Unit 1: Patient Care Skills, Informed Consent

● Health Insurance Portability and Accountability Act (HIPAA)

o Sets standards to protect individual’s healthcare
o PHI: identifiable personal information
● Interprofessional Collaboration
o co-treating with PT or Speech
● Professional Collaboration
o within your profession, OT works with COTAs
● Communication Types
o Verbal🡪 tone of voice, volume, inflection of voice, word choice
o Nonverbal🡪 eye rolling, fidgeting, gestures, body movements
o Audiovisual aids🡪 creative ways to communicate with patients with hearing or visual
impairments
o Written🡪 documentation, patient language vs. medical terminology
o Barriers to effective communication🡪 noisy environment
● Elements of Informed Consent Process
o Verify patient (first, last name, DOB)
o Verify diagnosis
o Describe recommended treatment plan
o Risks, complications, and precautions
o Expected outcome/prognosis
o Alternative forms of treatment
o Answering client’s questions accurately and professionally
o Explain possible consequences of no treatment
o Document process used to obtain informed consent
● Medical Errors
o Sentinel event🡪 injury, could be result of medical management process
o Potential adverse event🡪 injury could have been avoided, “close call”
o Active error🡪 caused by individual, ex: falls
o Latent error🡪 caused by faulty equipment, flaws in system or organizational design
● Safety Recommendations
o Hand hygiene
o Maintain sufficient space
o Perform transfers in unobstructed areas
o Implement maintenance program for equipment and materials
o Secure equipment, furniture, and assistive aids and store them when not in use
o Keep floors clear
o Attend to patient at all times
o Properly protect the patient
o Use trained, qualified, and competent personnel
o Avoid storing potentially hazardous materials or equipment
 Unit 2: Infection Control
● Healthcare-Associated Infections🡪 occurs in 1 out of 20 patients
o 4th leading cause of death
● Cycle of Cross-Contamination and Infection
o Key is to break the cycle
o Reservoir (place to grow)🡪 Exit (means to leave host)🡪 Transmission (must pass from one
person to another, air, droplets or direct contact)🡪 Infection (portal of entry)🡪 Susceptible
host (body cannot ward off infection)🡪 Infectious Agent
● Microorganisms
o Grow best in dark, warm and moist environments
o Spores🡪 difficult to destroy
▪ C-Diff
● Aseptic Techniques
o Protect barriers: skin & cilia of lungs
o Cleanliness of equipment
o PPE
o Hand hygiene
o Proper control of heat
o Medical Asepsis🡪 clean approach, confine pathogens
o Surgical Asepsis🡪 surgical scrub, create sterile field
● Standard Precautions
o Frequent hand washing/rubbing
o PPE wearing and proper disposal
o All body fluids may contain contaminants
● PPE (Personal Protective Equipment)🡪 gloves, gowns, masks, protective eyewear, shoe
coverings
● Transmission Based Isolation Precautions
o Airborne, Contact, Droplet
▪ Airborne🡪 Private room w/ negative airflow, mask required
▪ Contact🡪 Private room or cohort patient with same infection, gown & gloves required
▪ Droplet🡪 Private room, mask when working within 3 feet
o Modes of Transmission
