issue 1 june 2022 LEARN TOPICS BASIC INTERVENTIONS Learn these basic stretches and conditioning exercise that you can perform anytime! MORE TOPICS BELOW VITAL SIGNS TRANSFERS BED MOBILITY & POSITIONING RED FLAGS SUPPORT HOTLINES
TEMPERATURE Getting the body temperature helps you know if the person is having an infection and fever is a hallmark sign of a person having one. WHERE TO MEASURE? Temperature also varies by location: By the mouth – is also considered the base average of their usual temperature By the anus or the ear - hotter compared to by mouth Under the armpit – colder compared to by mouth ·Newborn = 36.8°C (Axillary) Note: each person is different and the ·1-3 Y.O. = 37.7°C (rectal) average temperature of one person ·Kids to Adults = 37°C (oral) should be considered, greater than ·Elderly = 36°C (oral) 1°C of normal temperature indicates fever FACTORS THAT CAN AFFECT BODY TEMPERATURE ·Time of Day and External Environment Can either increase or decrease depending on the normal temperature outside which can affect the temperature where you are in ·Age Younger people tend to have hotter temperatures than elderly people ·Emotions/Stress Stress and emotions can greatly increase body temperature ·Exercise More movement and exercise put the body into more workload which produces more heat in return ·Menstrual Cycle Women on their period have higher body temperature due to hormonal changes ·Pregnancy Pregnant women have high body temperatures due to more workload of the body because of the presence of the baby
HOW TO HANDLE SOMEONE WITH HYPER/HYPOTHERMIA ·For hyperthermia Let the patient rest and cool down. If your patient sweats a lot, it means the body is trying to cool down. Give plenty of fluids to prevent dehydration. Provide medications as prescribed by your doctor. ·For hypothermia Help the patient get warmth and treat them with utmost care. Wrap them in many blankets to help them heat up. Remove and wet clothing if they have any. Provide them with warm beverages. If the patient has suddenly dropped in temperature quickly, rush to the emergency. HOW TO USE A THERMOMETER 1. Wash hands and the instrument before using 2. Clear the area of any clothing 3. Insert the instrument in the area (must be an instrument to the skin) 4. Wait for at least 1 minute or until the instrument beeps 5. Check results 6. Wash the area and the instrument after use
It is important in monitoring heart diseases. Changes in blood pressure can indicate diabetes, hypertension other heart problems. NORMAL VALUES ·Newborn – 80/40 mmHg ·1-3 Y.O. – 98/64 mmHg ·6-8 Y.O. – 120/56 mmHg ·10 Y.O. – 110/58 mmHg ·Teen – 110/70 mmHg ·Adult - <120/80 mmHg ·Elderly – 120/80 mmHg (if taking meds, lowered blood pressure can be seen) HOW TO TAKE BLOOD PRESSURE With a manual BP apparatus: 1. Position the patient’s arm in level with the heart (put the arm on a leveled position if sitting) 2. Clear the area of clothing (roll up the sleeve if they are in sleeves) 3. Find the brachial pulse (open the arm upward, the skin fold of the elbow must be seen, point your stethoscope at the skin fold in the inner most side, near the side of the ribs) 4. Wear the BP cuff around the patient’s arm, it must be above the skin fold and the “artery” arrow should be pointing where the pulse is 5. Make sure the BP cuff is tightly fastened 6. Check your pressure gauge of the BP cuff using the rotatable knob and lock it 7. Point your stethoscope at the pulse area 8. Start pumping up until the gauge is around 200 mmHg 9. Slowly release the knob while measuring the BP a. Systole – The first audible sound you can hear through the stethoscope that is repeats with a loud thud b. Diastole – The last beat that you can hear while slowly releasing pressure 10. Record results
TERMINOLOGIES ·PULSE – is the wave of blood in the artery created by contraction of the left ventricle during a cardiac cycle (one complete cycle of cardiac muscle contraction and relaxation). ·PERIPHERAL PULSES – are those located in the periphery of the body that can be felt by palpating an artery over a bony prominence or another firm surface. ·PULSE RHYTHM – is the pattern of pulsations and the intervals between them. ·NORMAL PULSE RATE: 60-100bpm for normal and healthy adult. PROCEDURE 1. Wash your hands and obtain a timepiece that measures seconds. 2. Select an arterial site and firmly, but gently, place two or three fingertips over the artery. Avoid using the thumb, and applying excessive pressure that might occlude the artery. The most common sites used are the radial and carotid arteries. 3. Mentally count each beat within a minute. 4. Record the results in beats/ min, and don’t forget to also grade the pulse on its amplitude.
