Transcript Assisting with Cold and Heat Therapy and Ambulation

CHAPTER
42
Assisting with Cold
and Heat Therapy
and Ambulation
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
42-2
Learning Outcomes
42.1 Explain how medical assistants might assist with
some forms of physical therapy.
42.2 Describe ways to test joint mobility, muscle strength,
gait, and posture.
42.3 Discuss the benefits of cold and heat therapies.
42.4 List contraindications to cold and heat therapies.
42.5 Identify various cold and heat therapies.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
42-3
Learning Outcomes (cont.)
42.6 Demonstrate how to perform cold and heat
therapies.
42.7 Describe hydrotherapy methods.
42.8 Identify several methods of exercise therapy.
42.9 Compare different methods of traction.
42.10 Demonstrate how to teach a patient to use a cane, a
walker, crutches, and a wheelchair.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
42-4
Introduction
• Medical assistant
– Common duties
• Apply cold and heat
therapy
• Assist patients with
ambulation
• You may also
– Teach basic
exercises
– Demonstrate how
to use a wheelchair
– Demonstrate the
use of cane,
walker, and
crutches
– Discuss therapies
with the patient
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42-5
General Principles of Physical Therapy
• Physical therapy is a
medical specialty that
treats
– Musculoskeletal
disorders
– Nervous disorders
– Cardiopulmonary
disorders
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42-6
General Principles of Physical Therapy
(cont.)
• Assisting the therapeutic team
– Members
•
•
•
•
Physicians
Nurses
Medical assistants
Other specialists
You must have a
working knowledge of
therapy techniques.
– Coordinate patient
schedule
– Make referrals
– Explain treatment
approach
– Documentation
– Reinforce instructions
– Answer patient
questions
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42-7
General Principles of Physical Therapy
(cont.)
• Specialized
therapies
– Art
– Music
– Dance
– Writing
– Crafts
– Aquatic
– Horticultural
– Equestrian
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42-8
Patient Assessment
• Joint mobility testing
– Range of motion (ROM) – degree to which a joint
is able to move
– Goniometer
– Degree of movement
compared to a standard
measure
• Muscle strength testing
– Determines the amount of force the patient can
exert with a group of muscles
– Compare each side of body
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42-9
Patient Assessment (cont.)
• Gait testing
– The way a person
walks (gait and
swing)
– Includes
•
•
•
•
Length of stride
Balance
Coordination
Direction of
knees and feet
• Posture
– Body position and
alignment
– Checks spinal
curves
– Symmetry of
alignment
• Shoulders
• Knees
• Hips
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
42-10
Apply Your Knowledge
Match description with assessment type:
ANSWER:
___
D How a person walks
A. Joint mobility
___
A Range of motion
B. Muscle strength
___
C Body position and alignment
C. Posture
B Force exerted with a group of muscles D. Gait
___
___
A Goniometer
___
C Check spinal curves
___
D Length of stride
Good Job!
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
42-11
Cryotherapy and Thermotherapy
• Cryotherapy
• Thermotherapy
– Applying cold for
therapeutic
reasons
– Applying heat for
therapeutic
reasons
– Types
– Types
• Wet or dry
• Dry
• Chemical or natural
• Moist
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42-12
Cryotherapy and Thermotherapy
(cont.)
• Generally promote
healing
• Side effect – damage
to underlying nerves
and tissues
• Monitor patient
closely
• Factors affecting the
use of these
treatments
– Treatment location
– Circulation or
sensation impairment
– Temperature tolerance
– Age
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42-13
Principles of Cryotherapy
• Constricts blood vessels
• Physiologic responses to cold
– Prevents swelling
– Controls bleeding
– Reduces
inflammation
– Anesthetic effect for
pain
– Reduces pus
formation
– Lowers body
temperature
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42-14
Administering Cryotherapy
• Dry cold applications
– Ice bags and collars
– Chemical ice packs
• Wet cold applications
– Cold compresses
– Ice massage
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42-15
Principles of Thermotherapy
• Dilates blood vessels
• Physiologic responses to heat
– Relieves pain and congestion
– Reduces muscle spasms
– Muscle relaxation
– Reduces inflammation
– Reduces swelling
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42-16
Administering Thermotherapy
• Dry heat therapies
– Chemical hot packs
– Heating pad
– Hot-water bottle
– Heat lamp
– Fluidotherapy
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42-17
Administering Thermotherapy (cont.)
