Mobility in Context: Principles of Patient Care Skills

Description

Rely on this resource to help you navigate confidently in both common and complex clinical situations. Mastering patient care skills will ground you in fundamental rehabilitation principles; help you establish a culture of patient-centered care; and teach you to foster habits of clinical problem solving and critical thinking. YouÕll also learn how to help your patients progress toward greater mobility and independence. Over 750 full-color photographs and illustrations make every concept crystal clear. Inside Front Cover Title Page Copyright Dedication Preface Reviewers Acknowledgments Brief Contents Contents Establishing the Bar: AN INTRODUCTION The Fundamentals of Progressive Mobility Contexts Patient-Centered Care Dynamic Systems Professionalism Health and Wellness Decision-Making Guides As Much as Possible, as Normallyas Possible (AMAP/ANAP) Control Centrally, Direct Distally (CCDD) Biomechanics Stability to Mobility Focusing on the Objective Behaviors and Techniques Developing Expertise Mindful Practice Beginning the Progression: Movingthe Bar References Moving the Bar: Part 1 Preparing Yourself for Patient–Clinician Interaction Preparing for Personal Interaction Awareness of Values and Beliefs Practicing Mindfully Communication Skills Collaborative Goal Setting Preparing for the Task Knowing the Objective Mechanics of Movement Preparing the Environment Conclusion References Chapter 1 Establishing the Therapeutic Alliance Patient–Clinician Interaction:The Therapeutic Alliance The Person The Clinician’s Perspective The Patient’s Perspective The Tasks Collaboratively Set Goals Motivating and Engaging Patients in Healthful Activities Patient Education Patient Education Techniques Patient Adherence Challenging Patient Encounters The Environment Conclusion References Chapter 2 The Mechanics of Movement Biomechanical Aspects of Human Movement Mass Center of Mass Force Gravity Friction Representation of Forces Line of Action Components of Force Levers Moments and Moment Arms Application: Proper Body Mechanics, Part 1 Force Couples Loading Stress and Strain Pressure Managing Stability and Mobility Base of Support Dynamic Trunk Stabilization Controlled and Uncontrolled Mobility Application: Positioning for Stability Application: Directing Forces—Blocking the Knee Laws of Motion Inertia F = ma Action–Reaction Muscles Acting on Bones Open and Closed Chains Osteokinematics and Arthrokinematics Application: Glenohumeral Movement During ROM Putting It Together: Body Mechanics Application: Proper Body Mechanics, Part 2 Clinical Review Questions Reference Chapter 3 Special Environments Introduction Critical Care Environments Working as a Team Applying a Systematic Approach to Mobilizing the Patients in ICU Mobility Progression Critical Care Devices Home Environment Other Environments Clinical Review Question References Moving the Bar: Part 2 Initiating Mobility Attending to the Person: Establishing Rapport Creating a SupportivePhysical Environment Performing the Task Engaging the Patient in the Task Establishing Baselines References Chapter 4 Keeping It Clean: Maintaining Cleanliness in the Clinical Environment Cleanliness What Is Clean? Healthcare-Associated Infections How Infection Happens The Cycle of Infection Infectious Agents Pathogen Reservoirs Portal of Exit Means of Transmission Mode of Entry Susceptible Host Standard Precautions Hand Hygiene Respiratory Hygiene Personal Protective Equipment Application of Standard Precautions Clinical Attire Clean Environment Disposal of Soiled Items Sharps Containers Transmission-Based Precautions Contact Precautions Droplet Precautions Airborne Precautions Donning and Doffing PPE Donning PPE Doffing PPE Clean and Sterile Techniques Clean Technique Sterile Technique Protective Precautions for Special Populations Transplant Recipients Pediatric and Geriatric Patients Psychosocial Aspects of Isolation Clinical Review Questions References Chapter 5 Assessing Physiological Status Introduction Heart Rate Overview of Heart Rate Reasons for Assessing Heart Rate Normal Heart Rate Factors Affecting Heart Rate Methods of Assessing Heart Rate Blood Pressure Overview of Blood Pressure Reasons for Assessing Blood Pressure Normal Blood Pressure Factors Affecting Blood Pressure Methods of Measuring Blood Pressure Technique for BP Assessment by Auscultation Respiration Overview of Respiration Reasons for Assessing Respiration Factors Affecting Respiration Normal Respiration Rate and the Quality of Breathing Method of Assessing Respiration Temperature Overview of Temperature Reasons for Assessing Temperature Factors Affecting Temperature Normal Temperature Methods of Measuring Core Body Temperature Other Measures of Physiological Status Pulse Oximetry Pain Assessment Rate of Perceived Exertion Gait Speed