TERMINOLOGIES ·DEPTH OF RESPIRATION – refers to the amount (volume) of air exchanged with each breath (deep or shallow) ·RHYTHM – refers to the regularity of inspirations and expirations ·NORMAL RESPIRATORY RATE: 12-20cpm for normal and healthy adults. ·COMMON ABNORMAL SOUNDS OF BREATHING WHEEZING – the continuous whistling sound produced by air passing through a narrowed airway. May be heard on both inspiration and expiration but is more prominent on expiration. ·STRIDOR – harsh, high-pitched crowing sound that occurs with upper airway obstructions. Apparent in patients with tracheal stenosis or presence of foreign object ·CRACKLES – rattling or bubbling sounds that occur owing to secretions in the air passages. Apparent in patients with CHF ·SIGH – a deep inspiration followed by a prolonged, audible expiration Frequent sighs are abnormal and may be indicative of emotional stress ·STERTOR – a snoring sound owing to partial obstructions in the upper airway
PATTERNS OF RESPIRATION ·EUPNEA – normal breathing pattern of 12 to 10 times per minute in an adult ·HYPERVENTILATION – abnormally fast rate and depth of respiration often associated with anxiety, emotional stress, and panic disorders ·HYPOVENTILATION – reduction in the rate and depth of respirations ·DYSPNEA – difficult or labored breathing ·ORTHOPNEA – difficult of labored breathing when the patient is lying down that is relieved to a sitting or standing position ·TACHYPNEA – abnormally fast RR, usually above 20 breathes per minute ·BRADYPNEA – abnormally slow RR, usually 10 breaths or fewer per minute ·APNEA – the absence of respirations and is usually transient PROCEDURE 1. Wash your hands and obtain a timepiece that measures seconds. 2. As the examinee breathes normally, observe the rise and fall of the chest within a minute. 3. Also observe for notable abnormal sounds if present, and for the pattern of respiration.
NORMAL VALUES ADULT NORMAL VALUES PEDIATRICS ABNORMAL VITAL SIGNS
NORMAL VALUES ADULT
PRESSURE ULCERS ·Definition: are localized injury to the skin or underlying tissue due to pressure. ·The prevalence of Pressure Ucers shows to have been consistently increase with age and to patients that requires long confinement ·Pressure ulcers are fast to develop and very difficult to treat COMMON SITES
STAGES ·Intact skin ·Partial loss of skin ·Non-blanchable redness ·Reddish pink wound w/o ·Warmer or Cooler than slough surounding area ·Shallow crater wound ·Painful ·Painful ·Full loss of skin ·Exposed subcutaneous fat, ·Exposed subcutaneous fat, bone, bone, tendon tendon ·Slough and Eschars ·Slough and Eschars ·Tunneling and Undermining wound ·Exposed subcutaneous fat, bone, tendon ·Slough and Eschars ·Tunneling and Undermining wound
· Patient positioning must be considered before, during, and at the conclusion of treatment and when a patient is to be at rest for an extended period. It is important to teach other caregivers and family members the methods of proper positioning and the rationale behind positioning (i.e., prevention of pressure and contracture). Patient comfort is a consideration and constitutes one reason to position a patient, the caregiver must be aware that a position of comfort may be a position that could lead to the development of a soft tissue contracture or a pressure ulcer. Therefore frequent changes in the dependent patient’s position —at least every 2 hours—are necessary to prevent contractures and relieve pressure on the skin, subcutaneous tissue, and the circulatory, neural, respiratory, and lymphatic systems, as well as other structures.
