. total hip arthroplasty (posterior approach) ii. cerebrovascular accident (CVA) with hemiplegia iii. lower extremity (LE) amputation c. describe bed mobility and ways to assist to include: i. hook-lying ii. rolling iii. bridging iv. scooting in supine v. supine to sit 1. roll from supine to right side lying  2. lift or slide both LE off the EOB 3. hemiplegia: side lying weaker side a. side lying to sit EOB b. slide stronger foot under weaker ankle c. bring both legs off EOB d. press down with stronger hand, pushing the torso upright vi. sit to supine d. describes types and levels of assistance used when assisting with bed mobility i. total assist = clinician performs more than 75% of work ii. max assist = clinician performs 75% or more and pt performs 25% iii. mod assist = clinician and pt perform 50% iv. min assist = clinician performs 25% of the work and the pt 75% v. contact guard assist = clinician has one or both hands on the pt body to provide occasional steadying assistance for balance but is not lifting, moving, otherwise expending effort vi. stand by assist = clinician is not touching but needs to be close to provide assistance in case the patient experiences a loss of balance is at risk of colliding with an object or requires other interventions vii. distant supervision = pt requires someone within arms reach viii. close supervision = hands raised but not touching pt, full attention to pt ix. independent = pt is able to perform skill safely with no one present e. describe “zero-lift” policy and its purpose f. describe equipment used to assist with bed mobility i. tilt table ii. transfer boards iii. lateral transfer system 5. week 4 concepts and techniques of assisted transfers a. describe zero lift policy and its purpose i. mechanically assisted lifting when objective is to move a patient ii. OSHA manual lifting of residents should be minimized in all cases and eliminated when feasible iii. legal requirement in many states b. describe transfers, techniques to assist and their indication including: i. dependent transfers: 2 person lift ii. dependent transfer: hydraulic lift iii. dependent transfers: dependent standing pivot iv. assisted transfers: sliding board v. assisted transfers: assisted standing pivot vi. assisted transfers: squat pivot transfer c. describe equipment used to assist with transfers i. hydraulic lift ii. sit to stand lifts iii. sliding boards d. describe types and levels of assistance used when assisting with transferring a patient i. dependency levels 1. level 4 - total dependence ; no manual lifting a. mechanical lift with full sling 2. level 3 - extensive assistance; no manual lifting a. mechanical lift with fulls sling b. stand assist lift if deemed appropriate 3. level 2 or 1 - limited assistance or supervision a. Variable possibly some manual lifting b. may include mechanical lift, walker, transfer board, gait belt 4. level 0 - independent ; no mechanical assist typically needed ii. sit to stand lift = level 3 or 2 1. pt is able to bear some weights on the LEs 2. pt can flex hips knees and ankles 3. pt can maintain sitting balance without extensive support 4. pt can participate in transfer process 5. lift does not exacerbate any back problems iii. 2 person WC to bed lift 1. positing chair 2. position one clinician behind the pt 3. position another clinician in front of the pt 4. lift shift and lower 5. adjust as needed iv. floor to chair lift 1. the clinician behind the pt uses LEs rant UE to lift 2. the clinician in front of the pt faces the direction of the lateral move 3. the clinician behind the opt must clear the drive wheels and hand grasp v. hemiplegia 1. generally easier to transfer to the stronger side 2. more therapeutic to transfer to the hemiplegic side 3. pt may need to rely on the stronger side for unilateral pivot 4. the involved UE may need to be supported 5. do not pull on pt involved arm vi. THA posterior approach 1. scooting forward in chair w trunk flexion 60- 90 degrees 2. extend knee of involved LE prior to standing. This drops the knee, decreasing the hip flexion 3. avoid forward trunk flexion beyond 60-90 4. push to standing w trunk flexion is very difficult 5. avoid internal rotation of involved hip during pivot 6. avoid forward trunk flexion beyond 60-90 during sitting vii. THA precautions  1. if the feet are planted on the floor: a. be sure that the hip on the operated side does not internally rotate b. turning the upper body toward the involved or uninvolved side c. This may result in internal rotation of the involved hip viii. Spinal cord injury 1. SCI at level C7 and lower typically have potential to perform transfers independently 2. typically use a sitting pivot or sliding board transfers: feet contact the floor for stability but the forced to power the transfer comes from UEs 3. guard for trunk stability and watch for possible tissue damage e. educate a patient on their weight bearing precautions 6. week 5 concepts of gait and AD a. define the gait cycle and the 2 phases of gait i. gait cycle 1. all components of limb advancement 2. begins with a specific event on one foot 3. Ends when the same event is repeated on the same limb ii. stance phase 1. begins when one foot contacts the floor 2. ends when that foot leaves the floor iii. swing phase 1. begins when one foot lifts off the floor 2. ends when that foot contacts the floor iv. stride length 1. linear distance representing how far the body has traveled during one gait cycle v. step length 1. distance representing how far one foot has traveled relative to the other foot during one gait cycle b. identify and select various types of ambulation aids i. c. discuss indications and contraindications for use of various ambulatory AD i. walker disadvantages 1. difficult to store 2. difficult/impossible to use on stairs 3. decrease speed of ambulation 4. impedes normal gait pattern 5. too wide for narrow spaces ii. axillary crutches 1. allows greater mobility 2. provides less stability  3. allow unloading of one LE 4. Can be used for all WBing iii. Axillary crutches disadvantages 1. less stable than walker 2. can cause injury to axillary structures 3. require good standing balance 4. pt may feel insecure 5. requires functional strength of UE’s and trunk iv. cane: disadvantages 1. limited support 2. do not provide weight bearing support 3. two canes don’t provide sufficient support for a 3 point gait pattern d. list AD selection in sequence from most to least stable i. types of AD (most stable to least stable) 1. parallel bars 2. forearm support walker 3. standard walker 4. front wheel walker 5. four wheeled walker 6. axillary crutches 7. forearm crutches (loftstrand) 8. quad cane 9. straight cane e. list the AD selection in sequence from those requiring the most coordination/balance i. least coordination to most coordination 1. parallel bars 2. walker 3. cane 4. crutches f. describe the weight bearing precautions g. describe and demonstrate common gait patterns with AD including 2 point, 3 point, and 4 point patterns i. two point gait: AD and opposite LE advance together (one or two canes or crutches or one hemiwallker) ii. three point gait: two AD’s are advanced followed by one LE (often used with unilateral NWB) iii. four point gait : four contact point: AD #1, opposite LE, AD #2, opposite LE h. identify anatomical landmarks and demonstrate ability to properly fit each AD