Ptha 1405 - Basic Patient Care - Pierson And Fairchild Book And Hays Lecture - Exam 4

Front 1

What factors are associated with the selection of wheelchair type and components? ***

Back 1

- patient’s disability and functional ability
- mental and physical condition or capacity of the patient
- potential or prognosis for change in the patient’s condition, especially as it affects mobility

- patient’s age, size, stature, and weight
- temporary vs. permanent use
- expected use or patient needs of the wheelchair (e.g., indoors, outdoors, recreation, transfer needs, ability to transport the chair)

Front 2

Wheelchair seat types ***

Back 2

- sling – tends to adduct and IR hips (potential cause of contractures)
- firm – eliminates adduction/IR
- cushion – on a sling seat, eliminates adduction/IR
- abduction/adduction supports

Front 3

Wheelchair seat back types and factors to consider ***

Back 3

(should be below scapulae!)
- sling vs. firm (sling encourages slouching)

- stationary, reclining (postural hypertension, hip replacement), semi-reclining, tilt in space. Pg. 148

- height
- head rest if needed
- trunk – lateral supports

Front 4

Wheelchair restraint types ***

Back 4

(permission required for restraint!)
- lap belt (seat belt) usually at 45˚
- chest
- various closures

Front 5

Wheelchair armrest types ***

Back 5

- fixed or removable
- adjustable
- desk top, full length

Front 6

Wheelchair leg rests, front rigging and footplate types ***

Back 6

- fixed to frame or detachable
- swing away
- elevating leg rests – use for patients with restricted motion, edema, vascular patients

- tubular
- foot plates
- heel/toe loops, ankle straps

Front 7

Wheelchair wheel types ***

Back 7

- 20 – 26 inches, 24 inch standard
- tires: hard rubber, pneumatic or semi-pneumatic

- drive wheel camber, especially if in chair long-term
- casters – usually on front of wheelchair

Front 8

Wheelchair handrim types ***

Back 8

- used by patient to propel; no part of hand should be on the wheel
- chrome (slippery, not for weak grip), friction coated, projections (horizontal or vertical)

- one-arm drive
- power assist axle – Pg. 144

Front 9

Wheelchair frame types ***

Back 9

- standard folding frame
- rigid frame
- heavy duty – obese patients
- light-weight (aluminum)
- ultra light weight (titanium)

Front 10

Wheelchair brake types ***

Back 10

- lever (high mount)
- scissor
- extensions - for weaker pt, or post back surgery (shouldn’t be twisting)

Front 11

Wheelchair accessories ***

Back 11

- lap trays
- anti-tips
- extended push handles – for child-sized chairs (so you're not bending in half to get down to the handles to push)
- hill grades - pg. 142 (7-10)
- spoke protectors

Front 12

Types of wheelchairs ***

Back 12

- standard adult
- heavy-duty adult (bariatric; >200 lbs)

- intermediate or junior (small adult)
- growing (adjustable for next 3 years)
- child or youth

- indoors
- sports
- reclining

- “hemiplegic”: able to pull along with 1 leg; lower to ground, but makes transfers more difficult
- “amputee”- counteracts loss of weight of LE
- one-hand drive

Front 13

Proper seating and positioning in a wheelchair should.... ***

Back 13

- promote function
- prevent deformity
- improve body alignment
- prevent tissue damage (protective cushion, pressure relief)
- prevent additional complications

Front 14

Describe proper sitting posture in a wheelchair. ***

Back 14

- hips at 90 degrees
- feet flat
- ankles neutral

Front 15

Proper seat height for wheelchair ***

Back 15

measure from user's heel to popliteal fold and add two inches for footrest clearance

(average adult will be about 19.5 - 20.5 inches)

Front 16

Proper seat depth for wheelchair ***

Back 16

measure from user's posterior buttock, along the lateral thigh, to the popliteal fold, then subtract 2 inches to avoid pressure from the front edge of the seat against the popliteal space

(average adult will be about 16 inches)

Front 17

Proper seat width for wheelchair ***

Back 17

measure the widest aspect of the user's buttocks, hips, or thighs, and add 2 inches to provide space for bulky clothing, orthoses, or clearance of the trochanters from the armrest side panel

(average adult will be about 18 inches)

Front 18

Proper back height for wheelchair ***

Back 18

measure from the seat of the chair to the floor of the axilla with the user's shoulder flexed to 90 degrees, and then subtract 4 inches to allow the final back height to be below the inferior angles of the scapulae

(average adult will be about 16-16.5 inches)

NOTE: This measurement will be affected if a seat cushion is to be used--either measure the person while seated on the cushion or add the value of the thickness of the cushion to the measurement.

