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PTA 200 FUNDAMENTALS OF PHYSICAL THERAPY

PTA 200 FUNDAMENTALS OF PHYSICAL THERAPY. SPECIAL EQUIPMENT & THE ACUTE CARE SETTING. Key Terms. Dyspnea: Shortness of breath (SOB) Infiltrate: When fluid being administered through an IV leaks out of the vein into the subcutaneous tissues

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PTA 200 FUNDAMENTALS OF PHYSICAL THERAPY

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  1. PTA 200 FUNDAMENTALS OF PHYSICAL THERAPY SPECIAL EQUIPMENT & THE ACUTE CARE SETTING

  2. Key Terms • Dyspnea: Shortness of breath (SOB) • Infiltrate: When fluid being administered through an IV leaks out of the vein into the subcutaneous tissues • Intubate: When oxygen is being administered through an endotracheal tube the patient is “intubated”

  3. Key Terms • Occlude: To close off or obstruct • IV line or catheter • Airway

  4. Specialized Care Units • See text: Box 10-1 p 276

  5. Orientation to Special Care Units • Equipment to • Monitor the patient’s physiologic state • Vital signs • Ventilate (ventilator or respirator) • Provide intravenous (IV) therapy • Deliver oxygen • Remove fluids (suction, drains)

  6. Guidelines for Treating a Patient in an Intensive Care Unit • Precautions to Use in the Intensive Care Unit • see text Procedures 10-1 & 10-2 p 278

  7. Precautions to Observe: Specific to PT • Modify treatment to patient status • Shorter treatment sessions • Fewer repetitions • Less active participation

  8. PT Goals & Activities in ICU • Prevent contractures • Passive & active ROM • Positioning • Body alignment • Improve patient’s general condition • Bed mobility training • Transfer training • Ambulation activities • Increase functional independence

  9. Types of Beds (See Summary Handout) • Standard adjustable bed • Turning frame (Stryker Wedge frame) • Circular turning frame • Air-fluidized support bed (Clinitron) • Post-trauma beds (Keane, Roto-Rest) • Low air loss bed

  10. Life Support & Monitoring Equipment • Mechanical Ventilators (Respirators) • Use positive pressure to move or propel gas into patient’s lungs • Gas is delivered through an endotracheal tube (ETT) • When tube is in place, patient is intubated • Patients are weaned from vents as they start to breath on their own

  11. Endotracheal Tubes • Air will be induced into patient through a tube in one of several possible ways • All will provide a clear airway into the lungs and allow for suction of secretions • An ETT will restrict the patient from talking & once removed the patient is likely to complain of a sore throat and the voice may be distorted

  12. Life Support & Monitoring Equipment • Endotracheal tube locations • Oral pharyngeal • Nasal pharyngeal • Nasal endotracheal • Oral endotracheal • Tracheostomy • Laryngostomy

  13. Types of Ventilators Volume-Cycled Ventilators • For patients who require long-term ventilation • COPD • s/p thoracic surgery • CNS disorders • A predetermined volume of gas is delivered during inspiration dependent on patient’s need; expiration is passive

  14. Pressure-Cycled Ventilators • Used for short-term ventilation • Provides Intermittent Positive-Pressure Breathing (IPPB) • Delivers a predetermined pressure of gas during inspiration; expiration is passive

  15. Negative Pressure Device • Rarely used • Includes iron lungs • Create a negative pressure in the patient’s chest so air will enter the patient’s lungs

  16. Modes of Ventilation • See Summary Handout & Box 10-2 p 283 • Assist mode • Continuous positive airway pressure (CPAP) • Control mode • Assisted control mode • Intermittent mandatory ventilation (IMV) mode • Synchronized IMV mode • Positive end-expiratory pressure (PEEP)

  17. Precautions for Intubated Patients • Be certain tubing is long enough for the activity • Ask questions that can be answered with head nods or nonverbally • Monitor patient closely • Vital signs • Respiratory distress • Cardiopulmonary distress • Patient may not tolerate exercise as well as other patients

  18. Monitors • Exercise can be performed by patients on monitors provided care is taken not to disrupt the equipment • See Summary handout & text p 284-286

  19. Monitors • Vital signs • Arterial blood gases (ABGs) • Intracranial pressure (ICP) • Central venous pressure (CVP) • Arterial pressure (A-line)

  20. Monitors for Vital Signs • Blood pressure • Respirations • Temperature • Blood gases • Cardiac patterns • EKG or ECG • Telemetry

  21. Oximeter • Pulmonary artery catheter (Swan-Ganz catheter) • Intracranial pressure monitor (CP) • Central venous pressure catheter (CVP) • Arterial line (A line) • Indwelling right atrial catheter (Hickman)

  22. Feeding Devices • Nasogastric tube (NG tube) • Gastric tube (G tube) • Intravenous feeding • Intravenous infusion lines (IV)

  23. Urinary Catheters • External catheter (condom) • Indwelling catheter inserted through urethra into bladder • Foley catheter • Catheter bag must remain below the level of the bladder • Suprapubic catheter

  24. Oxygen Therapy Systems • Nasal canula • Oronasal mask • Nasal catheter • Tent • Tracheostomy mask or catheter

  25. Chest Drainage Systems • Ostomy devices • Enterostomy • Ileostomy • Colostomy

  26. Skeletal Traction • Balanced suspension traction • Thomas splint • Kirschner wires • Skull traction: Crutchfield tongs • Halo • External fixation devices: Hoffman • Internal fixation devices (ORIF)

  27. Patient-controlled analgesia (PAC) • Dialysis • Hemodialysis • Peritoneal dialysis

  28. Laboratory Values O2Sat (SAO2) 95-98% • Keep 90% when exercising • Hemoglobin (Hgb) 14-18 g/dl (males) 13-16 g/dl (females) • Hematocrit (Hct) 40-54 ml/dl (males) 37-48 ml/dl (females)

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