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Acute Care Occupational Therapy Hardin Memorial Hospital HARDIN MEMORIAL HosPiTaL Final Project by: Matt Hill, OTS Spalding University Mhillo3@spaidingedu rk Supervisor Godfrey, OTR/L Welcome to Hardin Memorial Hospital My intention for providing this binder is to help students comfortably. or as comfortably as possible, transition from student to entry level acute care occupational therapist by providing tips, information on conditions. helpful information on documentation, and a few suggestions for treatment ideas. | hope the information Provided will help to guide you on your journey to being an occupational therapist. Just to give you a frame of reference, my time here has gone by rather quickly, so it seems, and I'm now in my last week of my first level Il fieldwork, Coming into this fieldwork I did not have much hospital experience soit was a rough transition for me in the beginning Itis stressful to see many of the conditions and comorbidities that you WILL see, Remember. healthy people don't come tothe hospital. You may have the experience of seeing someone pass away or seeing others make an amazing recovery. Live in the ‘moment, be present in the moment, utilize your therapeutic use of self and you'll be just fine. The rehab staff here have been excellent resources for me to ask questions and they are willing o help you. Just ask the question, don't guess Utilize other professions to help you learn as well. Do not clase yourself off from the nurses nor the PCAS (patient care assistant) as they can be your best friends when you need them. You're in the healthcare profession and most people are go.ng to be wiling to help you if you ask nicely. Enough ofthat. Feel free to use and EDIT this binder for yourself as well as future students. If you don"t, no worries. I hope you have a wonderful experience here at Hardin Memorial Hospital All the Best, Matt Hill, OTS Spalding University Mhill03@spalding.edu Tips 1m this section 1 hope to provide some tps that have helped me throughout my time here at Hardin Memorial Hospital |. Lights above the rooms: When I first artived [had no idea what the lights above the Patients rooms meant Green Light ~ A nurse is in the room (Orange Light ~ A personal care assistant is inthe room Flashing White Light ~ The patient has pressed their call button, {a patient has pressed their call button, check on them and see how you can help them. If they are not on your easels. do not help them to the bathroom. Find someone who can help them like their nurse oF their PCA 2. Nursing boards (not sure of the actual name) — Within each floor and section of the hospital will be a white board that will tll you which nurse has which patient by room ‘number. The left side of the board is usually day shit andthe right side is night shift, IF the room number is circled. then that patient is either being discharged or being transferred out to a different room. Usually. a red cirele around the room number means they are being discharged and a blue circle around the room number means they are being, Uwansferred. This asthe system they had in place at the time Iwas there so it may ‘change. Just ask someone if you have questions! Your nametag says student, $0 ask, 3. On the ® ‘oJ nursing facility. Although students cannot work there <> iin the gym that you ean use, Weights, bands, puzzles, vn. You li have to look for yourself and be ereative with your ‘treatment ADI ~ » considered treaiment too. This placement likes to se theraps: ‘reat. qothing wrong with that, bat Pd definitely recommend 1 Fs patients will appreciate it too, 4. Don't worry about {est yout haul to take when you came in, oF that you will have to take. Tas ed rst time. 1 sll swear all the answers ate not inthe information packet that s1.c ane. Ch w 5. Be aware of what tin: breakfssUlunch are being served for each floor. This will help give you a good idea of what your day will look like when doing pathways, evaluations, ‘and treatments. For example, 6» ? North, where the orthopedic patients usualy are, ‘breakfast is served arowi) 51) wt. It yowarrive early enough, you can complete 2 pathways (Jepending on s .at you're given) before breakfast. Sometimes the ortho patients are slow and you can only get one in, You'll find your own organization system for your time at Hardin Memorial Hospital 6. Develop an organization system, | carried a small black file folder with sections labeled as follows: Evals, Treatments, To Dragon/Document, Complete, Discharge, and Shred. This really helped me with time management 7. Know your conditions! Ifyou don’t know one, look it