FOOT ULCERS n DETERMINE CAUSE – NEUROPATHIC – ISCHEMIC – COMBINATION

PREVENTION

n PREVENTION IS THE BEST WAY TO TREAT DECUBITIS ULCERS AND CONTRACTURES

HOW CAN WE PREVENT ULCERS TURN EXERCISE OBSERVATION

CONTRACTURES n TIGHTENING OR SHORTENING OF A MUSCLE DUE TO LACK OF MOVEMENT OR USAGE OF A MUSCLE n FOOT DROP IS A COMMON CONTRACTURE

PREVENTION OF CONTRACTURES n KEEP FOOT AT RIGHT ANGLE TO THE LEG n USE FOOTBOARDS AND HIGH TOP TENNIS SHOES TO KEEP FOOT IN POSTION n RANGE OF MOTION EXERCISES – ROM

WHAT IS RANGE OF MOTION n EXERCISES FOR PATIENTS THAT HAVE LIMITED ABILITY TO MOVE n ROM HELPS KEEP MUSCLES AND JOINTS FUNCTIONING n MAINTAIN THE HEALTH OF THE MUSCULOSKELETAL SYSTEM

THREE MAIN TYPES OF ROM n ACTIVE ROM n PASSIVE ROM n RESISTIVE ROM

ACTIVE ROM n PERFORMED BY THE PATIENT – PT MOVES EACH LIMB WITHOUT ASSISTANCE

PASSIVE ROM n ANOTHER PERSON MOVES EACH JOINT – PATIENT NOT ABLE TO EXERCISE

RESISTIVE ROM n THERAPIST n EXERCISES PERFORMED AGAINST REISTANCE PROVIDED BY THE THERAPIST

PRINCIPLES TO OBSERVE FOR ROM n MOVEMENT SLOW n PROVIDE SUPPORT TO THE PART ABOVE AND BELOW THE JOINT n PAIN MEANS STOP n PERFORM EACH MOVEMENTS 3 TIMES n PATIENT ASSIST WHEN POSSIBLE

BASIC PRICIPLES FOR PERFORMING ROM n AUTHORIZATION n IDENTIFY n BODY MECHANICS & PT SAFETY n POSITION SUPINE POSITION

PERFORM ROM n START AT HEAD & MOVE TO FEET n COMPLETE ONE SIDE OF BODY AND THEN MOVE TO OTHER SIDE n EACH MOVEMENT 3 TIMES n SUPPORT BODY PART ABOVE & BELOW JOINT n PAIN MEANS STOP

MOVES AND TURNS n PATIENTS WHO ARE CONFINED TO BED MUST BE TURNED FREQUENTLY n POSITION SHOULD BE CHANGED AT LEAST EVERY TWO HOURS – PER DR.’S ORDER

??WHY TURN?? n PROVIDES EXERCISE FOR MUSCLE n STIMULATES CIRCULATION n PREVENTS DECUBITIS ULCERS AND CONTRACTURES n PROVIDES COMFORT

DANGLING n SITTING PATIENT WITH LEGS HANGING OVER THE SIDE OF THE BED n PLACE PT IN DANGLING POSTION BEFORE BEING TRANSFERRED FROM BED

PULSE IS CHECKED THREE TIMES DURING PROCEDURE n TAKEN JUST BEFORE PATIENT MOVED TO SERVE AS RESTING OR CONTROL RATE n TAKEN IMMEDIATELY AFTER POSITIONING PATIENT IN DANGLING POSITION n TAKEN AFTER PATIENT HAS RETURNED TO LYING POSITION

n BY NOTING CHANGES IN PULSE RATE YOU CAN DETERMINE HOW WELL PATIENT TOLERATES PROCEDURE

OTHER OBSERVATIONS TO BE MADE n CHECK RESPIRATORY RATE n CHECK BALANCE AND NOTE VERTIGO OR DIZZINESS n NOTE AMOUNT OF PERSIPRATION AND COLOR

RETURN PATIENT IMMEDIATELY TO SUPINE IF n EXCESSIVE INCREASE IN PULSE RATE OR WEAK PULSE n SIGNS OF LABORED RESPIRATIONS n COLOR BECOMES PALE OR INCREASED PERSPIRATION NOTED n PATIENT GETS DIZZY OR WEAK

IMPLEMENTATION n PLACE BED IN LOW POSITION n RAISE HEAD OF BED n ASSIST PATIENT TO DANGLE

TRANSFERS n PATIENTS TRANSFERRED TO WHEELCHAIRS, CHAIRS, AND STRETCHERS n CORRECT PROCEDURES MUST BE FOLLOWED TO PREVENT INJURY TO BOTH PATIENT AND WORKER

n MANY DIFFERENT MODELS OF WHEELCHAIRS AND STRETCHERS AVAILABLE n IF NO INSTRUCTIONS ARE AVAILABLE, ASK IMMEDIATE SUPERVISOR TO DEMONSTRATE CORRECT OPERATION

MECHANICAL LIFTS n FREQUENTLY USED TO TRANSER WEAK OR PARALYZED PATIENTS n READ INSTRUCTIONS PROVIDED n CHECK STRAPS, CLASPS, AND SLING FOR ANY DEFECTS n USE SMOOTH EVEN MOVEMENTS WHILE OPERATING LIFT

n REASSURE FRIGHTENED PATIENTS THAT LIFT IS SAFE n MOVE UNNECESSARY FURNITURE OUT OF THE WAY DURING TRANSFERS n PARTICULARLY IMPORTANT IN HOME CARE SITUATIONS