– Moist heat applications
•
•
•
•
Hot soak
Hot compress
Hot pack
Paraffin bath
– Diathermy – highfrequency wave
achieves deep heat
penetration
• Ultrasound
• Shortwave
• Microwave
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42-18
Apply Your Knowledge
What is the main difference in the effect of
cryotherapy and thermotherapy that results in the
physiologic response of each?
ANSWER: Cryotherapy causes blood vessels to
constrict, resulting in its physiologic effects, while
thermotherapy causes blood vessels to dilate.
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42-19
Hydrotherapy
• Use of water to treat physical
problems
• Whirlpools
– Water is agitated by jets of air
under pressure
– Generates hydromassage
• Relaxes muscles
• Increases circulation
– Also used to clean and debride
wounds, ulcers, and burns
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42-20
Hydrotherapy (cont.)
• Contrast baths
– 2 baths, one hot
and one cold
– Patient moves
quickly from one to
the other
– Purpose
• Induces relaxation
• Improves
circulation
• Greater mobility
• Underwater
exercises
– Warm swimming
pool
– Buoyancy takes
pressure off joints
– Purpose
• Promotes
relaxation
• Increases
circulation
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
42-21
Apply Your Knowledge
What are the main effects of hydrotherapy?
ANSWER: Hydrotherapy relaxes muscles, increases
circulation, and improves flexibility and mobility.
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42-22
Exercise Therapy
• Preventive and therapeutic benefits
–
–
–
–
Flexibility
Mobility
Muscle tone
Strength
• Primary treatment for fractures,
arthritis, and some respiratory
diseases
– Minimizes symptoms
– Slows disease progression
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42-23
Exercise Therapy (cont.)
• Exercise
– Improves muscle tone
and strength
– Maintains ROM
– Improves circulation
– Prevents or corrects
physical deformities
– Relieves stress
– Promotes
neuromuscular
coordination
– Lowers cholesterol
levels
– Aids in resumption of
normal daily activities
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42-24
Medical Assistant’s Role
• Provide patient
information
– Types of exercise
programs
– Treatment plan

Assist with ROM
exercises

Teach the patient and
family about ROM
exercises.
• Provide support and
encouragement
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42-25
Types of Exercise
• Choice based on patient’s
physical condition
• Active mobility
– Self-directed exercises
– Increase muscle strength
and function
• Passive mobility
– Therapist or machine
moves the patient’s body
part
– Retain ROM and improve
circulation
• Aided mobility
– Self-directed with
assistance of a device such
as exercise machine
– Retain or improve ROM
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42-26
Types of Exercise (cont.)
• Active resistance
– Works against
resistance
– Increases muscle
strength
• Isometric
– Patient relaxes and
then contracts
muscles while in a
fixed position
– Maintains muscle
strength if immobilized
• ROM exercises
– Move each joint
through its full range of
motions
– Improves flexibility and
mobility
– Improves circulation
and muscle function
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
42-27
Electrical Stimulation
• Delivers a controlled amounts of lowvoltage electric current to motor and
sensory nerves
– Stimulates muscle
– Prevents atrophy
– Helps in healing injured joints
– Retrains a patient to use injured muscles
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42-28
YIPPEE
!
Apply Your Knowledge
Match description with type of exercise:
ANSWER:
B Self-directed; exercise machine
___
A. Isometric
E Self-directed; no assistance
___
B. Aided mobility
___
D Low-voltage current; stimulates
nerves/muscles
C. Active resistance
___
A Relax and contract muscles from
fixed position
D. Electrical
stimulation
___
C Exercise against counter-pressure
E. Active mobility
F Move joint through full range
___
F. ROM
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42-29
Traction
• The pulling or stretching of the
musculoskeletal system
– Used to treat fractured bones and dislocation,
arthritic, or other diseased joints
• Uses
– Create and maintain bone alignment
– Reduce and prevent joint stiffening
– Correct deformities
– Reduce and relieve muscle spasms
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42-30
Traction (cont.)
• Manual
– Stretching muscles
and separating joints
by gently pulling on
them
– Improves motion and
decreases stiffening
– Uses
• Static
– Weight traction using
harness and weights
– Used to relieve muscle
spasms
• Muscle spasms
• Stiffness
• Arthritis
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42-31
Traction (cont.)