Front 19

Proper armrest height for wheelchair ***

Back 19

measure from the seat of the chair to the olecranon process with the user's elbow flexed to 90 degrees, then add 1 inch

(average adult will be about 9 inches)

NOTE: This measurement will be affected if a seat cushion is to be used--either measure the person while seated on the cushion or add the value of the thickness of the cushion to the measurement.

Front 20

How should patient be seated during wheelchair fit confirmation? ***

Back 20

- chair should be on a level, smooth surface

- patient must sit erect with pelvis in contact with back upholstery

Front 21

How are wheelchair seat height and leg length fit confirmed? ***

Back 21

- with hand parallel to floor, you should be able to insert 2-3 fingers lengthwise between the posterior area of the patient's thigh and the seat upholstery to a depth of approximately 2 inches

- bottom of the footplate must be at least 2 inches above the floor

Front 22

How is wheelchair seat depth confirmed? ***

Back 22

with your hand parallel to the floor, you should be able to place the width of 2-3 fingers between the front edge of the seat and the popliteal fold

Front 23

How is wheelchair seat width confirmed? ***

Back 23

with your hands vertical to the floor, you should be able to slide each hand between the patient's hips and the clothing guard of the chair with minimal contact

Front 24

How is wheelchair back height confirmed? ***

Back 24

with your hand vertical to the floor, you should be able to place the width of four fingers between the top of the back upholstery and the floor of the axilla

Front 25

How is wheelchair armrest height confirmed? ***

Back 25

- observe the angle made by the posterior aspect of the upper arm and the back post when the elbows rest on on the armrest approximately 4 inches in front of the back post

- observe the position of the shoulders; they should be level

- observe the position of the trunk; it should be erect

Front 26

How is hip angle adjusted? ****

Back 26

by raising or lowering the foot rests

Front 27

How are armrests adjusted? ***

Back 27

by pushing the buttons and selecting a higher/lower hole

Front 28

Body mechanics ***

Back 28

use of one’s body to produce motion that is safe, energy-conserving, and anatomically and physiologically efficient and that maintains body balance and control

Front 29

Base of support ***

Back 29

the area on which an object rests and which provides support for the object

Front 30

Center of gravity ***

Back 30

- the point at which the mass of a body or object is centered

- for the human body, the COG is approximately 2nd sacral vertebra

Front 31

Lever arm ***

Back 31

- a component of a mechanical lever

- it may be the force arm or the weighted (resistance) arm

- when the length of the force arm is increased or the length of the weight arm is decreased, a greater mechanical advantage is created for the lever system.

Front 32

Lordosis ***

Back 32

- an increase in one of the forward convexities of the normal vertebral columns

- a lumbar or cervical lordosis can occur

Front 33

Pelvic tilt (inclination) ***

Back 33

- movement of the pelvis so the anterior superior iliac spines move anteriorly or posteriorly to produce an anterior or a posterior tilt or inclination of the pelvis

Front 34

Vertical gravity line (VGL) ***

Back 34

an imaginary vertical line that passes through the center of gravity of an object

Front 35

List the principles of proper body mechanics ***

(These are also the precautions for lifting, reaching for, pushing, pulling, or carrying an object.)

Back 35

- roll, push, pull, or slide an object instead of lifting it
- perform all activities within your physical capability
- mentally and physically plan the activity before attempting it

- position yourself close to the object to be moved to use short lever arms
- maintain your vertical gravity line within your BOS to maintain stability and balance
- position your COG close to the object's COG to improve control of the object

- use the major muscles of the extremities and trunk (quads, hamstrings, abs, glutes) to perform movements or activities and maintain your normal lumbar lordosis
- avoid simultaneous trunk flexion and rotation when lifting or reaching

- do not lift an object immediately after a prolonged period of sitting, lying, or inactivity; perform some gentle stretches for the back/LE first
- when performing a lift with two or more persons, instruct everyone how and when they are to assist; use a mechanical lift if one is available (person at head is in charge if moving a person)

Front 36

Common causes of back problems ***

Back 36

- faulty posture
- faulty, improper use of body mechanics
- improper lift, push, pull, reach or carry

- decline in general physical fitness
- poor flexibility of muscles and ligaments of the back and trunk

- stressful living and work habits--inability to relax or staying in a prolonged posture

- repetitive, sustained microtrauma to structures of the back and trunk
- episodes of trauma that culminate in one specific or final event ("the final straw"); stress, strain, or tear of muscle or ligament; disk may change shape and impinge on nerve roots; vertebral joints may become irritated

