A&S Unit 1 Perform Basic Measurements PDF

WSD in Rehabilitation Care Module 1: Assessment & Screening SS71012 Unit 1 Perform basic measurements DPREC_AS_v.1.0 (2022)  Unit Objectives Skills o Prepare for assessment appropriately o Conduct assessment appropriately o...

WSD in Rehabilitation Care Module 1: Assessment & Screening SS71012 Unit 1 Perform basic measurements DPREC_AS_v.1.0 (2022)  Unit Objectives Skills o Prepare for assessment appropriately o Conduct assessment appropriately o Carry out documentation and reporting appropriately  Unit Objectives Knowledge o Structure and functions of skin o Structure and functions of cardiovascular system o Purpose and procedures of conducting the following assessments:  Subjective assessment  Vital signs  Blood glucose  Skin Sensation  Unit Objectives Knowledge o Guidelines and principles in infection control o Safety precautions when conducting assessment o Normal and abnormal ranges of:  Blood pressure: hypertension, hypotension  Heart rate: bradycardia, tachycardia  Oxygen saturation level  Blood glucose: hyperglycemia, hypoglycemia  Unit Objectives Knowledge o Guidelines and principles in infection control o Safety precautions when conducting assessment o Normal and abnormal ranges of:  Factors affecting vital signs and blood glucose level  Documentation format and requirements Structures of the integumentary system Can you identify the structures of the skin ? Martini, 2018, pg 200 Structures of the integumentary system Martini, 2018, pg 200 Functions of the integumentary system o Physical protection from environmental hazards o Excretion of salt, water, and organic wastes o Thermoregulation o Synthesis of vitamin D o Storage of lipids o Detection of sensory information o Coordination of the immune system Martini, 2018, pg 199 Cutaneous Membrane Martini, 2018, pg 201 Accessory Structures Martini, 2018, pg 201  Tactile receptors in the skin Martini, 2018, pg 565 Tactile receptors in the skin Free nerve Located between the Ending epidermal cells Provide touch sensations Tonic receptors with small receptive fields Root hair Free nerve endings found plexus whenever hair is located Stimulated by hair movement, thus they monitor the distortions or movement across the body surface that has hair Adapt rapidly, that are sensitive in detecting initial contact and subsequent movement Martini, 2018, pg 565 Tactile receptors in the skin Tactile Made up of tactile cells Discs and a sensory nerve ending Found on skin surfaces that lack hair Fine touch and pressure receptors that is sensitive to shape and texture Extremely sensitive, with very small receptive fields Martini, 2018, pg 565 Tactile receptors in the skin Bulbous Branching sensory nerve Corpuscle fiber in a capsule surrounded by collagen fibers Sensitive to pressure and distortion of the skin Located in the reticular or deep layer of the dermis Slow adapting, and can detect skin stretch or compression Provide valuable feedback when we are gripping an object Martini, 2018, pg 565 Tactile receptors in the skin Lamellar Sensitive to deep corpuscles pressure and vibrations Fast adapting receptors and are most sensitive to pulsing or high frequency vibrating stimuli Consist of a single nerve ending encapsulated in a series of concentric layers of collagen fibers that are separated by fluid Exist in the dermis all over the body Martini, 2018, pg 565 Tactile receptors in the skin Tactile Sensations of fine touch corpuscles and pressure and low frequency vibration Responsible for our ability to manipulate fine objects with precision Found primarily on the skin on the fingertips, eyelids and lips. Adapt within seconds after contact Sense texture Martini, 2018, pg 565  The Cardiovascular System  Introduction The heart and circulatory system  https://www.youtube.com/watch?v=WuBeB7CI 6Tc Blood vessel circuits Arteries of the body  Veins of the body The Heart https://www.youtube.com/watch?v=CWFyxn0qDEU Connections with the lungs 4 heart valves Martini, 2017, pg 720 Coronary circulation Martini, 2017, pg 410 Martini, 2017, pg 722 Conducting system Martini, 2017, pg 726  Conducting system o Cardiac muscle contracts on its own – automaticity. o Specialised cells that initiate and distribute the stimulus to contract. o Include the following :  Sinoatrial (SA) node  Antrioventricular (AV) node  Conducting cells  Phases of Cardiac Cycle Ejection fraction relative to cardiac output o Movements and forces present during heart pumping. o Stroke Volume (SV)= Amount of blood pumpout o End diastolic volume (EDV) = max amount of blood in ventricle at end of filling o End systole volume (ESV) = amount of blood left in each ventricle after ejection of blood. o SV = EDV – ESV o Cardiac output: SV x HR o Ejection fraction: SV/EDV x 100% (Normal: approx 65%) Q. Why should Ejection Fraction be of a concern for rehabilitation? The four major functions of the cardiovascular system are: 1. To transport nutrients, gases and waste products around the body 2. To protect the body from infection and blood loss 3. To help the body maintain a constant body temperature (‘thermoregulation’) 4. To help maintain fluid balance within the body (“Major Functions of the Cardiovascular System”, n.d.)  Purpose of conducting SUBJECTIVE ASSESSMENT A detailed subjective assessment will help a therapist form provisional hypotheses as to the potential causes of the patient's presentation and therefore form the basis of the subsequent objective assessment. (Ahuja, 2020)  Procedures of conducting SUBJECTIVE ASSESSMENT The subjective examination includes collecting information regarding: o age, o race, o gender, o working status, o stress levels and o a current and past medical and family history. (Simmonds, J., 2010).  Procedures of conducting SUBJECTIVE ASSESSMENT The subjective examination includes collecting information regarding: Of particular importance are questions or completion of questionnaires relating to: o current and past physical activity tolerance and o preferred modes of exercise and physical activity.  