Patient Education and Self-Monitoring Clinical Review Questions References Chapter 6 Draping for Minimum Exposure and Maximum Dignity Introduction Awareness of Abuse: Empowerment, Trust, and Control Cultural Competence Maximizing Comfort and Dignity Provide Privacy Provide Chaperones When Needed Covering Provide Clinical Attire Drape With Linens General Procedures for Draping Prior to Treatment During Treatment After Treatment Draping Techniques by Patient Position Supine Prone Sidelying Sitting Draping While Adjusting Patient Position Clinical Review Questions References Chapter 7 Positioning Your Patient for Mobility Introduction Short-Term Positioning Objectives Positions for Short-Term Therapy Special Considerations for Short-Term Positioning Long-Term Positioning Objectives Preventing Pressure Injuries Preventing Contractures Preventing Edema and Cardiopulmonary Complications Minimizing the Risk of Deep Venous Thrombosis Long-Term Positions Special Considerations in Long-Term Positioning Positioning Devices Equipment Used for Positioning Restraints Conclusion Clinical Review Questions Appendix A STAGING OF PRESSURE INJURIES Stage 1 Pressure Injury:Nonblanchable Erythemaof Intact Skin Stage 2 Pressure Injury: Partial-Thickness Skin Loss With Exposed Dermis Stage 3 Pressure Injury: Full-Thickness Skin Loss Stage 4 Pressure Injury: Full-Thickness Skin and Tissue Loss Unstageable Pressure Injury: Obscured Full-Thickness Skin and Tissue Loss Deep Tissue Pressure Injury: Persistent Nonblanchable Deep Red, Maroon, or Purple Discoloration No Reverse Staging References Chapter 8 Transferring Dependent Patients: Safe Patient Handling and Mobility Introduction Risks Inherent in Manual Dependent Lifts Development of Safe Patient Handling and Mobility Programs Standard Hospital Equipment Standard Hospital Beds Standard Wheelchairs Safe Patient Handling and Mobility Vertical Lifts Total Body Lifts Choosing a Sling Being Lifted: The Patient’s Perspective Techniques for Vertical Lifts Techniques for Sit-to-Stand Lifts Lateral Transfers Indications for Use Lateral Transfers in Context Repositioning With Assistive Devices Supine Repositioning Seated Repositioning Special Consideration: Bariatrics Clinical Review Questions Appendix 8-A Definitions of Dependence Total Dependence Extensive Assistance Limited Assistance Supervision Independent Appendix 8-B ALGORITHMS FOR TRANSFERS Algorithm 1: Transfer to and From Bed ↔Chair, Chair ↔Toilet, Chair ↔ Chair, orCar ↔ Chair Algorithm 2: Lateral Transfer toand From Bed ↔ Stretcher ↔ Trolley Algorithm 3: Reposition in Bed: Sideto Side, Up in Bed Bariatric Algorithm 1: Bariatric Transferto and From: Bed ↔ Chair, Chair ↔Toilet, or Chair ↔ Chair Bariatric Algorithm 2: Bariatric Lateral Transfer to and From Bed ↔Stretcher ↔ Trolley References Moving the Bar: Part 3 Engaging the Patient in Early Functional Mobility Early Function Range of Motion Bed Mobility Transfers Motor Learning References Chapter 9 Maintaining Capacity for Mobility Through Range of Motion Introduction The Nature of Joint Motion Osteokinematics and Arthrokinematics: A Review Planes of Motion Muscle Excursion and Two-Joint Muscles Types of ROM Effects of Joint Motions Effects of ROM on Joint Tissues Effects of Passive ROM Effects of Active ROM Skeletal Muscle Pump Skilled ROM Decision-Making Indications and Contraindications Tissue Healing PROM Dosage AROM Dosage Choosing Planes of Motion ROM Exercise Progression Upper-Extremity and Lower-Extremity ROM Procedures Body Mechanics Providing Support Controlling and Directing Movement Encouraging Independence Systematic Approach ROM Procedures Achieving Full Joint Capsule Range Additional PROM Procedure Notes Additional AAROM Procedure Notes Additional AROM Procedure Notes Therapeutic Interventions Axial ROM Procedures Temporomandibular Joint (TMJ) ROM of the Spine Observing and Documenting ROM Findings Quantitative Findings Qualitative Findings Normal End Feels Patterns of Movement Caregiver and Patient Education Assisting Self-ROM Education Tips Clinical Review Questions References Chapter 10 Bed Mobility Introduction Bed Mobility Progression Developmental Positions Environment Equipment Clinical Decision-Making Bed Mobility Tasks in Supine Hooklying Bridging Scooting in Supine Rolling Moving from SupineàSitting Sitting Up Lying Down Bed Mobility Tasks in Sitting Special Health Conditions Total Hip Arthroplasty Hemiplegia Following Back Surgery Spinal Cord Injury Tilt Table Clinical Review Questions References Chapter 11 Manual Lateral Transfers Introduction Maximizing Safety General Procedure for Manual Dependent Transfers Underlying Assumptions for a Dependent Transfer With One Clinician Using a Gait Belt Blocking the Patient’s Knees Seated Transfers Dependent Lifts Transfers Using a Transfer Board Clinician Assistance for Lateral Seated Transfer With