Front 37

Guidelines for lifting activities ***

Back 37

- move the object by pushing, pulling, sliding, or rolling rather than by lifting when possible; push rather than pull
- mentally plan the lift; be certain you can safely lift the object without assistance; have sufficient space to perform the lift, and test the weight of the object before you lift it

- stoop or squat to lift any object below the level of your hips
- widen your feet to increase your BOS and improve your balance and stability
- move close to the object before you lift; keep it close to your body as you lift or carry it (COG)
- Maintain the lumbar curve in your lower back as you lift; do not flatten your lower back

- do not lift and twist your back simultaneously; instead, pivot when you need to turn
- do not lift quickly or with a jerky motion

- avoid repetitive and sustained lifting; use equipment or assistance to lift heavy objects
- use care when removing groceries, tools, or other items from the trunk of a car; do not bend at the waist and lift; bend your hips and knees slightly, and move the object close to you before lifting it

Front 38

Guidelines for pushing and pulling activities ***

Back 38

- crouch and face the object squarely

- use your arms and legs to push or pull; push with your arms partially flexed

- push or pull in a straight line; your force should be parallel to the floor

- be certain there are no objects in your path and doorways are wide enough for the object to pass through

Front 39

Guidelines for reaching activities ***

Back 39

- stand on a footstool or ladder to reach or place an object above your head

- move the object close to you or move close to the object before grasping, lowering, or raising it; be certain you will be able to control the object safely

- hold the object close to your body as you step down from or onto the footstool (COG)

- do not simultaneously reach and twist your body

Front 40

Guidelines for carrying activities ***

Back 40

- carry all objects holding them close to your body; the best positions are in front of your body at the level of your waist or mid-chest, or on your back

- balance the load whenever possible
- when a backpack is used, apply both shoulder straps
- if you carry an object in one hand (e.g., a suitcase) alternate carrying it in one hand and then in the other; do not twist your back when moving the object from one hand to the other; stoop to lift it from the floor

- some bulky or heavy objects can be carried on your shoulders, especially if you must carry them for a substantial distance

- avoid carrying or balancing a small child on one hip; use an infant carrier, or hold the child close to your chest or on your back using an approved child carrier

Front 41

Principles of proper posture ***

Back 41

- maintain normal anterior and posterior curves of the spine for proper balance and alignment

- stand with your ankles, knees, hips, and shoulders aligned; keep your head over your body, not in front of the shoulders
- stand with abdominal wall flat, head in neutral, shoulders level, chin parallel to the floor and slightly tucked, and your body weight evenly placed on each leg; keep your knees slightly flexed; and maintain lumbar lordosis
- stand and sit with your body erect so the shoulders and pelvis are level; avoid slouching or "round back" positions

- sit with your head in neutral, chin tucked or parallel to the floor, and elbows, knees, and hips flexed to 90 degrees with your feet flat on the floor or supported in a slightly inclined position; your forearms and low back curve should be supported during prolonged sitting; avoid slouching or kyphotic posture
- avoid standing or sitting in one position for a prolonged time; occasionally alter the position; move your head, neck, shoulders, back hips, knees, and ankles periodically

- when supine or partially side-lying, flex the hips and knees; use a pillow under or between the knees for support and avoid lying prone; use a small or medium-sized pillow to support your head, but do not position it under the shoulders; use a bed mattress that is firm and provides support to the natural curves of the spine

Front 42

Guidelines to reduce stress-producing positions or activities ***

Back 42

- alter your posture or position frequently; avoid prolonged standing or sitting

- avoid bending at the waist while working, washing your face, brushing your teeth, or performing activities that are below your waist (e.g., bathing children in a bathtub, removing clothes from washer/dryer); sit, stoop, or kneel instead of bending

- for activities that require prolonged standing, use a cushioned mat and wear low-heeled shoes with good arch supports; place one foot on a footstool or railing, and alternate feet occasionally for comfort (as when ironing or washing dishes); perform a 30-second exercise routine every hour that includes low back flexion/extension, hip and knee flexion (knee to chest while standing), neck extension, lateral bending, and shoulder ROM in all planes

- when seated at a work station for prolonged periods, keep elbows, knees and hips level and bent at 90 degrees; feet should be flat on the floor or supported at a slight incline; forearms should be supported by armrests, and the back should be supported by the chair back or a lumbar roll