up, In this binder is alist of many of the conditions that I saw and what they are 8. Therapeutic use of self; therapeutic use of self therapeutic use of self. Should I say it in? Therapeutic use of se You have the ability to be the bright spot in someone's dy or the extra bit of motivation they need to complete therapy forthe day. Be smar, actively isten, and you'll do just fine? ‘9, You are in an acute care rehab setting: it is possible that someone could poop on you or your shoes. If this happens, you'll be okay. It happened to me and I tured out just fine. something new each day and continue to push yourself That's what I have off the top of my head at this point in time. Ifyou woul like to edit this, andior add to it, please do. Acute Care Advice When one of our members takes the tne 1 type something this thoughtful, L want 1 J things can get “lost.” This ing starting a new ave ifor future reference. The group can be busy a ink job in acute care. | wanted to put i into document for easy access (with permission from the author. From Desirae Durance, Fist off, LOVED iy acute rotation. Theres probably not you an accurate picture, but here are some thoughts: Setup is skilled. If your patient ts on a vent has LY ines has device. wound vac.cte, you wil have to arrange lines in patter that wil allow for Je. thovigh youll get quicker at it as you Tear. hefone transferring, You will want them to rium chest drainage Silty. This time is bil Managing lines: Look at where your flow with the patient a they transfer, not hinder dhem. This can be tricky with multiple Tines, but can usually be managed with a lite pre-plannin If ithas wheels it moves. Hospital eds chairs, V stands rolling dresser, tables, et. {not possible to get a patent perform the task you want with the pitas standard fortnat. Dont be afraid t0 move the furniture to help room setup in th the patient accomplish what Nurses. Check with your nurse prior to worki nay have changed since you got your schedule that monn, ‘Chart reviews. {did my chart reviews as 1 got the okay to work with my patient rather ith patient. Your patien’s condition than doing them all in the morn. | lid this forthe same reason I contact first ADLs are therapy. | hear bringing in fine motor tools or other things t work with the patients, but you have most of what you nce inthe oom or clean uty atea, Many if ot all of your goals wll be ADL related so get your patient o brush this tet, comb thet hair do sponge baths or ress. Work on dressing and use of adaptive ey fel they should be showers iTable and you have doctor {quipment like @reacher and sock ai i appropriate Pay attention to precautions and tech them © your patients. Lally, they will be able to rally state the precaution and retura demonstrate appropriate behavior ‘Know your hospital’ requirements for out of bed activity. Some patients are on blood thinners like Coumadin and their INR mast be a therapeutic level before getting out of bed. Some patients may have low hemoglobin and it must be above a certain number (my hospitals was 8) to get out of bed Be persistent, but also understand of therapy to start but you have 10 en ‘Your patient may only be able to tolerate one unit them anu get them todo at least ait, ‘on the purpose of therapy they are cognitively appropriate. Sometimes, oll of those things, leave me alone My tied and true was {You cn just show me how you'd Educate th your patent will say, "Lean lways, "Well, your doctor ordered this for you and i dail these things. can mark you down so the doctorcan see you did it." The patient und would then work with me..most of ‘would often find that he coulda do it on his 0m Dectine/Death: Patients wil fen wan! 10 know about ther disease, medication, swat the scope of your profession he nurse Yo belp the potential for recovery, and tnd offer fo communicate the patient's needs or quest patent usestand things better ot pass things akong to the doctor. Don't promise fecovery. Phrasng will be different with every patient but let them know you're working icone” ¥our patients wil sometimes die ‘wth them to help give thew the best possible Know tha! you did your Best 0 lp then recone 9 comforatle, Ks only a question of when, not Supplies: Make sre You have what you ned before you gon the room. I absolutely stks when you dont have the ONE thing you need when youre doing ADLs, ALWAYS, bring a ep int the room. Patents almost always want o se a ins cup when brushing ke their end of life mone thei teeth and sometime Precautions. Always follow contact precautions. Somstimes you may find yourself doing ‘extra | ha one p- with a tach hat would coush and spray sputum fom