Transfer Board Anteroposterior Transfers Pivot Transfers Setting Up the Pivot Transfer Performing the Pivot Transfer Completing the Transfer Using Assistive Devices Special Patient Considerations in Pivot Transfers Adapting Transfers Toilet Transfers Bathtub Bench Transfers Car Transfers Clinical Problem-Solving Example 1: From Impossible to Possible With a Change in Approach Example 2: Sliding to Safety Example 3: Facilitating Independence in a Dependent Transfer Using an Assistive Device Clinical Review Questions References Chapter 12 Vertical Transfers: Chair to Plinth and FLoor to Chair Introduction Chair ↔ Plinth Transfers Preparing the Environment Preparing the Patient Dependent Transfers Between Chair and Floor Preparing the Environment Preparing the Patient Clinician Preparation Independent Transfers Between Chair and Floor Preparing the Environment Clinical Variations Clinical Review Questions Moving the Bar: Part 4 Locomotion Changes in Body Structure and Function Affecting Locomotion Musculoskeletal Changes Neuromusculoskeletal Changes Cardiopulmonary Changes Integumentary Changes Seated Locomotion —Mobility With Wheels Standing Locomotion —Mobility on Foot Task Environment Person References Chapter 13 Seated Mobility: Sitting But Not Sitting Still—Fitting and Propelling a Wheelchair Introduction Selecting a Wheelchair: The Process of Matching Needs and Resources Identifying Needs and Resources The Standard Wheelchair Postural Support Options Mobility Base Options Wheelchair Selection Trade-Offs Types of Wheelchairs Wheelchair-User Interface Fitting the Manual Wheelchair Measuring the Patient for Wheelchair Fit Seat-to-Floor Height Confirming the Fit Negative Effects of Ill-Fitting Chairs Manual Wheelchair Propulsion Dependent Propulsion Over Level Surfaces Dependent Propulsion Over Uneven Surfaces Assisted Navigation Through Doorways Assisted Propulsion on Inclines Dependent Navigation Up and Down Curbs Dependent Navigation Up and Down Steps Independent Propulsion Over Level Surfaces Independent Propulsion Over Uneven Surfaces: Wheelies Independent Navigation Through Doorways Safe Use of Powered Scooters Controlled Falling Falling Backward Falling Forward Falling to the Side Wheelchair Care and Maintenance Depot Wheelchair Maintenance Recommended Wheelchair Maintenance by the Owner Recommended Wheelchair MaintenanceThrough a Service Center Electric or Power WheelchairMaintenance Clinical Review Questions Appendix 13-A Wheelchair Measurement Laboratory Worksheet References Chapter 14 Navigating the Challenges of Ambulating Introduction Weight-Bearing Restrictions Methods of Monitoring Weight-Bearing Choosing an Assistive Gait Device Amount of Support Required Amount of Stability Required Energy Cost Fitting an Assistive Gait Device Guarding During Gait Revisiting Moments, Distances, BoS,and Line of Action of Force: Creating aMechanical Advantage While GuardingDuring Ambulation Where to Stand—Right or Left Side? Gait Belt Use During Ambulation Gait Patterns Patient Instructions Sit Sit ↔ Stand With Assistive Gait Devices Standing Sitting Forward Gait Turning Troubleshooting Stairs Functional Strength and ROM Demands Basic Gait Pattern Up and Down Steps Up and Down Steps With Bilateral Assistive Devices Up and Down Steps With a Unilateral Assistive Device Guarding on Steps Falling During Ambulation Facts on Falls Assessing Fall Risk Reducing the Likelihood of a Fall Minimizing the Risk of Injury From a Fall Responding If a Patient Begins to Fall Other Ambulation Challenges Opening Doors Navigating Obstacles Carrying Objects Handling Hazardous Surfaces Lighting the Way Walking on Inclines Clinical Review Questions Appendix 14-A Parameters for the Community Ambulator References Chapter 15 Implementing Device-Specific Gait Introduction Parallel Bars Indications Fit Guarding Sit ↔ Stand Advancing Turning Readiness to Progress Walkers Indications Fit Sit ↔ Stand Guarding Advancing Turning Going Up and Down a Single Step Going Up and Down Multiple Steps Going Up and Down Multiple Steps Without a Handrail Troubleshooting Readiness to Progress Axillary Crutches Indications Fit Sit ↔ Stand Guarding Advancing and Turning Going Up and Down Steps Readiness to Progress Forearm Crutches Indications Fit Sit ↔ Stand Guarding Advancing and Turning Going Up and Down Steps Guarding Troubleshooting Readiness to Progress Falling and Getting Back Up With Crutches Guarding Troubleshooting Indications Fit Sit Stand Guarding Advancing and Turning Knee Walker Hemi Walker or Walk-Cane Indications Fit Sit ↔ Stand Guarding Advancing and Turning Readiness to Progress Canes Indications Fit Sit ↔ Stand Guarding Advancing and Turning Steps Troubleshooting Readiness to Progress Clinical Considerations for Selected Conditions Alzheimer’s Disease Muscular Dystrophy Clinical Review Questions References GLOSSARY INDEX