Malcolm is a 62-year-old man with diabetes. He is 6′ tall and weighs 120 kg. Malcolm underwent a quintuple coronary bypass surgery 2 days ago and is in the cardiac care unit (CCU). He requires the 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 and 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?
The environment in which healthcare takes place can have a significant effect on the practice of patient care. In addition to the more common hospital and outpatient settings, 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.
CRITICAL CARE ENVIRONMENTS
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 rehabilitation clinician, the most common site where critical patient care techniques are practiced is 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 cardiopulmonary, neurological, 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
A physical therapist and respiratory therapist work together in the ICU to get a 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.
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.
Patients may experience many side effects of an ICU stay, and recovery can be prolonged. A rule of thumb in ...