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Case

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Malcolm

Malcolm is a 62-year-old man with diabetes. He is 6 3 tall and 32 kg overweight. Malcolm underwent a quintuple bypass surgery 2 days ago and is in the cardiac care unit (CCU). He has required assistance of the nursing staff to stand and transfer to a bedside chair. His vital signs are stable, and he is ready to begin postsurgical cardiac rehabilitation, including getting out of bed into a chair and attempting ambulation for short distances.

What needs to be assessed before beginning the intervention?

What might you expect to see and hear upon entering the CCU?

What may require special attention during Malcolm’s treatment?

Will you need help?

How might you feel about this session?

What may Malcolm be feeling about this session?

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Introduction

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The environment in which healthcare takes place can have a significant effect on the practice of patient care.

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Image not available. In addition to the more common hospital setting, patient-care techniques may be performed in homes, independent and assisted living facilities, skilled nursing facilities, hospices, outpatient clinics, schools, adult day-care settings, group homes, and community clinics. The settings can vary from those with extremely limited resources to very complex and highly technical environments.

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Critical Care Environments

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Because of its complexity and the vulnerability of the patients, the critical care environment is often the most intimidating setting for the new practitioner. Critical care combines the expertise of multiple healthcare professionals caring for patients in acute, life-threatening situations caused by trauma or illness. For the therapist, the most common site where critical patient-care techniques are practiced is the hospital-based intensive care units (ICUs). ICUs provide medical assistance to critically ill patients and may specialize in a specific kind of care, such as cardiac, respiratory, trauma, or neonatal care. Despite the critical status of the patient’s condition, mobility tasks are often called for in intensive care. In fact, depending on the patient’s medical condition, patient mobility techniques may be essential to the patient’s optimal recovery (Fig. 3-1).1

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FIGURE 3-1

A physical therapist and respiratory therapist work together to get an ICU patient, still on a ventilator, up and walking. Note that, when a gait belt cannot be used because of interference with incisions or tubes, the therapist must provide close guarding at optimal control points.

Graphic Jump Location
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CLINICAL TIP:

The ICU poses special challenges for patient mobility tasks such as positioning, bed mobility, transfers, and ambulation. Many of the medical factors that hinder a patient’s ability to perform mobility tasks, including pain, neuromuscular impairments, sedation, and side effects of medications, are magnified in the critical care environment.

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The side effects of an ICU stay can be many, and recovery can be prolonged. A rule of thumb in the clinic is that for ...

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