ninevirtues: (Default)
Some excellent commentary from the regional manager, a speech-language pathologist, on treating a mentally ill person:

"People who are mentally ill have a way of 'spearing you'-- they seem able to find your weak spots and make very hurtful comments about them. You need to remember that, when they do that, it's their illness talking--- it's not them-- don't take it personally. For that matter, anybody can go in a mentally ill patient's room, say, "Okay, let's do physical therapy," and when the patient says, "NO! EFF YOU," turn around and leave. It doesn't take skill to do that. Anybody with a minimum amount of training can get them out of bed and walk them around; nursing assistants do that routinely. What makes it a skilled service is your ability to persuade this difficult patient to work with you and perform a physical therapy session that they would not otherwise do.

She probably won't do things for the sake of doing them; you won't be able to say, "Okay, let's go from sit to stand five times to practice it." She won't care. You will need to find a way to do things she already wants to do, like go down to the kitchen for coffee, or go outside, or pack her bag, and get physical therapy out of it. She may not ever realize you're the physical therapist, and that's fine. She may think you're the coffee girl. But in the meantime, she gets better.
ninevirtues: (Default)
Whereas the current standard formula for normal maximum heart rate is 220 minus the patient's age, subtracting age times 0.88 from 206 provides a more accurate norm for women, according to Martha Gulati, MD, of Northwestern University in Chicago, and colleagues online in the journal Circulation.
ninevirtues: (Default)

Heh. To have a senior driver assessed for safety, contact a certified driving rehabilitation specialist.
You can find one at this link.

Heh heh heh.  After that brief superawesome resource pointer, I now return you to your usual lolcats.
ninevirtues: (Default)

Well’s Criteria for DVT

Active cancer?Yes +1
Bedridden recently >3 days or major surgery within four weeks?Yes +1
Calf swelling >3cm compared to the other leg?Yes +1
Collateral (nonvaricose) superficial veins present?Yes +1
Entire leg swollen?Yes +1
Localized tenderness along the deep venous system?Yes +1
Pitting edema, greater in the symptomatic leg?Yes +1
Paralysis, paresis, or recent plaster immobilization of the lower extremityYes +1
Alternative diagnosis to DVT as likely or more likely?Yes -2

1 pt: Low risk.
2 pts: High risk.

(Deadly dull unless you are a PT. Sorry! Or, okay, not at all sorry. ;-)
ninevirtues: (Default)
"Hey, Miz PT, what was that website you found that had cheap four wheeled walkers?"
ninevirtues: (Default)
Pilot Precise Gel 07 with a rubber gripper.

That is all.
ninevirtues: (Default)
Ray: "When my brother was a cop in San Francisco, he had a couple index cards full of useful phrases in Spanish. When he was a cop in Vietnam, he had a similar card full of useful phrases in Vietnamese. (Hmm, thinks I, I know how you get to be a cop in Vietnam. Hats off to Ray's brother.)

Ray continued, "This is why I know how to say, "Stop or I'll shoot," in Vietnamese."

Riiiiiiiiight. This is the way to go. Accordingly, one of today's patients speaks English and Tagalog, and he was kind enough to teach me these:

Masakit-- pain (say it mah-sah-kit)
Gumagalig-- better (say it gu-ma-ga-lig)
Lumalala-- more pain, e.g worse (Lu-ma-la-la)

Gawin mo ito-- this is what you're going to do (say it gah WIN mo ee-toe)

Salamat po-- thank you (say it sa-lah-mat PAUSE poe)

Kumusta Kayo-- hello, how are you (say it kooh moo stah kay yoh, like spanish)

wah lang an u man (you are welcome)
ninevirtues: (Default)
....The Beigton Hypermobility Score, that is. We now interrupt your day for a nerdy moment:

I retained a vague memory from years ago, in which we were shown a series of signs to look for that tell you whether someone is generally hypermobile (has loosely attached joints) or not. I found it again, and here it is:

If you can touch your thumb to your forearm.... 1 point per hand that can do it

If you can passively extend (bend back) your pinky finger knuckle joint more than 90 degrees, you get one point per hand that can do that.

If you can hyperextend your elbow more than 10 degrees, one point per elbow that can do that.

If you can hyperextend your knee more than 10 degrees, you get one point per knee.

If you can place your palms on the floor when you bend over to touch your toes, you get one point.

Total score: Up to 9 points. If you score 9 points, you get a trophy (a plastic Gumby, most likely).
ninevirtues: (Default)
As we know, 220-age does NOT accurately predict the maximum heart rate of which you are capable. The nice professors at Ball State came up with a better formula, one that incorporates gender, age, smoking status, and weight in kg as shown here:

What's that, you don't want the pub med tease-- you say you want the actual equation? Fine. I can arrange that. (Please note that the following is not medical advice.)

Now, when I say 'smoking code' I mean 0 = nonsmoker and 1 = smoker. If I remember correctly, there are 2.2 lbs in a KG. And, as you know, RHR means Resting Heart Rate. All that said, here's the formula:

For women: Max HR = 203.9 - (0.812 * age) + (0.276 * RHR) - (0.084 * Weight in KG) - (4.5 * smoking code).

For men: Max HR = 204.8 - (0.718 * age) + (0.162 * RHR) - (0.105 * Weight in KG) - (16.2 x smoking code).


Aug. 13th, 2007 08:03 pm
ninevirtues: (Default)
exhibit a:


exhibit b:

How to tell what arterial blood gas values mean...shamelessly viked from Not Nurse Ratched's blog and copied here because I want to keep track of it:

"I get a lot of Google hits by folks looking for ABG tricks, hints, and tips, so I’m going to post the system I was taught. It’s the best (meaning “most likely I will remember when I’m handed ABG values and asked, ‘What is wrong with this patient?’”) I’ve seen in the numerous treatises I’ve read on the subject.

1. Look at pH: if high, alkalosis. If low, acidosis.
2. Look at PaCO2 (normal range, 35-45); note if high or low.
3. Look at HCO3 (normal range, 22-26); note if high or low.

First, check for the respiratory aspect, which involves the PaCO2 value. Look for a “seesaw”: does pH go up while PaCO2 goes down or vice versa? If so, you’ve got yourself respiratory alkalosis or acidosis, respectively.

Second, check for the metabolic aspect, which involves the HCO3 value. Look for an “elevator” (if pH takes the same elevator, meaning both values go up or both go down), you’ve got yourself metabolic alkalosis or acidosis, respectively.

The problem is compensated if the pH lies within the normal range, and it is uncompensated if the pH lies outside the normal range. And if you have both a seesaw and an elevator, you have a respiratory AND metabolic problem (”alkalosis” or “acidosis” according to the pH).


pH 7.05 (low)
PaCO2 12 (low)
HCO3 5 (low)
Uncompensated metabolic acidosis (elevator, low pH)

pH 7.38 (WNL *on low side*)
PaCO2 76 (high)
HCO3 42 (high)
Compensated respiratory acidosis (seesaw appears if you count the nearly compensated pH as low; bicarb is high to make up for increased PaCO2)

pH 7.10 (low)
PaCO2 50 (high)
HCO3 15 (low)
Respiratory and metabolic acidosis (both elevator and seesaw present)




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