▪ Droplets, Airborne, Direct Contact, Indirect Contact
● Hand Hygiene
o Before/after patient contact
o Remove jewelry, avoid artificial nails/chipped polish, trim nails, proper care for breaks in
own skin, use warm water
o Hand Washing:
▪ Visibly dirty or contaminated
▪ 15-30 seconds
▪ Friction of rubbing removes bacteria
▪ Antimicrobial agent leads to antiseptic cleansing
▪ Avoid using bar soap
o Hand Rubbing:
▪ More effective
▪ Takes less time
▪ More accessible
▪ Decrease bacterial counts
▪ Decrease damage to skin
▪ HAND WASH IF C-DIFF
 ▪ After several rounds of rubbing🡪 wash hands
Unit 3: Vital Signs
● When to take vitals:
o Initial evaluation, before treatment, during treatment, after treatment
● General factors affecting vitals:
o Age, gender, demographic factors, genetic, medical history, emotional status, medications,
environment, time of day, measurement device
● Heart rate (pulse)🡪 indirect measure of left ventricle contractility
o Measured at multiple sites:
▪ Carotid, Radial, Brachial (most common)
▪ Femoral, dorsalis pedis, temporal, popliteal
o Normal Resting Values
▪ Adults🡪 60-100 bpm
● Well-conditioned athletes🡪 40-60 bpm
▪ Children:
● Infants🡪 90-160 bpm
● 1-10 y.o.🡪 70-130 bpm
▪ Abnormal
● Tachycardia🡪 >100 bpm
● Bradycardia🡪 <60 bpm
o Measurement
▪ Count number of beats in 30 seconds and multiply by 2
▪ Start counting at zero when you feel the first beat
o Use RPE instead in aquatic environment
● Blood Pressure🡪 indirect measure of cardiac output
o Always reported as systolic/diastolic (mmHg)
▪ Systole🡪 pressure during left ventricle contraction
▪ Diastole🡪 ventricle is at rest and is refilling
o Korotkoff Sounds
▪ 1 (systolic)🡪 first sound heard through auscultation
▪ 4 (diastolic)🡪 distinct and final muffling of pulse heard, best indicator of diastolic
pressure
▪ 5🡪 final diastolic phase, sound completely disappears
o Normal BP Ranges
▪ Adults🡪 <120/<180 mmHg
● Prehypertensive🡪 120-139/80-89
● Stage 1: 140-159/90-99
● Stage 2: 160/179/100-109
▪ Children (1-12)
● 100/60 to 120/75 mmHg
o Factors affecting BP
▪ Age, stress, physical condition, medications, hydration status, disease, patient
position (orthostasis)
● Orthostatic Hypotension🡪 moving from supine to sitting to standing; causes
dizziness, nausea, fainting
o Assessment of BP
▪ Locate brachial/radial artery palpation site and correct cuff size
▪ Ensure no contraindications (breast cancer, lymphedema)
▪ Find occlusion point🡪 point at which the pulse disappears
▪ Place stethoscope over brachial artery and slowly inflate cuff to 20-30 mmHg higher
than occlusion point
 ▪ Slowly open valve (rate of decrease 1-2 mmHg/second)
● Body Temperature
o Oral, axilla, temporal, or rectal
o Normal range🡪 96.8-99.3 degrees F
o Average: 98.6 degrees F
o Febrile🡪 >100 degrees F (body is fighting something off)
o Considerations:
▪ Decreases with overall age
▪ Altered due to environment
▪ Elevated in the evenings
▪ Varies with location of measurement
▪ Elevated with pregnant or ovulating females
● Respiratory Rate
o Inhale and Exhale
o Watch for chest rise/fall
o Normal range🡪 12-18 per min.
▪ Infants/toddlers🡪 30-40 breaths per min.