Procedures of conducting SUBJECTIVE ASSESSMENT The subjective examination includes collecting information regarding: It is important to ask detailed questions relating to: o functional ability on good and bad days. This is helpful in determining the baseline functional level for the programme. o An evaluation of current pain levels using a simple visual analogue scale (zero to ten) can be used.  Purpose of conducting VITAL SIGNS Vital signs are useful in detecting or monitoring medical problems. Vital signs can be measured in a medical setting, at home, at the site of a medical emergency, or elsewhere. (Johns Hopkins Medicine, 2022)  Procedures of conducting VITAL SIGNS o Vital signs – includes temperature, respirations, pulse and blood pressure. o Indicate the body’s ability to regulate body temperature, maintain blood flow and oxygenate tissues.  Purpose of conducting Temperature Taking o To obtain a the baseline temperature to enable comparisons to be made with future recordings. o To enable close observation in resolving hypothermia/hyperthermia. o To observe and monitor patients for changes indicating an infection. o To monitor the effect of treatment for antimicrobial therapy for infection. o Before and during a blood transfusion to monitor for signs of a reaction.  Temperature Taking Sites o Oral cavity - The oral cavity temperature is considered to be reliable when the thermometer is placed posteriorly into the sublingual pocket. This landmark is close to the sublingual artery, so this site tracks changes in core body temperature. o Tympanic – The tympanic thermometer senses reflected infrared emissions from the tympanic membrane through a probe placed in the external auditory canal. o Rectal – temperature taking from the anus. It is said to be the most accurate method for measuring the core temperature. o Temporal artery temperature - The temporal artery thermometer is quick to use. It is held over the forehead and senses infrared emissions radiating from the skin Components of thermometer  Practical Skills with APIE Assessment Evaluation Planning Implementation  Procedures of conducting Oral temperature (steps) ACTION Ensure that the patient is at rest. Determine if the patient has just taken a hot or cold drink or a 1 shower bath. (In these situations, temperature should be taken half an hour later). Remove the thermometer from the storage case and check that the confirmation mark is attained (according to manufacturer’s 2 code). Insert the thermometer into the disposable sheath. Place the tip (thermal sensor) of the thermometer under patient’s tongue, in either the right or left posterior sublingual pocket, at an oblique angle. 3 Instruct patient to close his/her mouth and hold the tip in place between the lips. Caution patient against biting on the thermometer.  Procedures of conducting Oral temperature (steps) ACTION Leave the thermometer in place until the electronic signal sounds (approximately 4 1 minute). Remove the thermometer and discard the sheath. Note the 5 temperature reading. Return the thermometer to its storage case. 6  Purpose for conducting Pulse Taking o See how well the heart is working. In an emergency situation, the pulse rate can help find out if the heart is pumping enough blood. o Help find the cause of symptoms, such as an irregular or rapid heartbeat (palpitations), dizziness, fainting, chest pain, or shortness of breath. o Check for blood flow after an injury or when a blood vessel may be blocked. o Check on medicines or diseases that cause a slow heart rate. o Check general health and fitness level. ------- Dr. Deborah Raines, MSN. Honor Society of Nursing (STTI)Nursing  Importance of Heart Rate Monitoring o In an emergency situation, the pulse rate can help find out if the heart is pumping enough blood. Sudden loss of blood will increase the heart rate. o Help to find the cause of symptoms, such as an irregular or rapid heartbeat (palpitations), dizziness, fainting, chest pain, or shortness of breath. o Monitoring for client’s on medication that will slow down heart rate (such as sedatives, beta-blockers, calcium-channel blockers, digoxin, opiates, cholinergic toxicity) o Monitoring of diseases that cause a slow heart rate. (sick sinus syndrome, myocarditis, hypothyroidism, OSA, AV block) o Check general health and fitness level.  Procedures for conducting Pulse Taking o As the heart forces blood through the arteries, you feel the beats by firmly pressing on the arteries, which are located close to the surface of the skin at certain points of the body. The pulse can be found on the:  side of the neck,  on the inside of the elbow,  or at the wrist. o For most people, it is easiest to take the pulse at the wrist. If you use the lower neck, be sure not to press too hard, and never press on the pulses on both sides of the lower neck at the same time to prevent blocking blood flow to the brain. (Johns Hopkins Medicine, 2022)  Procedures for conducting Pulse Taking When taking your pulse: o Using the first and second fingertips, press firmly but gently on the arteries until you feel a pulse. o Begin counting the pulse when the clock's second hand is on the 12. o Count your pulse for 60 seconds (or for 15 seconds and then multiply by four to calculate beats per minute). o When counting, do not watch the clock continuously, but concentrate on the beats of the pulse. o If unsure about your results, ask another person to count for you.  