CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42 Assisting with Cold and Heat...
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Transcript of CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 42 Assisting with Cold and Heat...
CHAPTER
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
42Assisting with Cold and Heat Therapy and Ambulation
© 2011 The McGraw-Hill Companies, Inc. All rights reserved.
42-2
Learning Outcomes42.1 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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General Principles of Physical Therapy (cont.)
• Assisting the therapeutic team– Members
• Physicians• Nurses• Medical assistants• Other specialists
– Coordinate patient schedule
– Make referrals– Explain treatment
approach– Documentation– Reinforce instructions– Answer patient
questions
You must have a working knowledge of
therapy techniques.
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General Principles of Physical Therapy (cont.)
• Specialized therapies– Art– Music– Dance– Writing
– Crafts– Aquatic– Horticultural– Equestrian
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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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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
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42-10
Apply Your Knowledge
Match description with assessment type:
___ How a person walks A. Joint mobility
___ Range of motion B. Muscle strength
___ Body position and alignment C. Posture
___ Force exerted with a group of muscles D. Gait
___ Goniometer
___ Check spinal curves
___ Length of stride
C
D
C
B
A
A
DGood Job!
ANSWER:
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42-11
Cryotherapy and Thermotherapy
• Cryotherapy– Applying cold for
therapeutic reasons
– Types • Wet or dry
• Chemical or natural
• Thermotherapy – Applying heat for
therapeutic reasons
– Types • Dry
• 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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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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Administering Thermotherapy
• Dry heat therapies– Chemical hot packs– Heating pad
– Hot-water bottle– Heat lamp– Fluidotherapy
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Administering Thermotherapy (cont.)
– Moist heat applications• Hot soak• Hot compress• Hot pack• Paraffin bath
– Diathermy – high-frequency wave achieves deep heat penetration
• Ultrasound • Shortwave• Microwave
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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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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
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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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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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Exercise Therapy (cont.)
• Exercise– Improves muscle tone
and strength
– Maintains ROM
– Prevents or corrects physical deformities
– Promotes neuromuscular coordination
– Improves circulation
– Relieves stress
– Lowers cholesterol levels
– Aids in resumption of normal daily activities
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Medical Assistant’s Role
• Provide patient information– Types of exercise
programs – Treatment plan
• Provide support and encouragement
Assist with ROM exercises
Teach the patient and family about ROM exercises.
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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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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
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42-27
Electrical Stimulation
• Delivers a controlled amounts of low-voltage 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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Apply Your Knowledge
Match description with type of exercise:
___ Self-directed; exercise machine A. Isometric
___ Self-directed; no assistance B. Aided mobility
___ Low-voltage current; stimulates C. Active resistance nerves/muscles
___ Relax and contract muscles from D. Electrical fixed position stimulation
___ Exercise against counter-pressure E. Active mobility
___ Move joint through full range F. ROM
D
E
F
C
A
YIPPEE!
B
ANSWER:
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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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Traction (cont.)
• Manual– Stretching muscles
and separating joints by gently pulling on them
– Improves motion and decreases stiffening
– Uses • Muscle spasms• Stiffness• Arthritis
• Static– Weight traction using
harness and weights– Used to relieve muscle
spasms
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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
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42-32
Apply Your Knowledge
True or False:___ Static traction uses a harness and weights to induce muscle spasms.
___ Manual traction stretches muscles and separates joints by gently pulling on them.
___ Skeletal traction uses pulleys and weights to provide continuous traction.
___ Mechanical traction maintains constant tension on the extremity.
F
T
T
F
alternately pulls and relaxes
relieve
ANSWER: FANTASTIC
!
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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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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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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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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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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 finger-
widths between supports and axilla
– 30º flexion at elbow
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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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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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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-Hip- Hurray!
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Referral to a Physical Therapist
• Referrals to preferred therapists– Provide physician’s order– Provide patient
information
• Therapists – Independent practitioners– Hospital or clinic– Home health
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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.
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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