Acute Care Handbook for Physical Therapists

509 Pages·2014·33.536 MB·English

by  Jaime C. Paz and Michele P. West (Auth.)

ACUTE CARE HANDBOOK
FOR PHYSICAL THERAPISTS

FOURTH EDITION
ACUTE CARE HANDBOOK
FOR PHYSICAL THERAPISTS
Jaime C. Paz, PT, DPT, MS
Associate Chair
Clinical Professor
Division of Physical Therapy
Walsh University
North Canton, Ohio
Michele P. West, MS, PT
Physical Therapist
St. Joseph Hospital
Nashua, New Hampshire
3251 Riverport Lane
St. Louis, Missouri 63043
ACUTE CARE HANDBOOK FOR PHYSICAL THERAPISTS ISBN: 978-1-4557-2896-1
Copyright © 2014, 2009, 2002, 1997 by Saunders, an imprint of Elsevier Inc.
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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information or
methods they should be mindful of their own safety and the safety of others, including parties for whom they
have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and
to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any
liability for any injury and/or damage to persons or property as a matter of products liability, negligence or
otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the
material herein.
International Standard Book Number: 978-1-4557-2896-1
Vice President and Publisher: Linda Duncan
Content Strategist: Jolynn Gower
Content Development Specialist: Megan Fennell
Publishing Services Manager: Catherine Jackson
Senior Project Manager: David Stein
Design Direction: Paula Catalano
Printed in the United States
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Contributors to the Fourth Edition
Sean M. Collins, PT, ScD Hillary A. Reinhold, DPT, CBIS
Associate Professor of Physical Therapy Senior Physical Therapist
and Biomedical Engineering Inpatient Complex Medical
Director, Human Assessment Lab Spaulding Hospital–Cambridge
College of Health Sciences Cambridge, Massachusetts
University of Massachusetts–Lowell
Lowell, Massachusetts Paul E.H. Ricard, PT, DPT, CCS
Clinical Specialist
Konrad J. Dias, PT, DPT, CCS Rehabilitation Services
Associate Professor Brigham and Women’s Hospital
Physical Therapy Program Boston, Massachusetts;
Maryville University of St. Louis Adjunct Faculty
St. Louis, Missouri Physical Therapy
University of Massachusetts–Lowell
Margarita V. DiVall, PharmD Lowell, Massachusetts;
Associate Clinical Professor Part-Time Lecturer
Director of Assessment Physical Therapy
School of Pharmacy Northeastern University
Northeastern University Boston, Massachusetts
Boston, Massachusetts
Falguni Vashi, PT, DPT
Cathy S. Elrod, PhD, PT Physical Therapist
Chair and Associate Professor Rehabilitation Services
Department of Physical Therapy St. Joseph Hospital
Marymount University Nashua, New Hampshire
Arlington, Virginia
Karen Vitak, PT, DPT
Harold Merriman, PT, PhD, CLT Clinical Assistant Professor
Associate Professor Director of Clinical Education
General Medicine Coordinator School of Health Sciences
Doctor of Physical Therapy Program Cleveland State University
Department of Health & Sport Science Cleveland, Ohio
University of Dayton
Dayton, Ohio Jessika Vizmeg, PT, DPT
Staff Physical Therapist
Kathryn Panasci, PT, DPT, CBIS, CWS St. Vincent Charity Medical Center
Assistant Professor Cleveland, Ohio
Doctor of Physical Therapy Program
Department of Rehabilitation Sciences Kelsea A. Ziegler
Texas Tech University Health Sciences Center Bouvé College of Health Sciences
Lubbock, Texas School of Pharmacy
Northeastern University
Danika Quinlan, PT, DPT Boston, Massachusetts
Staff Physical Therapist
Dayton VAMC
Dayton, Ohio
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Contributors to Previous Editions
James J. Gaydos, MS, PT Rachael Maiocco, MSPT
Senior Physical Therapist Physical Therapist
Department of Inpatient Acute Care Brigham and Women’s Hospital
New England Baptist Hospital Boston, Massachusetts
Boston, Massachusetts Infectious Diseases
Musculoskeletal System
Cheryl L. Maurer, PT
Marka Gehrig, MPT Senior Physical Therapist
Department of Rehabilitation Medicine Outpatient Physical Therapy Services
The Cleveland Clinic Foundation Massachusetts General Hospital
Cleveland, Ohio; Boston, Massachusetts
Therapy Partners Musculoskeletal System
Cleveland, Ohio
Musculoskeletal System Leah Moinzadeh, PT
Physical Therapist
Jennifer Lee Hunt, MS, PT Inpatient Rehabilitation
Physical Therapist Rehabilitation Services
Rehabilitation Services Lahey Clinic
Lahey Clinic Burlington, Massachusetts
Burlington, Massachusetts Organ Transplantation
Organ Transplantation
Jackie A. Mulgrew, PT, CCS
Marie Jarell-Gracious, PT Clinical Specialist
Owner Physical Therapy Services