Purpose for BP taking o Screening for hypertension o Following the effect of anti-hypertensive treatments in a patient to optimize their management o Assessing a person’s suitability for a sport or certain occupations o Estimation of cardiovascular risk o Determining for the risk of various medical procedures o Figuring out whether a patient is clinically deteriorating, or is at risk for it  BP taking sites Blood taking pressure site: https://www.pinterest.com.au/pin/503277327079821014/  Types of BP taking devices Semi-automatic blood pressure monitor: http://www.medicalexpo.co m/prod/suzuken- company/product-70230-  Semi-automatic blood pressure monitors 420947.html  Vital Signs Monitor Dinamap Carescape Vital Signs Monitor: http://www.woodleyequipment.co m/clinical-trials/vital-signs- monitoring/dinamap-carescape- vital-signs-monitor-414-82- 1203.php/ Procedures to Taking BP (manual) Assess patient’s ability to comprehend. Explain to the patient on procedure and purpose. Make the patient comfortable. He should be lying down or resting comfortably in a chair. Expose the patient’s upper arm and remove any constricting clothing. Extend his elbow and support his arm with his palm turned upward and externally rotated to expose the brachial artery on the inside of the elbow. Clean the earpieces and diaphragm of the stethoscope with alcohol swabs. Empty the cuff of all air by pressing it flat. Palpate for the brachial artery. Position the cuff 2.5cm above the site of the brachial pulsation. Centre the arrow marked on the cuff over the artery. Wrap the cuff firmly and evenly around the arm evenly. Position the mercurial manometer so that the bulb is level with both the heart and the arm. Palpate the radial artery with fingers of one hand. Tighten the screw of the control valve of the pressure ball with the fingers of the other hand. Inflate cuff rapidly to 20-30mm Hg above the point at which the pulse disappears. Apply the earpieces of the stethoscope to the ears. Place the diaphragm of the stethoscope over the brachial artery. Release the cuff pressure slowly by gentle release of the screw of the control valve to allow mercury to fall. Allow the mercury to fall at a rate of 2-3 mmHg. Listen for the first clear sound (systolic pressure), and note the level on the mercury column of the manometer at eye level. Continue to release the cuff pressure slowly until the sound becomes muffled or disappears. Note the level of the mercury column of the manometer at eye level. Release the remaining air from the cuff. Remove the cuff, roll it up neatly and replace it.  Pain o Refers to a highly unpleasant physical sensation caused by illness or injury, great care or trouble. o Pain has been identified as the fifth vital signs by Australian and New Zealand College of Anaesthetists and the Chronic pain Coalition in an attempt to facilitate accountability for pain assessment and management (Chronic Pain Policy Coalition, 2007; ANZCA, 2005). o Assessment of a patient’s experience of pain is a crucial component in providing effective pain management.  Causes of pain Acute pain o injury o surgery o illness o trauma o Painful medical procedures Chronic pain o headache o post-surgical pain o post-trauma pain Acute chest pain: Image from o lower back pain https://sites.psu.edu/siowfa15/2015/ o cancer pain 09/30/who-has-the-higher-pain- tolerance-boys-or-girls/ o arthritis pain o neurogenic pain (pain caused by nerve damage)  Pain Assessment Tool: Numeric rating scale o Patients are required to rate their pain from a scale of 0 – 10. With: o 0 being no pain o 1-3 as mild pain o 4-6 as moderate pain o 7-10 as intense pain o 10 being to most extreme pain ever experienced Numeric rating scale for pain. Image from: https://www.physio-pedia.com/File:NRS_pain.jpg  Pain Assessment Tool: Visual analogue scale (VAS) o Visual analogue scale [VAS] is a measure of pain intensity. It is a continuous scale comprised of a horizontal (called horizontal visual analogue scale) or,vertical called Wong-Baker FACES® Pain Rating Scale. Image from: https://www.physio- vertical visual analogue scale. The pedia.com/File:Sadface_vas.jpg procedure includes: o The pain visual analogue scale is self completed by the respondent. The respondent is asked to place a line perpendicular to the VAS line at Horizontal visual analogue the point that represents their pain scale. Image from:http://boneandspine.c intensity. om/visual-analog-scale-for- pain/ o After the patient has marked, using a ruler, the score is determined by measuring the distance (mm) on the 10-cm line between the “no pain” anchor and the patient’s mark.  Pain Assessment Tool: Visual analogue scale (VAS) o The scores can be from 0– 100. Wong-Baker FACES® Pain Rating Scale. Image from: https://www.physio- pedia.com/File:Sadface_vas.jpg o Based on the distribution of pain VAS scores in patients, the following cut points on the pain VAS have been Horizontal visual analogue recommended scale. Image from:http://boneandspine.c o No pain (0 –4 mm) om/visual-analog-scale-for- pain/ o Mild pain (5–44 mm) o Moderate pain (45–74 mm) o Severe pain (75–100 mm)  Purpose for conducting Blood glucose o Checking the blood glucose levels helps to see how the food, exercise, activities, stress, medication and insulin doses are affecting the individual. o Knowing this helps them make any necessary changes to their lifestyle. (Health Hub, 2021) Procedure for conducting Blood glucose  Components of Glucometer o Glucometer o Lancet o Test strip Figure A Figure B Figure C Parts of Glucometer. Source: http://www.phc-online.com/ARKRAY_Glucose_Monitor_p/advance-intuition.htm Common Sites for blood glucose testing o Finger tips o Palm o Forearm o Upper arm o Thigh o Calf Common sites for blood glucose taking: http://www.bd.com/us/diabetes/blood- glucose-monitoring/how-to-test/alternate-site  Skin Sensation o The skin is an important sensory organ that receive information about our external environment. o The dermis of the skin contain sensory receptors called cuntaneous receptors, which are stimulated by heat, cold and touch, including pressure. o Sensory neurons carry impulses from these receptors to the brain where the sensation is interpreted.  