●A small pillow or a cervical roll may be placed under ●the patient’s head A small pillow, rolled towels, or a small bolster can be ●placed behind the knees A small, rolled towel or small bolster may be placed under the patient’s ankles to relieve pressure to the calcaneus (heel), but knee hyperextension should be ●avoided The patient’s upper extremities may be elevated on pillows or positioned in whatever way the patient desires for comfort (such as by the patient’s side, in a reverse T ●position, or folded on the chest). The patient’s body and extremities should be totally ●supported on the mat or table No part or portion of the body or extremities should ●project beyond the surface Remember that the areas of greatest pressure
●Place a small pillow or towel roll under the patient’s ●head, or position the head to the left or right A pillow placed under the patient’s lower abdomen will ●reduce lumbar lordosis A rolled towel should be placed under each anterior ●shoulder area A pillow, towel roll, or small bolster should be placed ●under the anterior portion of the patient’s ankles The patient’s upper extremities may be positioned for comfort (e.g., along the sides of the body, in a T position, ●or with the hands under the head). Remember that the areas of greatest pressure
●Initially a patient in a side-lying position should be positioned in the center of the bed, mat, or table with the ●head, trunk, and pelvis aligned Both of the patient’s lower extremities should be flexed ●at the hip and knee The uppermost lower extremity should be supported on one or two pillows and positioned slightly forward of the ●lowermost extremity. A small towel roll can be placed just proximal to the ●lowermost lateral malleolus to relieve pressure. One or two pillows should be used to support the ●patient’s head. A folded pillow placed at the patient’s chest is used to support the uppermost upper extremity and to prevent ●the patient from rolling forward. Placement of a folded pillow along the posterior area of the patient’s trunk may be necessary to prevent the ●patient from rolling backward. Remember that the areas of greatest pressure
●First, go to the side where you are near to ●the patient Second, position one forearm under the neck or upper back and the other forearm ●on middle of the back Gently slide the upper body and head toward you without ●lifting Third, position forearm under the lower trunk and distal to the pelvis- slide the ●segment towards you Lastly, forearm on thighs and legs- slide towards you Proper body mechanics: bend your hips and knees when necessary; avoid lifting
●2.UPWARD MOVEMENT First, bring patient closer to the near edge; the bed is ●flat- no pillows from under the head or shoulder Second, ask patient to do bridging to help assist by pushing with the legs; thighs may be supported with ●pillows Face towards patient head and stand approx. opposite to ●midchest of the patient with a stride position Support patient head and upper trunk with your arms and lift until inferior angle of the scapula has clear the bed ●Slide lower trunk and pelvis upward approx 6-10 inches ●Proper body mechanics: your chest should be close to the patient’s chest= short arm lever
3.DOWNWARD MOVEMENT ●Same with upward ●movement Cradle and lift pelvis slightly before you slide the upper body and head down Move the patient 6-10 inches and then reposition yourself
4.MOVE TO A PRONE POSITION ●First, do the side lying ●technique However arm should be positioned in one of two ways: (1) hands by side- external rotation, straight elbow, palm up and hands tucked under the pelvis, and (2) flex arm until it rests by the side of the ear and the side by which the roll is directed should remain by the side Have enough space for rolling
5.MOVE TO A SITTING POSITION ●First, move patient on near edge (use thigh of the patient as a guide) and roll the patient to side lying which the knees should ●be partially flexed Elevate trunk by lifting under the shoulders or by instructing to push up by using either or both ●upper extremity Let patient engage ●neck and trunk muscles Pivot lower extremity ●as trunk is raised If patient is unable to control the lower extremity to put them on the floor, you need to assist lower extremity to prevent pain Do not leave patient unattended
1. Side to side movement, patient supine ●First, tell the patient to flex hips and knees ●Second, position one UE next to trunk and the other UE ●approx. 4 inches from the trunk Third, instruct patient to push down with the LE (bridging position) to lift pelvis and move towards abducted UE and elevate the upper trunk by pushing into the bed with elbows and the back of the head to move towards the abducted ●elbow Patient should reposition after.
2. Upward movement, patient supine ●First, tell the patient to fully flex hips and knees ●Second, position UE with elbows flexed and next to the ●trunk with shoulder pulled up towards the ears Third, the patient elevates the pelvis and elevates upper ●trunk by pushing the elbow and back of the head Patient moves upward by pushing with the lower ●extremities and depressing the shoulders Reposition after.
3. Downward movement, patient ●supine First, tell patient to partially flex hips and knees (approx. 8-12 ●inches away buttocks) Second, position UE with elbows flexed and next to the trunk with ●shoulder depressed Third, the patient elevates the pelvis and elevates upper trunk by pushing the elbow ●and back of the head Patient then moves downward by pulling with LE, simultaneously pushing up with the shoulders and pulling ●downward with FA Reposition after.
4. Move to side-lying position, patient supine ●First, instruct patient to move to far edge of the bed ●If rolling to the right side, instruct patient to place left ●UE over the right, and lift diagonally L LE over the R LE Ask patient to use the neck and abdominal muscles to ●roll on the side or use left hand to grasp on the bed Instruct to maintain side lying by using the left hand on the bed and by flexing the LE. pillow is need in the head.
●5. Move to a prone position, patient supine Same with dependent mobility. ●6. Move to a supine position, patient supine To roll to right, patient position R UE under right side or ●flexed so the upper arm is near the ear The patient pushes with the left UE, lift the L LE over the right and moves to a side lying position ●Patients should reposition if necessary ●And then roll to supine.
●7. Move to a sitting position, patient supine First, let the patient move on near edge (use thigh of the ●patient as a guide) Second, patient rolls to a side lying position and flexes the hips and the knees to maintain the position briefly, ●then the upper hand on the bed at midchest level Third, push with the upper arm while the lower arm is ●used to maintain the position Then, elevate the trunk by pushing both UE to a side ●sitting position The LE can be pivoted simultaneously over the edge of ●the bed THIS TECHNIQUE IS BENEFICIAL FOR LOW BACK DYSFUNCTION OR PAIN.
