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Flashcards in Acute care Deck (31)
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1
Q

What are the differences between joint effusion and edema?

A

Joint Effusion

– Contained by joint capsule
– Feels like a water balloon
– Moves when palpated then returns

Edema

– Fluid in interstitial space
– Press on tissue with finger – dent (pit) remains

• Measurement of edema with circumference is
reasonable accurate and correlates well with CT
scans

2
Q

What is PRICE, RICE and PRICES?

A

PRICE: protect, rest, ice, compress, elevate
RICE: all of the above except protect.
PRICES: all the above, add support

3
Q

With external compression wrapping, what direction do you wrap?

A

Distal to proximal

4
Q

What accessories can you utilize to increase compression?

A

J or horseshoe shaped felt pad held in place with the wrap.

5
Q

What is internal compression and what are the methods?

A

Compression of lymph vessels and veins.

– Muscle contractions (if safe)
– ROM, pumping ankles, alphabet, isometrics

6
Q

What does external compression do for circulation?

A

Pushes fluid towards the heart (therapeutic and prophylactic for Deep Venous Thrombosis (DVT) and Venous Thrombo Embolism (VTE)

Pushes arterial blood into extremity
– Ischemia, intermittent claudication

7
Q

When is intermittent compression appropriate and what would you use?

A

Acute or chronic edema

  • Mechanical device (usually pneumatic)
  • Inflates to compress part
8
Q

Whats the most common form of intermittent compression?

A

Intermittent sequential graded compression

• 3- compartments
– Distal,
– Intermediate
– Proximal

• Inflated for minutes
then deflated then
repeated hours per
day

9
Q

T/F

Intermittent compression can be combined with cooling?

A

True

10
Q

What are the positive effects of elevation?

A
• Gravity augments lymph flow
• Elevation above heart level significantly
reduced edema in 20 minutes
• Dependent position increases edema (in
normals)
– Probably more profound in inflammation
11
Q

What kind of things fall under the “support” category?

A
Nutrition
Education
Taping, bracing, crutches, canes, etc.
Referral for emotional support
Etc.
12
Q

Bracing and taping are great for acute support, but what are some downsides?

A

Not much research
Tape stretches within 20-30 minutes
Bracing can inhibit muscle actions (e.g. knee brace inhibit the hamstring from contracting).

13
Q

T/F

When structure and function of a joint are not severely compromised, it’s still best to be safe and cut out any weight bearing activity on that part of the body.

A

False,

If not severely compromised, careful and partial weight bearing is better than non weight bearing.

14
Q

When fitting crutches, what should patient orientation be?

A
  • Low heeled shoes
  • Stand with tall posture
  • Feet close together
15
Q

When fitting crutches, how should the crutch tips be oriented relative to the feet?

A

– 6”(15 cm) from outer margin of shoe

– 2”(5) cm in front of shoe

16
Q

When fitting crutches, how should the arm brace and hand brace be oriented?

A

Arm brace
– 1-2” below ant. axillary fold

• Hand brace
– elbow flexed to 30 degrees

17
Q

What are some abnormal stresses that can come from improper usage or fitting of crutches?

A

–Lumbar/pelvic subluxation
–Low back strain
–Hip strain

18
Q

What anatomy is effected by crutch palsy and what are the symptoms?

A
  • Pressure on axillary nerves and vessels

* Temporary or permanent numbness

19
Q

What should be the orientation of crutches while walking for weight bearing and non weight bearing?

A

• Non-weight bearing = tripod gait
• Partial weight bearing = tripod or 4-point
gait

20
Q

How can you instruct your patients so that they don’t experience crutch palsy?

A

Instruct them to always use an upright spinal posture

Discourage them from resting on the underarm braces.

21
Q

What are the 7 aspects of tripod non-weight bearing gate with crutches?

A
• Affected foot fully elevated
• Crutch tips move 12 to 15 in. ahead of feet
• Lean forward, straighten elbows
• Pull underarm brace firmly
against torso
• Swing both legs between
crutches
• Step onto unaffected foot
• Recover crutches to forward
position
22
Q

What is swing-to gait and swing through gait?

A

Swing-to gait: bring fit to crutches (easier, less coordination)

Swing-through gait: foot lands in front of crutches (faster, more coordination).

23
Q

What’s another name for tripod partial weight bearing gait?

A

Four point gait.

24
Q

What is tripod non-weight bearing gait?

A

• Affected leg and crutches move forward together

– Partial weight placed on affected leg

25
Q

What are the two gait options when going up and down stairs?

A

Tripod gait: tripod gait if no handrail, curbs
• “The good go up, the bad go down”

Handrail gait – Preferred, safer
– Both crutches under one arm
• Away from railing
• Crutches remain on affected side if possible

26
Q

What is the proper steps to going up and down stairs with handrail gait?

A

Going up: unaffected side goes first, follow by crutches and bum leg.
Going down: crutches down, then affected leg, then unaffected leg.

27
Q

What is the proper steps to going up and down stairs with tripod gait?

A

Going up: unaffected leg goes first, followed by crutches and bum leg.

Going down: Crutches and affected leg go down first, then unaffected leg. `

28
Q

What kind of footwear should patients wear when fitting a cane?

A

Low heeled street shoes

29
Q

What is the appropriate length for a cane?

A

Superior aspect of greater trochanter

30
Q

T/F

Cane is to be used on the side of involvement

A

False,

cane’s are to be used on the OPPOSITE side of involvement.

31
Q

T/F

Cane is to move with the involved side

A

True