Types of skin sensation Exteroceptive Sensations: originate in peripheral receptors in response to external stimuli and changes in the environment. These sensations include: o Pain: Pain sensory testing evaluates the presence of a lesion affecting the peripheral nerve, lateral spinothalamic tract, thalamus or sensory cortex. o Tactile/Light touch: creates the awareness of tactile stimuli and has a role in warning of impending damage. o Temperature: Temperature, like pain provides a mean to alert the body to potential tissue damage o Proprioceptive: sense of the relative position of body segments in relation to other body segments.  Purposes of skin sensation To assess the individual on the following: o Pain o Tactile/Light touch o Temperature o Proprioceptive  Procedures of Skin Sensation Testing Pain and Light touch: o Initial evaluation of the sensory system is completed with the patient lying supine, eyes closed. o Instruct the patient to say "sharp" or "dull" when they feel the respective object. o Show the patient each object and allow them to touch the needle and brush prior to beginning to alleviate any fear of being hurt during the examination. o With the patient's eyes closed, alternate touching the patient with the needle and the brush at intervals of roughly 5 seconds. Begin rostrally and work towards the feet. Copyright © 2018 ITE Dermatome  Pressure Pressure o The therapist’s fingertip or a double-tipped cotton swab is used to apply a firm pressure on the skin surface. o The pressure should be firm enough to indent the skin and to stimulate the deep receptors. o Patient is asked to indicate when an applied stimulus is recognized by responding “yes” or “no.”  Hot Cold Test Temperature: o This test determines the ability to distinguish between warm and cool stimuli. o Two test tubes with stoppers are required for this examination; 1- warm water and 2- crushed ice. o The side of the test tube should be placed in contact with the skin (as opposed to only the distal end). o All skin surfaces should be tested. o The patient is asked to reply hot or cold after each stimulus application.  Proprioception Proprioceptive/position o JOINT POSITION SENSE AND THE AWARENESS OF JOINTS AT REST. o o The extremity or joint(s) is moved through a ROM and held in a static position. o Be aware of hand placements to avoid excessive tactile stimulation. o While the extremity or joint(s) is held in a static position by the therapist, the patient is asked to describe the position verbally or to duplicate the position of the extremity or joint(s) with the contralateral extremity (position matching).  Conditions requiring skin sensation test o Diabetes mellitus, thiamine deficiency and neurotoxin damage (e.g. insecticides) are the most common causes of sensory disturbances. The affected patient usually reports paresthesias (pins and needles sensation) in the hands and feet. o Lesions of the spinal cord due to injury of the spinal cord. o Brain tumours/Injury/Bleeding o Diabetic neuropathy o Guillain-Barré syndrome  Guidelines and principles in infection control Standard Precautions o include a group of infection prevention measures that are to be applied when managing all patients at all times regardless of whether infection is present or suspected. o It is based on the principle that all blood and body fluids, secretions, excretions except sweat, non-intact skin and mucous membranes may contain transmissible infectious agents. o The recommended precautions should be applied for patients known to have Human Immunodeficiency virus (HIV), Hepatitis B, Hepatitis C and other blood-borne pathogens as well. No more is needed to prevent transmission of blood borne diseases. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Standard Precautions includes the following components: a) Hand Hygiene National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021 Page 28 b) Personal Protective equipment (PPE) when in potential contact with blood or body fluids c) Respiratory hygiene/Cough etiquette d) Needlestick / sharps injuries and blood or body fluid exposure prevention e) Safe Injection Practices (not applicable) f) Environmental Hygiene g) Safe handling of potentially contaminated equipment, instruments/devices h) Linen and waste management. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Hand Hygiene o Hands contaminated with transient bacteria pose a significant risk for transmission of infection. o The purpose of hand hygiene is to remove or destroy any bacteria picked up on the hands (transient bacteria). o Hand hygiene remains the most important control measure in LTCFs, community care services, sheltered homes and other healthcare facilities. o Data has shown that improved hand hygiene practices have been associated with reduced HAI rates. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Personal Protective Equipment (PPE) for Potential Blood and Body Fluid Exposure o This refers to wearable equipment that is intended to protect HCWs from exposure to infectious agents. o The type of PPE used should be appropriate for the procedure being performed and the type of exposure to blood, body fluid or pathogen anticipated. o PPE available includes gloves, fluid resistant gowns or aprons, masks and eye protection/ face shields. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Personal Protective Equipment (PPE) for Potential Blood and Body Fluid Exposure o This refers to wearable equipment that is intended to protect HCWs from exposure to infectious agents. o The type of PPE used should be appropriate for the procedure being performed and the type of exposure to blood, body fluid or pathogen anticipated. o PPE available includes gloves, fluid resistant gowns or aprons, masks and eye protection/ face shields. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Personal Protective Equipment (PPE) for Potential Blood and Body Fluid Exposure National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Personal Protective Equipment (PPE) for Potential Blood and Body Fluid Exposure National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Gloves Gloves should be worn whenever exposure to the following is anticipated: Blood/blood products/body fluids with excretions and secretions; a) Urine; b) Faeces; c) Saliva; d) Mucous membranes; e) Wound drainage; f) Drainage tubes; g) Non-intact skin. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Gloves o Gloves must not be reused. They should be put on immediately before an episode of close resident contact or treatment and removed as soon as the activity is completed. o Gloves should be changed between caring for different patients, or between different care or treatment activities for the same patient. o Torn, punctured or otherwise damaged gloves should not be used, and should be removed immediately if damage occurs during a procedure. o Hand hygiene must be performed immediately after the removal of gloves. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Gowns/Aprons (Fluid Resistant) o Fluid resistant gowns or aprons can be selected based on the risk of exposure. o They should be worn when there is potential for soiling clothing with blood/body fluids, secretions and excretions, or when there is a risk that clothing may be contaminated with pathogenic micro-organisms. o Gowns/aprons should be changed between patients and procedures. o It may be also necessary to change gowns/aprons between tasks on the same patient to prevent unnecessary cross-contamination. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Masks and eyewear (e.g. face shields, goggles) o Masks and eyewear should be worn during procedures where there is potential blood/body fluids exposure to the face and eyes. o Well fitted, fit for purpose and comfort of the mask/eyewear is important to ensure adequate protection. o Mask/eyewear protection should not be touched while being worn and should be removed and disposed of immediately following a procedure. o If non-disposable goggles/face shields are used, LTCFs should ensure that there is a decontamination process established. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Respiratory Hygiene/Cough Etiquette o The purpose of respiratory hygiene is to prevent the transmission of respiratory infections. o It is recommended that visual alerts be posted at appropriate locations to inform staff, patients and visitors to practise respiratory hygiene/cough etiquette. o The following respiratory hygiene/cough etiquette measures to contain respiratory secretions are recommended for individuals with symptoms. a) Cover the nose/mouth when coughing or sneezing; b) b) Use tissues to contain respiratory secretions and dispose of them in the nearest waste receptacle after use; and c) c) Perform hand hygiene (e.g. handwashing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic handwash) after having contact with respiratory secretions and contaminated objects/materials. o Staff should teach respiratory hygiene/cough etiquette to residents, family members and visitors as needed. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Environmental Hygiene o Cleaning and disinfecting non-critical surfaces in resident care areas are part of standard precautions. o The cleaning and disinfection of frequently touched or high touched surfaces (e.g. bedrails, bedside tables, commodes, doorknobs, sinks, surfaces and equipment) is important, especially those closest to the patient. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Safe Handling of Equipment, Instruments and Devices o Equipment/instruments/devices used on patients can become contaminated via simple contact but also via blood, body fluids, secretions and excretions during the delivery of care. o Medical equipment and instruments/devices must be cleaned and maintained according to the manufacturer’s instructions to prevent patient-to-patient transmission of infectious agents. o Commodes, intravenous pumps and ventilators must be thoroughly cleaned and disinfected before use on another resident. o All such equipment and devices should be handled in a manner that will prevent HCWs from contacting infectious material. It is also important to clean electronic devices (e.g. computers and mobile tablets) used in LTCFs. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Linen and Waste Management o Soiled linen and waste should be handled carefully to prevent cross contamination to HCWs and other patients. o Waste should be bagged in impervious bags and segregated according to the national regulation. o Soiled linen should be handled as little as possible. o Gloves should be worn when handling linen soiled with blood or body fluids. o Linen shall be bagged in an impervious bag and placed in the designated location in the facility or into the washing machine. o Soluble bags are not necessary. o Washing cycle temperature should reach 65⁰C for at least ten minutes, or 71⁰C for at least three minutes. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Linen and Waste Management o Soiled linen and waste should be handled carefully to prevent cross contamination to HCWs and other patients. o Waste should be bagged in impervious bags and segregated according to the national regulation. o Soiled linen should be handled as little as possible. o Gloves should be worn when handling linen soiled with blood or body fluids. o Linen shall be bagged in an impervious bag and placed in the designated location in the facility or into the washing machine. o Soluble bags are not necessary. o Washing cycle temperature should reach 65⁰C for at least ten minutes, or 71⁰C for at least three minutes. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Hand Hygiene o Hand Hygiene is the most important and effective procedure to prevent and control the spread of hospital associated infections (HAIs). o In the context of a residential area where communal activities are common, 4 moments of hand hygiene should be practiced instead i.e. exclude after touching patient’s surroundings. o Methods of Hand Hygiene Effective hand hygiene kills or removes transient bacteria on the skin via any of the following two methods: a) Use of an alcohol-based hand rub (ABHR); and b) b) Hand washing with soap and running water. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021 Guidelines and principles in infection control National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021 Guidelines and principles in infection control National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Indications for Hand Hygiene o “Your moments for Hand Hygiene” is designed by WHO to guide residential home Healthcare professionals (HCWs) and volunteers on the fundamental moments for hand hygiene. (See Figure 6.3). National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021 Guidelines and principles in infection control  Guidelines and principles in infection control Indications for Hand Hygiene o Many of the activities in LTCFs are shared. o Examples of opportunities for hand hygiene in LTCFs would include: a) Before beginning and after ending group activities (some residents may need help cleaning their hands before they begin and after they end an activity) b) b) Before assisting with meals or snacks c) c) After exposure of the hands to saliva or mucous membranes National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Indications for Hand Hygiene for residents and visitors Patients and visitors should be given teaching on indications for hand hygiene: a) Before meals or drinks b) Before touching eyes, nose, or mouth c) Before and after changing wound dressings or bandages d) After using the toilet or commode e) After blowing nose, coughing, or sneezing f) After touching hospital surfaces such as bed rails, bedside tables, doorknobs, remote controls, or the phone g) Before and after significant contact with other residents National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Indications for Hand Hygiene for residents and visitors Patients should be also encouraged to: a) Ask staff about hand hygiene practices b) Participate in hand hygiene c) Ask family and visitors to clean their hands when they visit them d) Ask sick family or visitors to refrain from visiting National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Disinfection and Cleaning o Routine cleaning and disinfection are necessary to maintain a standard of cleanliness, reduce microbial contamination and control or minimize the spread of infectious agents from infected/colonized patients to other patients or healthcare workers (HCWs). o Medical equipment also requires decontamination for safe resident care. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Environmental Hygiene o All surfaces in health care settings have the potential to harbour pathogenic microorganisms. o It is essential to maintain a routine and consistent basis of cleanliness and environmental hygiene in healthcare settings including LTCFs. o Routine housekeeping can reduce or control the spread of infectious agents. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Sample guide on cleaning procedure on Blood and body fluid spills 1. Assemble the materials/spill kit required for dealing with the spill prior to putting on PPE 2. Thorough inspection on the area around the spills for splatters or splashes 3. Restrict activity around the spill until the affected surroundings have been cleaned, disinfected and allowed to dry 4. Don PPE appropriately 5. Wipe up the blood or body fluids spill immediately with disposable towels. Dispose of the materials into regular waste receptacle, unless the soiled materials are so soaked that blood can be squeezed out of them, and they must be segregated into biohazard waste (i.e. yellow bag). 6. Disinfect the entire spill area used by the individual LTCFs or as recommended. 7. Wipe up the area again using disposable towels and discard the materials into regular waste. 8. Care to be taken to avoid unnecessary splashing during the clean-up. 9. Remove PPE and perform hand hygiene. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Routine Cleaning Routine cleaning and disinfection regimens are based on: a) Whether surfaces are high-touch or low-touch b) Type of activity taking place in the area and the risk of infection associated with it (e.g. isolation room vs meeting room) c) Vulnerability of residents housed in the area d) Risk of contamination of body fluid contamination of surfaces in the area External areas including balcony and garden should be kept clean and adhere to NEA guidelines in vector control. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control High-touch Surfaces o High-touch surfaces require more frequent cleaning and disinfection than minimal contact surfaces. E.g. nurse’s station, doorknobs, call bells, bedrails, light switches, computer keyboards, and medication cart. o Cleaning and disinfection is usually done at least daily and more frequently if the risk of environmental contamination is higher. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Low-touch Surfaces o Low-touch surfaces are those that have minimal contact with hands. Examples include floors, walls, wall clock, ceilings, mirrors and windowsills. o Low-touch surfaces require cleaning on a regular (but not necessarily daily) basis. o However, prompt and appropriate cleaning is required when surfaces are visibly soiled, and when patient is discharged from the healthcare setting. o Follow manufacturer’s recommendations for equipment cleaning. National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Guidelines and principles in infection control Personal Hygiene To ensure personal hygiene, wash hands thoroughly with soap and water: a) before handling any food items or utensils b) before and after preparing food, especially raw meat, poultry and seafood c) before handling cooked or ready to eat food d) after blowing nose, sneezing or coughing e) after using the toilet f) after handling waste or touching rubbish bins National Infection Prevention Control Guidelines for Long Term Care Facilities, 2021  Falls precaution when conducting assessment 1. Check for giddiness/lightheadedness at rest 2. Vitals signs are stable 3. Environment (obstacle-free, no spillage) 4. Lighting is good 5. Appropriate footwear (remove socks if necessary) 6. Provide assistive aids if necessary (grab bars/manual support)  Safety Precautions when conducting assessment Reasons for immediately stopping include the following: 1. chest pain, 2. intolerable dyspnea, 3. leg cramps, extreme leg muscle fatigue 4. staggering, evolving mental confusion or lack of coordination 5. diaphoresis/excessive sweating, 6. pale or ashen appearance 7. Giddiness/Lightheadedness 8. Persistent SpO2 < 85%. 9. Any other clinically warranted reason  Safety Precautions when conducting assessment 1. Access to rapid appropriate response equipment Crash cart Phone 2. Supplies of oxygen, GTN, aspirin, albuterol (MDI, nebulizer) 3. BCLS certification 4. ACLS certification 5. Doctors may or may not be present 6. Chronic oxygen therapy dosage depends on physician or protocol  Common Medical Terminologies Vital signs – includes temperature, respirations, pulse and blood pressure. Indicate the body’s ability to regulate body temperature, maintain blood flow and oxygenate tissues. Blood Pressure – is the force exerted by the blood on the walls of the blood vessels as the heart contracts or relaxes. Pulse Rate – the waves of blood that cause pulsation through the arteries are palpable as a pulse, which can be felt when a superficial artery is partially compressed by fingers. Body Temperature – the human body is warm blooded with inbuilt mechanisms that maintain a balance between heat production and heat lost. Diabetes Mellitus – is a disorder of glucose regulation characterised by abnormal metabolism of carbohydrates.  Common Medical Terminologies Body Mass Index (BMI) – provides guidelines for healthy weight ranges as well as therapeutic ranges for blood cholesterol and blood sugar. Skin sensation – the dermis of the skin are sensory receptors which are stimulated by heat, cold and touch, including pressure. Tachycardia– is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Bradycardia – Bradycardia is a condition wherein an individual has a slow heart rate, typically defined as a heart rate of under 60 beats per minute (BPM) in adults. Hypertension – also known as high blood pressure, is a long-term medical condition in which the blood pressure in the arteries is persistently elevated systolic reading of above 160mmHg. Hypotension –is the medical term for low blood pressure with systolic reading of 8mmol/l)level. It is a indicating sign of diabetes Hypoglycaemia- also known as low blood sugar, is when blood sugar decreases to below normal levels (< 4mmol/l). This may result in a variety of symptoms including clumsiness, trouble talking, confusion, loss of consciousness, seizures, or death. Normal & Abnormal ranges of Blood Pressure (Hypertension) Normal & Abnormal ranges of Blood Pressure (Hypotension) o A blood pressure reading lower than 90mmHg for systolic or lower than 60mmHg for diastolic is generally considered as Low Bloor Pressure (Hypotension).  Heart/Pulse Rate: A Vital Sign o A normal resting heart rate for adults ranges from 60 to 100 beats a minute. o A normal resting heart rate of children ranges from 80 to 100 beats/min for 3-4 year old. o Generally, a lower heart rate at rest implies more efficient heart function and better cardiovascular fitness. Maximum heart rate chart: o Heart rate can be taken from palpating the radial pulse at the https://www.health.harvard.edu wrist, carotid pulse on the neck and other arteries. /heart-health/what-your-heart- rate-is-telling-you o The rate at which the heart is beating when it is working its hardest to meet the body's oxygen needs is known as the maximum heart rate. Maximum heart rate plays a major role in setting aerobic capacity—the amount of oxygen are able to consume. Normal & Abnormal ranges of Heart rate (Bradycardia & Tachycardia) Normal & Abnormal ranges of Oxygen Saturation levels ("Safe, Normal, Low Blood Oxygen Levels: Pulse Oximeter Chart", 2022)  Normal & Abnormal ranges of Oxygen Saturation levels Blood Oxygen Levels: Chart o Oxygen levels are measured according to the percentage of oxygen saturated in your blood. This is called your SpO2 level.  Normal & Abnormal ranges of Oxygen Saturation levels Normal Blood Oxygen Levels o For medical purposes, a normal blood oxygen saturation rate is often considered between 95% and 100%. However, you may not experience any symptoms if your percentage is lower. 'Concerning' Blood Oxygen Levels o Oxygen concentrations between 91% and 95% may indicate a medical problem. People in this situation should contact their healthcare provider.  Normal & Abnormal ranges of Oxygen Saturation levels Low Blood Oxygen Levels o The medical definition of a low blood oxygen rate is any percentage below 90% oxygen saturation. Oxygen saturation below 90% is very concerning and indicates an emergency. Call 995 immediately if you or someone you know experiences such a low blood oxygen level. When Low Oxygen Saturation Affects Your Brain o By the time your oxygen saturation has fallen to between 80% and 85%, your brain may be affected by the lack of oxygen. You may also experience vision changes.  