o Look for:
▪ Belly breathing or labored breathing
o Abnormal sounds:
▪ Wheezing, gasping, rumbles, crackles, muffled/wet gurgling
● PulseOx
o Quick, easy and reliable
o Measures HR and O2 saturation
▪ Hypoxemia🡪 <90%
▪ Normal🡪 95-99.5%
● Other Vitals: RPE and Pain
o RPE🡪 Borg’s Scale
▪ Can be used to develop goals in rehabilitation
▪ Utilized over HR in aquatic environment/pool
▪ Modified🡪 1-10
▪ Regular Borg Scale🡪 6-20
o Pain
▪ Subjective measurement
▪ Difficulty in reporting accuracy
 Unit 4: Body Mechanics and Posture
● Produce movement:
o That is safe and energy conserving
o That is anatomically and physiologically efficient
o That maintains body balance and control
● Object’s COG🡪 point at which the object is heaviest to move
● Person’s COG🡪 approximately at belly button
● Vertical Line of Gravity🡪 imaginary vertical line that passes through COG of an object
● Lift Techniques:
o Deep Squat Lift
▪ Hips below knees, feet straddle object
o Power Lift
▪ Half squat, hips above knees, object between legs
o Straight Leg Lift
▪ Knees slightly bent/straight
▪ AP stance
o One-Leg Stance (Golfer’s Lift)
▪ Lift light objects
▪ AP stance, weight shifted to forward leg
o Half-Kneeling Lift
▪ Kneel on one knee, place object on thigh
o Traditional Lift
▪ Deep squat, hold object close to body, AP stance
o Stoop Lift
▪ Bend legs down and suitcase carry
● Normal and Abnormal Posture
o Normal Posture
▪ Normal lordosis🡪 cervical and lumbar spine
▪ Normal kyphosis🡪 thoracic spine
 Unit 5: Immobility, Positioning, Draping
● Changing Body Positions
o Prevent contractures
o Relieve pressure to skin, organs, etc.
● Change positions🡪 every 2 hours or in wheelchair (every 15 min for 15 seconds)
o Supine🡪 pillow behind head, on sides under arms
o Prone🡪 rolled towel under head, pillow under abdomen, ankle propped on pillow
o Three-quarters prone🡪 one pillow under knee parallel to leg
o Three-quarters supine🡪 pillows between knees and elevate heels, hugging a pillow
o Side-lying🡪 flexed hip and knee over pillow, arm on pillow at chest, pillow behind them
to prevent rolling
● Hemiplegia🡪 weak side on pillows, that side is always supported
● Skin Inspections (required twice a day)
o 4 Stages:
▪ Redness
▪ Paleness/blanching
▪ Numbness/tingling🡪 rupture in skin
▪ Localized edema🡪 bone exposing
● Total Hip Replacement
o Adduction, internal rotation, flexion past 90 degrees
● Total Knee Replacement
o Keep in extension
o Hip in extension
● Draping Reason
o Expose only area to be treated
o Provide modesty
o Maintain body temperature
o Protect skin and clothing
● Clothing removal
o Expose treatment area, landmarks, and prevent soiled clothing
● Immobility🡪 causes ulcers, contractures, muscle atrophy
 Unit 6: Bed Mobility
● Levels of Assistance
o Independent🡪 no verbal or manual assistance
o Assisted🡪 requires some assistance to perform activity safely in acceptable time frame
o Standby assistance🡪 requires verbal or tactile cues from another person close to but not
touching
o Modified independent🡪 uses adaptive or assistive equipment to perform a task
independently
o Contact guarding🡪 caregiver close to patient with hand on gait belt
o Minimal assistance🡪 patient performs 75% or more of activity
o Moderate assistance🡪 patient performs 50-74% of activity
o Maximal assistance🡪 patient performs 25-49% of activity
o Dependent🡪 patient requires total physical assistance from one or more persons to
accomplish the activity safely
● Moving Side to Side in Bed
o Remove bed rail and pillow
o slide forearms under head & shoulder blades (AP stance)🡪 pull towards you
▪ right hand should be on right side, left hand under left side
o arms should be crossed and knees bent
o Hand under hips and waist🡪 pull towards you
o hands proximal to ankles (AP stance) 🡪 pull towards you
o put bed rails back up
● Supine🡪 Side-Lying
o Move side to side (lateral shift)
o Cross leg and place closest arm in reverse T, arm straight up or tucked under leg slightly
▪ if moving to left: move patient far right, have patient’s right leg on top when crossed,
left arm is the arm positioned, right arm is on stomach
▪ if moving to right: move patient far left, have patient’s left leg on top when crossed,
