PTA 200 FUNDAMENTALS OF PHYSICAL
THERAPY
SPECIAL EQUIPMENT & THE
ACUTE CARE SETTING
Key Terms



Dyspnea: Shortness of breath (SOB)
Infiltrate: When fluid being administered
through an IV leaks out of the vein into the
subcutaneous tissues
Intubate: When oxygen is being
administered through an endotracheal tube
the patient is “intubated”
Key Terms

Occlude: To close off or obstruct


IV line or catheter
Airway

Specialized Care Units

See text: Box 10-1 p 276
Orientation to Special Care Units

Equipment to





Monitor the patient’s physiologic state
 Vital signs
Ventilate (ventilator or respirator)
Provide intravenous (IV) therapy
Deliver oxygen
Remove fluids (suction, drains)


Guidelines for Treating a Patient in an
Intensive Care Unit
Precautions to Use in the Intensive Care
Unit

see text Procedures 10-1 & 10-2 p 278

Precautions to Observe: Specific to PT

Modify treatment to patient status
 Shorter treatment sessions
 Fewer repetitions
 Less active participation

PT Goals & Activities in ICU






Prevent contractures
 Passive & active ROM
 Positioning
 Body alignment
Improve patient’s general condition
Bed mobility training
Transfer training
Ambulation activities
Increase functional independence

Types of Beds (See Summary Handout)
 Standard adjustable bed
 Turning frame (Stryker Wedge frame)
 Circular turning frame
 Air-fluidized support bed (Clinitron)
 Post-trauma beds (Keane, Roto-Rest)
 Low air loss bed

Life Support & Monitoring Equipment
Mechanical Ventilators (Respirators)




Use positive pressure to move or propel gas into
patient’s lungs
Gas is delivered through an endotracheal tube
(ETT)
When tube is in place, patient is intubated
Patients are weaned from vents as they start to
breath on their own
Endotracheal Tubes



Air will be induced into patient through a
tube in one of several possible ways
All will provide a clear airway into the
lungs and allow for suction of secretions
An ETT will restrict the patient from
talking & once removed the patient is
likely to complain of a sore throat and the
voice may be distorted
Life Support & Monitoring
Equipment

Endotracheal tube locations






Oral pharyngeal
Nasal pharyngeal
Nasal endotracheal
Oral endotracheal
Tracheostomy
Laryngostomy
Types of Ventilators
Volume-Cycled Ventilators
 For patients who require long-term ventilation
 COPD
 s/p thoracic surgery
 CNS disorders
 A predetermined volume of gas is delivered
during inspiration dependent on patient’s need;
expiration is passive
Pressure-Cycled Ventilators
 Used for short-term ventilation
 Provides Intermittent Positive-Pressure Breathing
(IPPB)
 Delivers a predetermined pressure of gas during
inspiration; expiration is passive
Negative Pressure Device
 Rarely used
 Includes iron lungs
 Create a negative pressure in the patient’s
chest so air will enter the patient’s lungs

Modes of Ventilation








See Summary Handout & Box 10-2 p 283
Assist mode
Continuous positive airway pressure (CPAP)
Control mode
Assisted control mode
Intermittent mandatory ventilation (IMV) mode
Synchronized IMV mode
Positive end-expiratory pressure (PEEP)
Precautions for Intubated Patients




Be certain tubing is long enough for the activity
Ask questions that can be answered with head
nods or nonverbally
Monitor patient closely
 Vital signs
 Respiratory distress
 Cardiopulmonary distress
Patient may not tolerate exercise as well as other
patients
Monitors


Exercise can be performed by patients on
monitors provided care is taken not to
disrupt the equipment
See Summary handout & text p 284-286
Monitors





Vital signs
Arterial blood gases (ABGs)
Intracranial pressure (ICP)
Central venous pressure (CVP)
Arterial pressure (A-line)

Monitors for Vital Signs





Blood pressure
Respirations
Temperature
Blood gases
Cardiac patterns
 EKG or ECG
 Telemetry






Oximeter
Pulmonary artery catheter (Swan-Ganz catheter)
Intracranial pressure monitor (CP)
Central venous pressure catheter (CVP)
Arterial line (A line)
Indwelling right atrial catheter (Hickman)
Feeding Devices




Nasogastric tube (NG tube)
Gastric tube (G tube)
Intravenous feeding
Intravenous infusion lines (IV)
Urinary Catheters



External catheter (condom)
Indwelling catheter inserted through urethra into
bladder
 Foley catheter
 Catheter bag must remain below the level of
the bladder
Suprapubic catheter
Oxygen Therapy Systems





Nasal canula
Oronasal mask
Nasal catheter
Tent
Tracheostomy mask or catheter


Chest Drainage Systems
Ostomy devices
 Enterostomy
 Ileostomy
 Colostomy
Skeletal Traction

Balanced suspension traction






Thomas splint
Kirschner wires
Skull traction: Crutchfield tongs
Halo
External fixation devices: Hoffman
Internal fixation devices (ORIF)

Patient-controlled analgesia (PAC)

Dialysis


Hemodialysis
Peritoneal dialysis
Laboratory Values
O2Sat (SAO2)
95-98%
 Keep 90% when exercising

Hemoglobin (Hgb)
14-18 g/dl (males)
13-16 g/dl (females)

Hematocrit (Hct)
40-54 ml/dl (males)
37-48 ml/dl (females)