Sleep
Based roughly on a 24-hour clock and use environmental cues, such as light and temperature to determine the time of day
Circadian rhythms
When lifting__________
Bend with knees- not back, position items to waist height, don't reach, or twist, ask pt to help, use wide base, smooth coordinated motion, keep trunk straight
Pt is lying flat on back____
Then sits up to a 45-90 degree____
head is lower than feet
supine
fowlers
Trendelenburg
what ever your patient says it is and when
Trouble sleeping, daytime sleepiness, low energy, irritability, depressed mood
Factors that influence a person’s sleep and wakefulness
medical conditions, medications, stress, sleep environment, foods and fluids consumed, and LIGHT
Principles of ROM
involves extremities and joints, use passive, active, active assist, do at least 2x day, 10-15x for count of 15 sec., support limb above and below,
Patient is having difficulty breathing so you position?
Tripod or high fowlers
PQRSTU
Provocation/Palliation, Quality, Region, Severity, Timing/Treatment, Understanding
sleep in own bed, reduced lights, avoid bedtime food esp sugary, adjust noise level, lights, use white noise machine, use a favorite toy/blanket to sleep with, follow routine,
Restoration takes place mostly during
non-REM
How to use cane?
The client holds the cane on their strong side and moves the cane and weak side forward together, and then moves the strong side.
Restraint principles
Need order, use least restrictive, Should be able to fit index & middle fingers between pt & device easily, not too tight, removed and pt move every 2 hr, Secure device to an immovable part of bed frame (not the side rails) using a halfbow knot/slip knot/quick release & use supportive pillows under extremities/bonyprominences
Opening the gate allows the transmission of pain sensation,& closing the gate blocks this transmission• High sensory input closes the gate (distraction)• Anxiety opens the gate vs. decreased anxiety closes it
Gate Control Theory
Fire extinguisher
RACE
rescue, alarm, contain, extinguish
Why is sleep important?
healthy brain function, emotional well-being, physical health (heart, kidneys, BP, diabetes, stroke, obesity, immune system), healthy hormone balance (hunger, insulin, growth hormones),supports growth & development, energy, performance, lack of sleep leads to mistakes, accidents,
2-3 finger gap between crutch and armpit, elbow flex at 30 degree, go up with good leg, go down with bad leg, when sitting- back up to touch chair, both crutches to injured leg, keep injured leg extended, feel for chair on good side
Fall prevention
document all falls,Assess coordination, strength, balance. If dizzy assess BP& Document activity tolerance, Nonskid footwear, Clear clutter/Familiarize environment, Assistive devices, Gait belts, Consult with PT, Avoid bedrest, bed/chair alarm, Handrails/Grab bars, Nightlights,Patient room placement(close to nurse station), Hourly round (6 P’s), toilet q 2, briefs, keep call light close.
Life span consideration
newborn/infants feel pain but can't express it, Toddlers and preschoolers often have difficulty describing identifying, and locating pain, School-age children and adolescents may try to be “brave” and rationalize the pain, Older adults are at increased risk for undertreatment of pain.
OLDCARTES
Onset, location, Duration, Characteristics, Aggravating factors, Radiating, Treatment, Effect, Severity
What are Healthy Sleep habits?
Sleep in a cool, quiet place. Avoid artificial light from the TV or electronic devices, Go to sleep and wake up around the same times each day, Avoid caffeine, nicotine, and alcohol before bedtime. regular physical activity least 5 to 6 hours before going to bed, Avoid daytime naps, Eat meals on a regular schedule and avoid late-night dinners, Limit how much fluid you drink close to bedtime, manage stress, avoid certain meds
Principles of immobility
turn every 2 hours, cough/deep breath every 1 w/a, increase fluids to 3L d, adequate nutrition-fiber, incontinence care, keep linens dry, smooth, frequent skin assessments, use special beds
What is MORSE FALL SCALE?
assessment to determine fall risk- includes- hx of falls, secondary dx, use of ambulatory aid, IV, ability to ambulate, and mental status- high risk is greater than 51
Pain management strategies
all assessed/screened, criteria consistent w/ age, condition, cognitive ability• Patients involved in planning • Pain is treated (or referred for treatment)• Nonpharmacologic treatment• Patients at high risk for adverse outcomes r/t opioid use are monitored• Pts experiencing opioid substance abuse are referred to treatment programs• Prescription drug monitoring program/database is used• Pain is reassessed/evaluated & responded to• Pts are educated about pain management d/c plan
types of pain:
diffuse, difficult to locate, and often referred to a distant, usually superficial, structure_______
of nociceptors in ligaments, tendons, bones, blood vessels, fascia, and muscles and is a dull, aching, poorly localized pain.________
described by patients as “burning” or “like pins and needles.”
Visceral
deep somatic
Neuropathic