●Planning and ●After explaining the organization are required transfer let the patient before a patient attempts ●repeat. ●to perform any transfer. Do not ask “do you Informed and taught understand” instead let them ●first before attempt ●repeat the procedure Demonstration may Avoid lengthy explanations, be specific. ●help SAFETY CONCERNS IN Careful attention to safety precautions ●TRANSFER Patient should always wear ●BEFORE TRANSFERS proper shoes Prepare the patient, environment and ●Safety belt when needed yourself. ●Be alert ●Any bandages or equipment ●Review medical record ●Decision for attached to the patient should appropriate transfer ●always be protected should base on your In wheelchair, make sure evaluation, available drive wheels are locked written information, before transfers information from patient or family members and ●Anticipate need of assistant the goals of treatment. ●It is best to be in front and ●slightly to one side ●DURING TRANSFERS Transfer should be Do not leave patient unless explained before transfer support and stability is ●is begun ●provided Obtain consent after Make sure that the giving instruction environment is free from obstacles
SPECIAL PRECAUTIONS
STRETHCHING ●·SHOULDER FLEXION For this self exercise, let the good arm of patient assist/move their bad arm (arm with green band) to ●perform the exercise Let patient clasp their hands ●together Then, assist or let them slowly lift ●their arms overhead Then hold the position for 10 ●seconds and repeat 6-10 times Caregiver can also manually do this if patient can't do the self-exercise ●SHOULDER ABDUCTION For this self-exercise, let the good arm of the patient assist/move their bad arm (arm with green band) to ●perform the exercise Let patients clasp their hands ●together Then, assist or let them slowly lift their arms out to the side and ●overhead Then hold the position for 10 ●seconds and repeat 6-10 times Caregiver can also manually do this if the patient can't do the self-exercise
●ELBOW EXTENSION For this self exercise, let the good arm of patient assist/move their bad arm (arm with green band) to perform ●the exercise Let patient clasp their hands ●together Then, assist or let them slowly ●straighten their elbows At times, it will be very hard to straighten the arm. What you can do is to slowly massage the biceps muscle side-to-side or in a circular motion. This can help relax that muscle so you ●can slowly straighten the arm. Then hold the position for 10 seconds and repeat 6-10 times
WRIST, HAND, AND FINGER ●OPENERS First, slowly straighten the thumb away from the rest of the ●fingers Next, slowly open the fingers and put the hand palm down on a ●table Hold this position as long as possible or do this with the previous exercises You can also let the patient do this on their own but may need help
●ANKLE DORSIFLEXION Place a pillow or a towel under the knees of the bad leg of the patient ●With one hand, place hand under the heel of the patient ●With the other hand on the sole of the feet ●Then, slowly push up on the sole of the patient (like the feet is pointing up to the ceiling) ●Hold this position for 10 seconds and repeat 6-10 times ●You can also let the patient do this on their own but may need help
1.CHAIR LEG RAISE Start by sitting in a chair with your back straight and two feet flat on the floor Slowly, straighten your right leg, keeping it straight for as long as you can. Lower it back and repeat with your left leg. This can be done 2-3 sets on each leg of 10-15 seconds hold You can also progress by putting weights or on the ankle and as tolerated.
2.Heel Slides Start lying down with the knees bent and the feet only a moderate distance from your buttocks. Slowly slide the foot towards your buttocks as much as you can and hold for 2-3 secs
Slowly return it to its original position and slide again until the knee is straight. Do this 10 reps and 3 sets per foot. You can also progress by putting some weights on the ankles that the patient can tolerate.
4. Biceps Curls Begin standing or sitting. Keep your abdominal muscles engaged. Hold dumbbell (water bottle) on the good arm. Let your arms relax down at the sides of your body with palms facing forward
5. Wrist Curls In a seated position, theforearm should be resting on the table and wrist hanging on top. Curl your wrists upward as you exhale. Perform this movement slowly to engage the forearms and prevent the weights from straining your wrists. Extend your wrists downward as far as they will comfortably go on an inhale. Do this for 8-10 reps and as tolerated. You can also start by doing the exercise without weights then progress as tolerated.
RED FLAGS RED FLAGS INDICATING THE NEED FOR MEDICAL CONSULTATION 1. Severe nonstop pain 2. PaIn unaffected by medication or positions 3. Severe night pain 4.Severe pain with no history of injury 5. Severe spasm 6. Inability to urinate or hold urine 7. Elevated temperature (especially if prolonged) 8. Psychological overlay
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