it, This pt. was not on precautions, ut Wore a gown anyway because I didnt want ion my clothing ‘Showers: If your patients strong encuzh, has orders, and it will help progress them toward gol, DO IT! Paints don et showered enough, wstlly geting sponge baths and they REALLY appreciate them Ia patient has dressing that cant be wet, cover ‘vith plastic and tape i up (with nursing’ approval... Most importantly, find out what isimportant tothe patient. The OTR will have set goals determined By the initial eval, but sometimes they lack a personal touch, Many of these goals will help the patient reach their ultimate goals. One of mine wanted to walkin the park, but Fefused bed mobility. When {talked to this patent about walking in the park, they became more wing to participate Thanks Desirae! Great Advice [anyone has more to oer, please post inthe comments section of this document Weall earn from one another.-never sop Additional THR Precautions Bed Positioning (Supine and Sidelying) ‘AdG'.o. IKR Precautions (confinved) Arbultion . cenit = ergpne rece nye i prs teeter Hip Fractures = Encourage Anli-Embollc Exercises ‘eee tears an 008 pao Weigh! Beoring Definitions pet bench mig "ou down rte tach ght berg Wo waht ped cin Talos my sbeebs er ae + Cage ha wera gph Cerebrovascular Accident (AY or Stroke in I Sgt Soe oe | I ‘teak apng | Anaplastic Glioma Arial Fbeittion Bradycardia Bronchitis (Carpal Tunnel Syndrome eccounting for about 33% ofthese tumors ors sripinat in the pic inthe bain. Gia eels ate the ‘issue that surtounds and sopgertsmotwcons i the ran, n marked by scvere pa nthe ches, fen sso rs, and neck, eared by an reading 10 the shoulders adequate blood supply tothe heart painful inflammation ad sifiness ofthe joints 1s quivering or iregula beartbeat arth hms hat ean leat blo cls. stoke, hear flue and other ear. related complications. Some people refer to AF as 8 dquixering hear Bradcarda i slower han normal art rate-The heart ‘sually beats betwen 60 aed 100 ines a mina in an adult at rest. Ifyou have bradycardia bmad-e-KAHR-dee th). Your heartbeats ewer than 60 times a mine ‘nflanmation of the mucous membrane in the bronchial bronchospasm and coughing es. I typically cause compression of a major nerve where itp age atthe fron ofthe wri by repetitive movements over along period, of ‘arpa bones through a ‘alongside the ‘naabneas x burning CHIRE = Cheale Hyperepnie Respir Faire Cub Feet (Congestive Meaet Faure ‘Coronary Artery Disease ysis Deep Vein Thrombosis Degen oi Diese Depeesion Diabetes Mellitus Type I ipa ea na rome ema aT eae ca Ra oleae ira ae enact ile means that you don't have enough oxygenin 7% tite tc too oa "at cnc imines psa og ito iss acanosatnste ihe anes pe sparred cron ebseton se familie terms cbonic ger wed, but are mow inte within the COPD dass Conary eat evese (CHD) wa sense wt tna substance called plague builds up inside the coronary aes. These atriessoply blood i your heart mascle. When plague builds wp the are the condition called aheroceon wo tothe rai ipa By fore of anartery 1 the Bain. ACVA i a0 wiroke Shmptoms ofasroke depend on blockage orn the area ofthe train affected innarnmation of thc urinary Blader 11s fen exe By infection and sul accompanied by frequen paint ing dep below the shin spell aul ying lees. tsa patculae hazard of lo another term fr ontcoatis mehr Horde ofthe mental process and marked by memory norte, ® changes, and impaired reasoning cling of sere cy and Se Rlpeaheeiee aetna a cme dbo hos. 5 alvonie condition in which trode wallow sugar lucox) 0 enter cells to produce ‘aes melinas pe 2 tong erm metabo sore ‘ats characteris high Bloc sug, ini resistance, and relative lac! sulin, Common gmp include increas hit, jue rnin, and Gutain Bare Syndrome ypertipidemia Nspomatenia Lymphedema Lipoma- A benipn neoplasm of adipose Gave, com C in neoplasm Of adore tse componed mate fa els, Syndrome is are donde in which out bodys immune system attacks your nerves Weakness and ingliog in our extremities are usualy the fst symptom an abnormally high concentration of fats iy high concentration af fits lipids inthe Pood isa condition hat ccs wh the eve of stum in your bod is aba low. Sod is an lets andi hips regulate the amount of water tats in and around swelling caused bya compromised ype tem, shih normally ret iets Ad othe horace du. then the bloodstream Ntyasthenia Gravis Neuragenc Blade NipDM semaker Placement Peripheral Vascular Disease Peamathoras TSD - Post Traumatic Stress Disorder ressve disease volving Samage tothe seat of nerve cls in he bain and spina cord mise rpms ny nce nubs. impairment of if musclor coordination, bared vision ad a crni,iypcal