Normal & Abnormal ranges of Oxygen Saturation levels Cyanosis o The first visible symptoms of low blood oxygen, cyanosis causes a blue tinge to develop on your skin, particularly around your mouth and lips and beneath your fingernail matrix. This change occurs when your blood oxygen saturation reaches approximately 67%. Normal & Abnormal ranges of Blood Glucose  Normal & Abnormal ranges of Blood Glucose A blood sugar level less than 140 mg/dL (7.8 mmol/L) is normal. A reading of more than 200 mg/dL (11.1 mmol/L) after two hours indicates diabetes. A reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) indicates prediabetes. o Random blood sugar test. A blood sample will be taken at a random time. Regardless of when you last ate, a blood sugar level of 200 milligrams per deciliter (mg/dL) — 11.1 millimoles per liter (mmol/L) — or higher suggests diabetes.  Normal & Abnormal ranges of Blood Glucose o Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. o Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood sugar levels are tested periodically for the next two hours  Factors affecting vital signs o Gender: Women usually experience greater temperature fluctuations than men because of hormonal changes. Temperature variations occur during the menstrual cycle mainly in response to the progesterone level. o Race: Some ethnic groups are more susceptible than others to homodynamic alterations. The incidence of hypertension is higher in African- Americans than in European Americans.  Factors affecting vital signs o Lifestyle: Lifestyle factors, such as cigarette smoking, cause chronic changes in the lungs as manifested by impaired ventilation. Stimulants such as caffeinated beverages and tobacco elevate heart rate. The effects of exercise and stress are discussed below. o Environment: Environmental factors such as temperature and noise level can alter heart rate. o Medications: Some medications can directly or indirectly alter the pulse, respirations, or blood pressure. Digitalis preparations (cardiac glycosides) decrease the pulse rate. Narcotic analgesics (pain medications) can depress the rate and depth of respirations and lower the blood pressure. Factors affecting blood glucose levels Blood glucose level rises when: o Too much food, like a meal or snack with more carbohydrates than usual o Not being active o Not enough insulin or oral diabetes medications o Side effects from other medications, such as steroids, anti-psychotic medications o Illness – body releases hormones to fight the illness, and those hormones raise blood glucose levels o Stress, which can produce hormones that raise blood glucose levels o Short- or long-term pain, like pain from a sunburn – body releases hormones that raise glucose levels o Menstrual periods, which cause changes in hormone levels o Dehydration Factors affecting blood glucose levels Blood glucose level drops/ becomes lower when: o Not enough food, like a meal or snack with fewer carbohydrates than usual, missing a meal or snack o Alcohol, especially on an empty stomach o Too much insulin or oral diabetes medications o Side effects from other medications o More physical activity or exercise than usual – physical activity causes the body more sensitive to insulin and can lower blood glucose. Documentation format & requirements for SUBJECTIVE ASSESSMENT Subjective o This component is in a detailed, narrative format and describes the patient's self-report of their current status in terms of their current condition/complaint, function, activity level, disability, symptoms, social history, family history, employment status, and environmental history. It may also include information from the family or caregivers and if exact phrasing is used, should be enclosed in quotation marks. The patient's goals and prior response to treatment intervention are also included. Medical information obtained from the patient's chart can also be included the therapist has not directly observed these findings. Documentation format & requirements for SUBJECTIVE ASSESSMENT Subjective o It allows the therapist to document the patient's perception of their condition as it relates to their progress in rehabilitation, functional performance, or quality of life. o Common errors: Passing judgment on a patient e.g. "Patient is over- reacting again". Documenting irrelevant information e.g. patient complaining about previous therapist. o Example of a “S” documentation: S: Pt. reports not feeling well today, "I'm very tired". Pt also reports periodic pain on his left shoulder of VAS 6/10. Documentation format & requirements for VITAL SIGNS Objective o This section outlines what the therapist observes, tests, and measures. Objective information must be stated in measurable terms. Using measurable terms helps in reassessment after treatment to analyze the progression of the patient and hindering as well as helping factors. o [VITAL SIGNS & Blood Glucose will be documented under “O”]. Documentation format & requirements for VITAL SIGNS Objective o The objective results of the re-assessment help to determine the progress towards functional goals, and the effect of treatment. The therapist should indicate changes in the patient's status, as well as communication with colleagues, family, or carers. o Common errors: Scant detail is provided. Global summary of an intervention e.g. "ROM exercises given". o Example of a “O” documentation for Vital Signs: O: Temp: 36.5; RR: 13bpm; BP: 132/80mmHg; PR: 65bpm; Fasting Blood Glucose: 5.8 mmol/L References Ahuja, D. (2020). The art of a subjective assessment. Retrieved 25 February 2022, from https://physioguru.com/physiotherapy-blog/the-art-of-a-subjective-assessment American Diabetes Association. “Factors Affecting Blood Glucose“. Online: http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose- control/factors-affecting-blood-glucose.html Australian and New Zealand College of Anaesthetists (ANZCA) 2005. Acute pain management; scientific evidence. Bennett, M. (2001) The LANSS pain scale; the Leeds assessment of neuropathic symptoms and signs. Pain; 92: 1-2, 147-157. ARUN PAL SINGH. BONE&SPINE.COM: Visual Analog Scale For Pain. 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