right arm is the arm positioned, left arm is on stomach
o hands should be placed at shoulder and hip
o therapist is on the side where the patient is initially positioned; the patient will be moving
away from the therapist. This gives the therapist control
o Roll patient over to side and place pillow between knees and under arm
● Moving Up in Bed
o make sure the bed rail is down
o AP stance (one leg forward slightly bent, other behind)
o legs and cross arms
o Grab under shoulder blades and shift up
o knees bent
o Ask patient to lift head
o Draw sheet: positioned at the head of the bed in AP stance, pull draw sheet without flexing
elbows
● Moving Down in Bed
o Patient lifts head and remove pillow
o bend knees and cross arms
o Pull patient down by pelvis
o may need to occur multiple times to move patient where he/she needs to be
o you can elevate the head of the bed for help
● Supine🡪 Prone
o Move side to side (lateral shift)
o Roll patient onto side
o Cross legs and turn head, place arm above head or tuck hand under pelvis
o Lateral shift patient back with chicken wing method
o Roll patient onto stomach
o Place pillow under ankles
● Prone🡪 Supine
o Lateral shift
o Tuck hand under pelvis
o Roll patient towards you (patient facing away)
o Lateral shift patient if needed
● Supine🡪 Sitting (Modified Swoop)
o Roll patient to side
o Place arm in reverse T and cross leg
o Patient pushes off of elbows onto hand and places them behind her
o Drop legs off, push hip, catch shoulder
o Lower bed to when patient’s feet touch the floor
● Supine🡪 Sitting (Walk around method)
o Have patient sit up
o Therapist supports affected limb
o Lower bed
● Sitting🡪 Supine (Walk around method)
o Push back with unaffected leg
o Therapist supports affected leg
● Sitting🡪 Supine (Reverse Swoop)
o Help patient lying on shoulder
o Help patient with lying supine
 Unit 7: Transfers and Gross Strength Assessment

*Maintain Trunk Contact

*Don’t leave front of patient once foot plates are removed

● Standing Assisted Pivot Transfer

o Wheelchair at 45 degree angle
o Transfer patient toward strong/unaffected side
o Remove foot plates & lock chair
o Have patient scoot towards front of chair
o Position foot on outside of affected leg
o Take steps towards bed and have patient sit
● Standing Assisted Pivot Transfer w/ Walker (FWW)
o Wheelchair parallel to table on strong side
o Move hips forward to position gait belt
o Lock and adjust bed height
o Extend at knee to remove foot plates
o One hand on gait belt and one on trunk of affected side
o Affected leg out forward and unaffected under chair
o Walker🡪affected🡪 unaffected
▪ Turn toes out**
o Affected🡪 walker🡪 unaffected
o Reach for table leaning back
● Standing Dependent Pivot Transfer
o Place gait belt
o Remove foot plates
o Chair positioned 45 degree angle
o Have patient scoot towards edge of chair
o Position heels facing bed
o Remove arm rest
o Legs positioned on outsides of both knees
o Pull patient up and move to bed
o Lower bed and give call bell
● Sitting Sliding Board Transfer
o Scoot hips forward-Therapist
o Remove arm rest
o Head hips relationship to place board under femur
o Reposition legs
● Sitting Lateral Swing Transfer
o Scoot hips forward
o Rock 1,2,3
o Remove arm rest
o Head hips relationship-Patient
o Patient pushes off 1 hand on chair, 1 hand on bed to swing body towards bed
● One Person Dependent Lift Transfer
o Patient’s head on hip or shoulder
o Grab under ischial tuberosities or gait belt
o Rock 1,2,3
o Patients hands are in lap, heels angled towards bed
● Two Person Dependent Lift Transfer
o Patients arms around shoulders
o Lift with legs
o One arm locked with other therapist, other arm under patient’s thigh
o “Fireman Carry”
● Gross Strength Assessment
o Hold arm out🡪 resistance on elbow top & bottom
o Elbow out🡪 resistance on anterior and posterior wrist
o Squeeze two fingers
o Shrug shoulder and provide resistance
o Do other side
o Lift knee and provide resistance above and below
o Kick leg out and bend behind you, provide resistance anterior and posterior
o Test dorsiflexion and plantarflexion, hand sanitize🡪test other side