Specialty Care Massachusetts General Hospital
Mokena, Illinois Boston, Massachusetts
Burns and Wounds Circulatory Assist Devices
Kimberly Knowlton, PT David Nicoloro, PT, MS
Clinical Lead Physical Therapist In-Patient Physical Therapy Coordinator
Rehabilitation Services Department of Rehabilitation Services
University of Massachusetts Memorial Medical Center Newton-Wellesley Hospital
Worcester, Massachusetts Newton, Massachusetts;
Burns and Wounds Clinical Instructor
Northeastern University
Eileen F. Lang, PT, DPT Department of Physical Therapy
Senior Physical Therapist Boston, Massachusetts
Rehabilitation Services Gastrointestinal System
Lahey Clinic North Shore
Peabody, Massachusetts Kara O’Leary, MS, PT, CCS
Medical-Surgical Equipment in the Acute Care Setting Senior Physical Therapist
Inpatient Physical Therapy and Outpatient
V. Nicole Lombard, MS, PT Pulmonary Rehabilitation
Staff Physical Therapist Rehabilitation Services
Department of Physical Therapy Lahey Clinic
New England Baptist Hospital Burlington, Massachusetts
Boston, Massachusetts Pulmonary System
Infectious Diseases
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viii CONTRibuTORS TO PREViOuS EDiTiONS
Susan Polich, PT, MA (ASCP), MEd Marie R. Reardon, PT
Assistant Clinical Specialist Clinical Specialist
Department of Physical Therapy Inpatient Physical Therapy Services
Northeastern University Massachusetts General Hospital
Boston, Massachusetts; Boston, Massachusetts
Adjunct Instructor Musculoskeletal System
Physical Therapy Assistant Program
Community College of Rhode Island Jennifer A. Silva, MS, PT
Newport, Rhode Island Physical Therapist
Oncology Outpatient Rehabilitation Center
Fluid and Electrolyte Imbalances South Shore Hospital
South Weymouth, Massachusetts
Jason D. Rand, PT Functional Tests
Physical Therapist
Inpatient Physical Therapy Services Timothy J. Troiano, PT
Winthrop University Hospital Senior Physical Therapist
Mineola, New York Outpatient Physical Therapy Services
Amputation Massachusetts General Hospital
Boston, Massachusetts
Oncology
For my loving wife, Tallie, and my spirited boys,
Will and Henry—thanks for bringing life to me.
To Nay and Tay, thank you for the gift of promise
and hope.
J.C.P.
For my husband, Jim, the reader…
and the many new chapters in our life.
For my daughters, Isabelle and Genevieve,
you make motherhood an honor and a true pleasure.
For my sister, Marie, an author in her own right.
M.P.W.
Preface
Acute Care Handbook for Physical Therapists was originally • An improved design that includes a new order of chapters,
developed to provide clinicians with a handy reference for with each chapter formatted to highlight informative tables
patient care in the hospital setting. It was created primarily for and clinical tips.
physical therapy students and clinicians unfamiliar with entry- As a member of the health care team, the physical therapist
level acute care practice. This handbook was never intended to is often expected to understand hospital protocol, safety, medi-
be a formal comprehensive textbook; however, over the past cal-surgical “lingo,” and the many aspects of patient care from
three editions, many students and physical therapy programs the emergency room setting to the ICU to the general ward.
have adopted this reference as part of their curricula. Given This handbook is therefore intended to be a resource to aid in
the recent advances in acute care literature and practice, we the interpretation and understanding of the medical-surgical
are thankful to be able to contribute to this area of clinical aspects of acute care.
practice. Each chapter about a major body system or diagnosis in this
For this edition, we have retained past contributors and edition of Acute Care Handbook for Physical Therapists includes:
again have added new contributors from around the country, • A review of body structure and function.
providing this edition with a broader perspective. Four of these • An overview of the medical-surgical evaluation of a patient
new contributors are faculty members, which helps this edition admitted to the hospital, including pertinent diagnostic pro-
be more commensurate with the advancement of the profession cedures and laboratory tests.
toward an entry-level clinical doctorate degree. The overall • A review of health conditions that emphasizes information
mix of clinicians and faculty as contributors provides a good pertinent to physical therapy management.
balance of clinically applicable information that is current with • Guidelines for physical therapy examination and
evidence. intervention.