- When seated at a computer terminal, the vision display terminal should be directed about 10 degrees below horizontal; the chair used should encourage a supported lumbar lordosis with a seat pan that is tilted slightly forward; the keyboard should be pushed forward to permit the arms to rest in front of it, ideally with the wrists supported on a padded surface; performing a 1-minute exercise break every hour to include neck flexion/extension and lateral bending stretching exercises, chin tucks, wrist flexion and extension stretches, shoulder pendulum exercises, tennis elbow stretch, and standing back bends is recommended

- enter and leave an automobile with a sideward, rather than a twisting motion of the trunk; adjust the car seat so your knees are at the same level as or slightly higher than your hips, your chin tucked and head held erect; use a lumbar support; stop frequently when driving long distances to walk or stretch your arms, legs, and back

Front 43

Transfer definition ***

Back 43

the safe movement of a person from one surface or location to another or from one position to another

Front 44

Transfer training definition ***

Back 44

to teach(!) a patient how to successfully transfer from one surface to another, with the goal of maximum independence of the patient

Front 45

Impairment terminology ***

Independent definition

Back 45

patient is able consistently to perform skill safely with no one present

Front 46

Impairment terminology ***

Supervision definition

Back 46

patient requires someone within arm's reach as a precaution; low probability of patient having a problem requiring assistance

Front 47

Impairment terminology ***

Close guarding definition

Back 47

person assisting is positioned as if to assist, with hands raised but not touching patient; full attention on patient; fair probability of patient requiring assistance

Front 48

Impairment terminology ***

Contact guarding definition

Back 48

therapist is positioned as with close guarding, with hands on patient but not giving any assistance; high probability of patient requiring assistance

Front 49

Impairment terminology ***

Minimum assistance definition

Back 49

patient is able to complete majority of the activity without assistance

Front 50

Impairment terminology ***

Moderate assistance definition

Back 50

patient is able to complete part of the activity without assistance

Front 51

Impairment terminology ***

Maximum assistance definition

Back 51

patient is unable to assist in any part of the activity

Front 52

Descriptive terminology ***

Bed mobility

Back 52

independent - no cuing* is given

the following may require cues:
- supervision
- minimum assistance
- moderate assistance
- maximum assistance

* types of cues: verbal, visual, or tactile; in some cases (e.g., person with memory deficit, short attention, learning disability, visual loss) a decrease in the number of cues may represent treatment progress, even though the level of dependence remains the same

interim progress notes can denote these changes by citing frequencies (e.g., 2/3 tries or an arbitrarily defined rank order scale (e.g., always/occasionally/rarely)

Front 53

Descriptive terminology ***

Transfers: ambulation

Back 53

independent - no cuing* is given

the following may require cues:
- supervision
- close guarding
- contact guarding
- minimum assistance
- moderate assistance
- maximum assistance

* types of cues: verbal, visual, or tactile; in some cases (e.g., person with memory deficit, short attention, learning disability, visual loss) a decrease in the number of cues may represent treatment progress, even though the level of dependence remains the same

interim progress notes can denote these changes by citing frequencies (e.g., 2/3 tries or an arbitrarily defined rank order scale (e.g., always,/occasionally/rarely)

Front 54

Balance definitions ***

Normal

Back 54

patient is able to maintain position with therapist maximally disturbing balance

Front 55

Balance definitions ***

Good

Back 55

patient is able to maintain position with therapist moderately disturbing balance

Front 56

Balance definitions ***

Fair

Back 56

patient is able to maintain position for short periods of time unsupported

Front 57

Balance definitions ***

Poor

Back 57

patient attempts to assist but requires assistance from other person to maintain position

Front 58

Balance definitions ***

No balance

Back 58

patient is unable to assist in maintaining position

Front 59

What should be done with the patient's medical records and other health care providers before a transfer? ***

Back 59

- read PT's evaluation and daily progress notes

- communicate with the nurse/other pertinent HC providers, and the patient before transfer regarding current status

Front 60

What types of things should be assessed pre-transfer? ***

Back 60

- physiological condition
- mobility
- strength/endurance
- balance
- comprehension
- motivation

Front 61

What factors should be assessed with respect to physiological condition pre-transfer? ***

Back 61

- if it is first time up since surgery
- if they have postural hypotension
- if they have low HG or lower) and/or RBC counts
- if they have fatigue, pallor, SOB
- if they have/had a sudden onset of headache (may be high BP) and/or nausea

Front 62

What factors should be assessed with respect to mobility pre-transfer? ***

Back 62

- if any joint motions are restricted

- if there are flexion contractures present

Front 63

What factors should be assessed with respect to strength/endurance pre-transfer? ***