• Skeletal
– Long-term/heavy
weights
– Pins, wires, or tongs
surgically placed
– Pulleys and weights
provide continuous
traction
• Mechanical
– Device intermittently
pulls and relaxes
– Promotes relaxation
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
42-32
Apply Your Knowledge
ANSWER:
True or False:
F Static traction uses a harness and weights to induce
___
relieve
muscle spasms.
T Manual traction stretches muscles and separates joints by
___
gently pulling on them.
T Skeletal traction uses pulleys and weights to provide
___
continuous traction.
F Mechanical traction maintains constant tension on the
___
extremity.
alternately pulls and relaxes
F
A
N
T
A
S
T
I
C
!
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42-33
Mobility Aids
• Devices to improve patients’ ability to
ambulate or move about
• Mobility aid chosen depends on
– Patient’s disability
– Muscle coordination
– Strength
– Age
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42-34
Canes
• Standard
– Patient who needs only small amount of
support
• Tripod (3 legs) and quad-base (4 legs)
– Create wide base of support
– More stable than
standard canes
• Must be adjusted to
correct height for patient
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42-35
Walkers
• Used by older patients with
– Difficulty walking unassisted
– Balance problems
• Provides a sense of stability
• Types – Table 42-2
• Adjust to proper height for patient
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42-36
Crutches
• Transfers weight to
the arms
• Types
– Axillary
• Ground to axilla
• Short-term use
– Lofstrand, or
Canadian
• Ground to forearm
• Long-term use
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42-37
Crutches (cont.)
• Complications may arise
if not measured properly
– Pressure on nerves in
axilla
– Strain on back, imbalance
• Measuring for crutches
– Should be 2 to 3 fingerwidths between supports
and axilla
– 30º flexion at elbow
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42-38
Crutches (cont.)
•
Crutch gaits
– Four-point – slow gait for a patient who can
bear weight on both legs
– Three-point – used when patient cannot
bear weight on one leg
– Two-point – used when patient can have
some weight on both legs; must have good
muscle coordination and balance
– Swing gait – used when patient has severe
disabilities
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42-39
Wheelchairs
• Type of chair chosen
– Depends on patient’s disability
– Length of time wheelchair needed
• Always ensure patient safety during
transfers
• Use appropriate lifting techniques
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42-40
Apply Your Knowledge
When would a walker be an appropriate mobility
device for use by your patient?
ANSWER: Walkers are used by older patients who are
too weak to walk unassisted or who have balance
problems.
Hip-HipHurray!
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42-41
Referral to a Physical Therapist
• Referrals to preferred
therapists
– Provide physician’s order
– Provide patient
information
• Therapists
– Independent practitioners
– Hospital or clinic
– Home health
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
42-42
In Summary
42.1 A medical assistant may be asked to apply cold and
heat; teach basic exercises; demonstrate how to use
a cane, walker, and crutches; demonstrate how to use
a wheelchair; and discuss with the patient specific
therapies for use at home.
42.2 Various physical tests are performed on patients,
including joint mobility testing, muscle strength
testing, gait, and posture testing.
42.3 Cold and heat therapy promote healing and increase
patient comfort.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
42-43
In Summary (cont.)
42.4 Contraindications to cold and heat therapies include
circulation problems, pain, and hemorrhage.
42.5 There are various types of cold and heat therapies.
These include dry and wet, cold, and heat
applications.
42.6 The general steps to applying cold and heat therapies
include checking the physician’s order, positioning
and draping the patient, applying the pack, and
monitoring the patient.
42.7 Various types of hydrotherapy used to treat physical
problems include whirlpools, contrast baths, and
underwater exercises.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
42-44
In Summary (cont.)
42.8 There are several methods of exercise therapy,
including active mobility, passive mobility, aided
mobility, and active resistance.
42.9 The different methods of traction used to treat
physical problems include manual, static, skeletal,
and mechanical.
42.10 There are various mobility aids, including canes,
walkers, crutches, and wheelchairs. Specific
instructions for each of these aids must be followed
to reduce the possibility of patient injury during their
use.
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
42-45
End of Chapter 42
Disability is a matter of
perception. If you can do
just one thing well,
you're needed by
someone.
~ Martina Navratilova
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.