Chapter 1/6
What is implicit and explicit bias?
Implicit bias: unconscious bias, unaware of their biases
explicit bias: conscious bias, they are aware of their biases
What is controlled mobility and uncontrolled mobility. Use BOS and COM to answer
Controlled mobility, COM moves toward the boundaries of the BOS but does not leave, allow for balance and stability when moving
Uncontrolled mobility, COM moves beyond the boundaries of BOS which causes us to lose balance
What are psychological aspect of isolation (4)
increased stress
anger
helplessness
anxiety and depression
What are the 4 universal vital signs
What are other useful measurements in PT
temperature at rest: 98.6 F or 37 C blood pressure
Respiration Rate: 12-20 breaths/min
Blood pressure: 120/80 mmHg
Heart rate: 60-100
Pulse oximetry - measures the percentage of oxygen in the persons blood. recommended to lower exertion if SPO2 falls below 90%
Gait speed
pain scale
perceived exertion
Ways to prevent pressure injuries
Prevent Edema
no more than 2 hours in one position in bed
no more than 15 minutes in one position in sitting
shift weight and reposition more frequently if patient has increased risk factors.
Prevent edema: position distal extremities at or above the level of the heart to minimize edema
What are common negative biases of a healthcare provider
race/ethnicity
gender
age
viruses/disease/infection (HIV/aids)
disability
substance abuse
mental health
immigration status
How would you increase stability. Use COM and BOS when answering
To increase stability we would want to increase the surface area of our BOS and lower our COM. The more centered the COM within our BOS, the more stability it provides.
What are standard precautions?
Standard precautions apply to all healthcare setting and patients
Includes:
hand hygiene
PPE
Respiratory hygiene
Cleaning and disinfection
Safe handling of equipment/sharps disposal
What are the sites temperature can be measured at and which site is the most accurate?
orally
axillary
tympanic
temporal
rectal (most accurate)
possible factors that make a patient more susceptible to development of pressure ulcers
decreased mobility
fragile skin
history of skin breakdown
incontinence
impaired sensation
impaired circulation
cachexia (condition that caused significant weight/muscle loss)
muscle atrophy
postural impairment
friction or shear
nutrional deficiencies
impaired cognition
medication that affects mobility or awareness
Effects of Bias commonly found in studies
white people
What are the 3 laws of motion and describe them?
Second Law: Force = Mass x Acceleration. An objects acceleration depends on the net force applied to it and its mass. Greater force produces greater acceleration, while greater mass produces less acceleration for the same force
3rd Law: Action-reaction. For every action, there is an equal and opposite reaction
Donning vs Doffing PPE
Donning
Gown->Mask->facemask->gloves
Doffing
Gloves-facemask->gown->mask
What are some red flags regarding BP when in rehab
Normal range: 120/80
Systolic BP greater than 250 mmHg
diastolic BP greater than 115 mmHg
systolic drop greater than 10 mmHg from baseline
Systolic pressure does not increase with increasing work load
Measure BP on Left side (same side as heart)
Objectives for short term positioning
Objectives for long term positioning
Short term: Safety, Comfort, Access (by healthcare worker)
Long term: safety, prevention, intervention, Quality of life
Prevention: prevent injuries, contracture, edema
Intervention: promote efficient bodily function (as much as possible, as normally as possible)
quality of life: comfort, function, independence, and overall well-being
Steps to maximize comfort and dignity
communicate clearly with the patient
provide privacy for changing into and out of garments
include chaperone who is the same gender when appropriate
Describe the loading forces
Tension
Distraction
Friction
Shear
Torsion
compression
Tension (lengthening): pulling on each end of a surface or attempting to stretch or lengthen the tissue
compression (pushing): pushing two surfaces together
distraction: pulling that tries to separate two surfaces from each other
friction: an objects resistance to moving relative to another object
Shear: two forces, opposite in direction, that are parallel to contacting surfaces
Torsion: a twisting force about the structures long axis
Other precaution/protective precautions
Scrubbable surfaces in the room
limit visitors/visitation
no fruits, veggies, live plants
patient wears mask and gloves when traveling outside their room
protecting children
immunized staff
How to calculate Max HR and target HR
How is Borg exertion scale calculated
Max HR = 220 - persons age
target HR = Max HR x %intensity
Borg exertion scale goes from 6-20 (6 resting or minimal exertion; 20 maximum exertion). multiple their score by 10 to get target HR.
Clear airway
good spinal alignment
minimized pressure over bony prominences
minimized gravity creating shearing forces
cushioned support surfaces
immobile extremities elevated (to avoid edema)
prevent joint and soft-tissue contractures
trunk and extremities supported and stabilized
long-term functional positions
positioned to optimize interaction with environment (line of sight, communication, etc.)
Special needs accommodated
What are the 4 elements of stress management?
1. Setting appropriate limits and boundaries with patients
2. having a support/social network
3. engage in regular physical activity/exercise
4. meditation/relaxation
Guidelines/principle for good body mechanics
1. plan ahead
2. position yourself close to the load
3. maintain wide BOS
4. maintain normal spinal curvature
5. bend at hips and knees, not back
6. keep the weight close to your body
7. engage the trunk muscles before lifting
8. exhale during exertion
9. avoid twisting at the trunk, particularly when trunk is flexed
10. when possible, push rather than pull an object over distance
11. get help if you need
12. keep your lifting equipment in good shape
Infectious agent: virus, bacteria, pathogen
Reservoir: Place where pathogens live, grow, multiply. Humans, animals, environment, contaminated surfaces
Portal of exit: Route a pathogen uses to leave a reservoir. Nose, mouth, bodily fluids, opening in skin
Means of transmission: Direct or indirect contact, droplets, airborne
Portal of entry: Route pathogen uses to enter new person. mouth, nose, bodily fluids, opening in skin
Susceptible host: elderly, compromised immune systems, children, can be regular people depending on the virus/disease
What do we measure in respiration?
Rate
depth
rhythm (Dyspnea or Apnea)
ease
breath sounds
Physiological consequences of prolonged immobility and inadequate positioning
Skin ulcers
Muscle atrophy and decrease bone density
contracture: shortening of muscles and soft tissues that limit ROM
poor circulation and edema