sean rare craic auimmune dea marked ‘ncaness witout op, and eused ction of acet olin a sien teraenelnnstaepmte a) neurologic damage. Symptons can include overfiow rwontncnee frequency, pet, urge ncontinence, and retrtion Rink of serious copistions (ep. recarent reflex). Infection, vescoaretertreflus, autonose dy roninlin-dependentabetesmelitos inwhich nsalin peoduction snadequa becomes resistant isin a {Egereraton of nt eartlage andthe underying bone. trast common fom mid age oar Ht causes pin and fies expecially the hip. kee, and thumb ons ‘Su Smit ves tats pace m he ees help canto sora art rhythms. cncry electrical pulses to promt the rormal rate Paceraers ae wed “Achythmlas ae problems wi the ate heartbeat ee dncase of elder ps issu. epecal nthe spine shall ‘or pls, sometimes causing severe ps estes deformane (nVD) wast ang progressive relation donee ‘apd by marowing,boskage, or pases ia ‘ese PVD inay involve disease nay ofthe ‘sve cade ofthe Heat inci the arteries, ein Ipmpatie vessel. a Tang tflsrimaton caused by bactnlor viinfeton, chi the asc fil with pus and may become slid the presence of sr or gas in the My fiche all caning calla @F BE, Maniacs, nightmares and severe ane a8 well 8 Putman fits (PPIs one af ed dean calls So ‘SOB Shores of Breath Total Hp Replacement i alae ssclted rh ooking do fom reat eight ot seas flecting the ner eo the vestibular OT Inpatient Evalu MEDICAL DIAGNOSIS_Cap.Cn.Copd ONSET DATE 5 REFERRING PHYSICIAN PAIN SCALE: 10 PRECAUTIONSICONTRAINDICATIONS Fall precautions SUSPECTED ABUSENEGLECTIEXPLOITATION: None idénified ‘SOCIAUPSYCHOLOGICAL NEEDSIBARRIERS: None Identtied PAST MEDICAL HISTORY. COPD, CAO, hypertension. back pain, anxely, bipolar dorder PAST SOCIAL HISTORY: Patent Wee with her spouse in an apartment with 15 steps to enter (no handrai) PRIOR FUNCTION: Patent was independent with ADL tasks. She typically stands 1 shower using standan n rab bar” She stands at onk fo groom and uses a regular commode, Paiont was ambulating nsepens watnout assstwe device, Nohome oxygen PATIENT GOALS/EXPECTATIONS: Regain independence trough rehabitation 1 retum ho HISTORY: Patent i a 62 year old female admits to the due to recent decine n ADLs/vansters. No previous OT services for current condition, ‘oeJecrive: Treatment Ideas Therapeutic Exercise Ideas ‘Upper body exercise including bands, wands, and weights. Grade this by increasing reps making the client complete the exercise slower, or increasing the weight/resistance 4, sitting up at the edge of bed, or standing Therapeutic exercise can be completed supine be Thisis a great way to hit two birds with one stone serapeutic exercise is an option for treatment, | wouldn't recommend this every Although the pital setting but rewarding for the time. Occupation based treatment is HARD to do within a hos patients when ican be completed. Usually ths involves the patient not knowing they are doing therapy, Once someone is siting at the edge of the bed, treatment activities that can be completed. ‘opens up a world of different Sitting Treatments ‘Sitting treatments work on sitting balance and can also address functional ‘endurance/activity tolerance Appropriate to ICU and acute care patients; keep things straightforward and functional, ‘especially for low level patients. Though there is not much they can do, going through familiar routines, such as washing the face and hands, may be easier than following directions for novel tasks, + Lateral leaning: Start with three pillows on the side and let the patient lean laterally to ‘touch elbow to pillow, then regain upright. Grade to no pillows. That isa pre-skll to seated bathing. + Sit €08 and do the Macarena (or another song with motions) in slow motion + Sit €08, functional reach for ADL items on the tray table; work up to doing grooming at FOB + Grooming at EOB: have them reach for the items and han: wash face wash hands comb hair oral care apply lotion chapstick shave with electric shaver make-up drinking. ecch Sat. taking meds as appropriate (grade by how much nthe 6) Phone and call fora brief chat ‘wipe off the bedside table (might spill ttle water on purpose) Active weight shifting: lace tsue box net to the patient onthe bed and have them bush It toward the head ofthe bed and then toward the fot of the bed ative trunk rotation (not indicated for those with spinal injuries: Passa ball around the back or over the shoulder to increase balance for toleting and hygiene {nflate a glove or balloon and use it to tap the edge of the bed inflate 2 glove or balloon and tap it back ad forth between you andthe patient. Work on active head/neck range of motion: play I spy” to find objects around the room while sitting (also useful while standing) Board games, card games, computer, craft at EO8 (as appropriate, helpful to increase {engagement and work on visual/attention skills) Play dominoes while seated on the edge of the bed. This takes cognitive reasoning as well as sitting balance and fine motor movement. 