Thus the fourth edition was revised to serve its original Clinical Tips appear throughout each chapter. These helpful
purpose and includes a revision of all chapters with updated hints are intended to maximize safety, quality, and efficiency of
literature, available at the time of revision, to assist with imple- care. These clinical tips are suggestions from the editors and
menting evidence-based practice in this setting, such as: contributors that, from clinical experience, have proved to be
• A review of anticoagulation and international normalized valuable in acclimating therapists to the acute care setting.
ratio (INR) parameters. With advances in literature pertaining to acute care, more of
• Information on minimally invasive surgery for cardiac these tips have become validated and thus are referenced accord-
patients. ingly in this new edition.
• Updates on bariatric surgery and physical therapy It is important to remember that all the information pre-
management. sented in this book is intended to serve as a guide to stimulate
• Burn and wound care management by a certified wound care independent critical thinking within the scope of practice of
specialist. physical therapy and the spectrum of medical-surgical tech-
• A more streamlined orthopedic chapter aimed at facilitating niques and trends. As health care practice continues to evolve
clinically applicable information. with either shortened lengths of stay or the creation of new
• Information on multimodal neuromonitoring. types of settings, clinicians will need to adapt information to
• An updated pharmacology chapter written by a pharmacol- the best of their ability. As is the case with evidence-based
ogy expert that includes pharmacologic implications for practice, this reference should serve as one of the many resources
physical therapists concerning medication side effects and involved with clinical decision making. Developing and main-
the use of combination drugs. taining a rapport with the medical-surgical team are highly
• Expanded sections on standardized outcome measures that recommended because the open exchange of information among
are appropriate to clinical practice in the acute care setting. professionals is invaluable. We believe this new edition of Acute
• Pertinent issues related to the acute care setting including Care Handbook for Physical Therapists can enhance the clinical
documentation, patient confidentiality, electronic health experience by providing readers with valuable information
records, latex allergy, fall risk prevention, and medication while they are reviewing charts, preparing for therapy interven-
reconciliation. tion, and making clinical decisions in the acute care setting.
• Unique considerations including intensive care unit (ICU) J.C.P.
psychosis, alcohol withdrawal syndrome, and end-of-life M.P.W.
issues.
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Acknowledgments
We offer sincere gratitude to the following people: • The community at Walsh University for providing an atmo-
• Kathy Falk, Jolynn Gower, and Elsevier for their confidence sphere of collegiality and professional development.
in creating a fourth edition of this book. • The many clinicians from around the country who have
• Megan Fennell for her vision and creativity in helping rede- spoken to me and offered positive feedback and sugges-
sign the format of the textbook along with her endless tions for this textbook to help make it a true resource
supply of patience, support, guidance, and resourcefulness for them.
during the editorial process. • My faith and church community who has helped me to see
• David Stein and his colleagues for their high level of profes- beyond the scope of everyday life.
sionalism and dedication toward producing a high-quality
text. Personal thanks from Michele to the following:
• The contributors—both past and present—we sincerely • My husband, Jim, for your patience and understanding
appreciate your expertise and the time taken out of your lives during the writing of this manuscript, especially during the
to enhance this textbook. summertime.
• The many patients and students, who continually challenge • My daughters Isabelle and Genevieve, for motivating me in
yet enrich our lives, both professionally and personally. many ways.
• My family and friends, who offered encouragement through-
Personal thanks from Jaime to the following: out the publishing process.
• Tallie, for all her support and positive encouragement during • My co-workers and patients, who inspire me to become a
this revision. better clinician.
• Michele West, for her ongoing editorial contributions, • Erin Monahan, for your assistance with articles on
insights, and ideas, which continually add value to this text. telemetry.
• Katherine Valek for her work in providing research assistance • Beth Derego, for your insight on current post-anesthesia
to the Oncology chapter. nursing care.
• Maggie Zronek and Susan Shultz for their help in gathering • Cindy Sloan, Medical Librarian at St. Joseph Hospital, for
articles for the Genitourinary and Endocrine chapters. your assistance with literature searches.
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