Back 63

whether fatigue or weakness will prevent completion of the transfer

Front 64

What factors should be assessed with respect to balance pre-transfer? ***

Back 64

- if the patient has a tendency to fall or lean to one side

- if there is hemiparesis present (CVA/CHI/TBI)

Front 65

What factors should be assessed with respect to comprehension pre-transfer? ***

Back 65

if the patient is
- lethargic
- confused
- combative
- visual- or hearing-impaired

Front 66

What factors should be assessed with respect to motivation pre-transfer? ***

Back 66

- whether patient is cooperative, willing, medicated

- whether patient is agitated, in pain, fearful, depressed

Front 67

What are some general transfer principles? ***

Back 67

- predetermine patient's mental and physical capabilities to perform the transfer, including weight-bearing status
- patient's clothing and footwear should be suitable for the transfer
- mentally pre-plan the activities and sequence associated with the transfer; teach and practice components of the transfer before attempting the transfer
- instruct the patient slowly and concisely; allow time for the patient to process and apply the information
- select, position, and secure needed equipment; apply a safety belt
- be alert for unusual events that may occur
- do not guard the patient using clothing or grasping the arm; use the safety belt and trunk
- position yourself to guard, guide, direct, and protect the patient throughout the transfer
- request the patient to initiate and perform the transfer in simple, directive terms; assist as necessary
- at the conclusion of the transfer, position the patient for comfort, stability, and safety; document changes in the patient's performance

Front 68

If WB status is unknown, what is assumed? ***

Back 68

NWB

Front 69

How is WB status described? ***

Back 69

- NWB
- TTWB
- PWB
- WBAT
- in pounds or % of body weight (use scale so they get a feel for it)

Front 70

What precautions should be taken prior to transfer training? ***

Back 70

- know WB status

- ensure all extraneous attachments are taken care of (casts, IVs, catheter bags, drainage/feeding tubes, armrests, footrests, orthotic devices, etc.)

- use care with the transfer belt, especially in cases of:
---- recent colostomy/iliostomy
---- severe cardiac or respiratory conditions
---- recent abdominal, chest, or back surgery

- do not allow patient to hang on your neck!!

Front 71

What should you not allow patient to do to you during transfer training? ***

Back 71

hang on your neck

Front 72

What conditions require special precautions during transfers? ***

Back 72

- total hip replacement (esp during initial 2 weeks after surgery)
- low back trauma or discomfort
- spinal cord injury
- burns
- hemiplegia

Front 73

What special precautions are required during transfers for a total hip replacement patient? ***

Back 73

the hip should not be
- adducted
- rotated
- flexed more than 90 degrees
- extended beyond neutral flexion-extension

do not
- cross the ankles/knees
- pull on the affected extremity
- allow the patient to lie on the replaced hip

keep hip
- abducted when moving and side lying (non-affected side)
- in semireclining position
- separated with abduction pillow

Front 74

What special precautions are required during transfers for a patient with low back trauma or discomfort? ***

Back 74

- avoid excessive lumbar rotation, lateral bending and flexion

- may be less painful to "logroll" when turning

- may be more comfortable with hips and knees partially flexed when supine or side-lying

Front 75

What special precautions are required during transfers for a patient with a spinal cord injury? ***

Back 75

- injury site may be protected by external device (brace, plaster/plastic body jacket or halo), internal fixation (bone graft, metal rods, wires), or a combination of the two; distracting and rotational forces should be avoided

- logrolling probably better than segmental turning

- protective positioning or restraints will be required when this patient is in a side-lying position or sits without a back support

- for patients with injuries that occurred months or years earlier, be aware that osteoporosis, especially in the long bones of LE and vertebral bodies, may be present and even mild to moderate stress or strain may lead to fracture

- be aware this patient may experience syncope when transferred from a supine to a sitting position b/c the blood pressure may not adapt to the positional change

Front 76

What special precautions are required during transfers for a patient with burns? ***

Back 76

- primary precaution is to avoid creating shear forces across surface of burn wound, graft site, or area from which the graft was taken

- sliding creates shear force, causing friction and disruption of the healing process

- patient should be instructed to elevate the body or extremities when moving an area with a burn to avoid shear forces

Front 77

What special precautions are required during transfers for a patient with hemiplegia? ***

Back 77

- pulling on the involved or weakened extremities to control or move the patient should be avoided, particularly for the affected shoulder, because the muscles will not provide adequate support to the joint due to the effects of paralysis

- many patients experience pain or discomfort when they lie on or roll over the involved shoulder