7 Waite numbers or letters on plastic cups and use them for sequencing tasks while seated * "High Fives” reaching in different directions, which aso challenges the visual motor system Hugs and kisses with family members Work up from motion in semi-recined, provide tabilty by letting the patient hold onto ‘ed mobility and pulling to sit using a bed ladder ora gait belt ~cue to use stomach muscles Change the pillowcases while siting EOB (rolling to change the sheets is also helpful): works on dynamic reaching, trunk static hold isometric abdominal contracture) ‘Standing Treatments ~ BE SURE TO FOLLOW PRECAUTIONS AND WEIGHT BEARING STATUS. DO YOUR CHART REVIEW. KNOW YOUR PATIENT. {AS OTs, we do not want our patients staying in bed. If we can get them to stand, utilizing 2 rolling walker, there are even more activities that can be completed while standing. ‘Transfers — we can work on supine to sit and then st to stand transfers in preparation for grooming activities while at the ink + Dressing acthities - when a patient can stand, now Is the time to work on lower body dressing, Tis will also work on st to stand transfer. Helping the patient with adapt ‘equipment while dressing can be very beneficial wth the orthopedic patient + Play board games, card games, or any other type of game while standing ~ addressing standing activity tolerance and dynamic standing balance Do a puzzle on the tray while standing to keep the patients mind off of working 20h eetting' potinat uff ixil 5 Gnade ty deigroomhig « proct + Grooming atthe sink treatment idea. They can brush teeth, clean denchers, put on deodorant, shave, wash their face, et. You get the point, ADL. + Wecan also work on toileting and sequencing while making sure the cl independent as possible by the time the patient goes home. ‘not only are these therapeutic, they are azo great for working on 1s as safe and + Adult coloring books someone's standing balance. Have the patient stand and color with you. This wil allow them to open up to you a ttle more. Once they open up you may be able to find something else that they like to do and come up with your own stellar treatment idea Some of these ideas are from the Occupational Therapy Treatment Ideas & Information Facebook Group Aurora BayCare Medical Center For Your Well Being CP psrora Health Core? — BBurCaee Ci Upper Extremity Theraband Exercises - Sitting 1, Chest Pull + Sitor stand with your feet shoulder= width apart pus + Loop theraband around each palm. Put your arms in front of your body with elbows slightly bent + Pull theraband outwards, across your chest + Hold for 3 seconds. + Slowly retum to starting position + Repeat 10 times. 2. Shoulder Flexion + Sit or stand with theraband held at hip or ‘waist height. + Poi your thumb toward the ceiling + With your elbow straight, raise hand toward ceiling, + Hold for 3 seconds. + Slowly return to starting position + Repeat 10 times. 3. Shoulder Diagonals + Sitor stand with theraband at hip of waist level. + Pll heat rom opposite ip up toward the ceiling on a diag + Hold for 3 seconds, + Slowly return to starting position, + Repeat 10 times, ‘ ' i i TAT a ficeE aa, it ee Gr a4 4 ik 7 4 i qt iy Are You Up to Grade? Le Spalding University Auerbach School of Occupational Therapy (ASOT) Level Il Fieldwork Completion Check List Dear Fieldwork Educator and Student, This check list has been created for you to use during the last week of the fieldwork experience as a tool to help ensure completion of all processes prior to departure. Fullilling all iterns on this list will facilitate a smooth transition for all involved. Hf anything on this check list still requires attention, please address the item prior to student departure. ‘Once the check list is fulfilled, you may keep a copy with your student records or dispose of properly. The student will electronically submit the completed check list after the fieldwork experience is complete. Feel free to contact me if you need assistance. Thank you again, and we look forward to more experiences in the future! Angela M. Cecil, MBA, OTR/L ‘Academic Fieldwork Director ‘Auerbach School of Occupational Therapy Spalding University 1845 South Third Street Louisville, KY 40203 Office: 502-992-2431 Fax: 502-585-7149 Email: acecil03@spalding edu

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