Cardiac Precautions

CARDIAC PRECAUTIONS:

  • Consider gait belt placement
  • Manage any wires and tubes attached to patient
  • Measure vital signs (heart rate before, during, after the session)
  • Observe any sternal precautions and/or lifting precautions
  • Rate exertion according to RPE or follow recommended METs
  • Encourage pacing & energy conservation techniques

***Watch for red flag symptoms/complaints (chest pain, dyspnea, diaphoresis, etc.)

Cervical Precautions

CERVICAL PRECAUTIONS:

  • Wear your cervical collar at all times or as recommended by doctor
  • Avoid lifting objects more than 5 to 8 pounds
  • Avoid raising arms above shoulder height
  • Avoid bending and turning your neck

Activities:

  • Avoid lying on too many pillows
  • Avoid sitting for long periods of time
  • Avoid driving
Chemo Precautions

CHEMO PRECAUTIONS:

***Pregnant or breastfeeding staff/family should consider changing switching their caregiver role with a colleague or other family member.

  • Caregivers must wear gloves when handling the patients’ blood, urine, stool, or emesis. Dispose of the gloves after each use and wash your hands.
  • After using any devices for bodily waste, patients should thoroughly wash their hands and the devices with soap and water. Dry the devices with paper towels, and discard the towels.
  • Flush toilets twice each time they are used.
  • Handle medications with care. Don’t crush, chew or cut chemotherapy tablets.
Craniectomy & Craniotomy Precautions

CRANIECTOMY & CRANIOTOMY PRECAUTIONS

  • Helmet when OOB
Fall Precautions

FALL PRECAUTIONS:

Follow your facilities’ guidelines for fall precautions.

  • ‘Fall Risk’ arm band
  • Alarms activated for chairs, wheelchairs, beds, etc.
  • Low beds
  • Appropriate number of bedrails up
  • Wheelchair torso belts (if cognitively safe)
  • Good footwear (such as grippy socks)
  • Clear area of cords, clutter, etc.
Mastectomy Precautions

MASTECTOMY PRECAUTIONS:

  • Take blood pressure on opposite arm
  • Move your arm(s) soon after your surgery.
  • Perform deep breathing exercises as soon as possible to help your lungs recover after surgery.
  • Avoid cradling your arm(s) against your chest.
  • First 4 to 6 weeks following surgery:
    • Do NOT lift anything over 10 pounds.
    • Do NOT do any heavy pushing, pulling or repetitive movements with the affected arm(s).

***Notify nurse or doctor if you observe:

  • Incision, arm, or hand becomes red, swollen or very painful.
  • Temperature is 38 degrees Celsius or 100 degrees Fahrenheit or higher for over 24 hours.
  • Unusual drainage of fluid or a lot of bleeding from where you had your surgery. “A lot of” means a “soaked” bandage.
Pacemaker Precautions

PACEMAKER PRECAUTIONS:

are Sternal Precautions on the left side of the body involved (implanted) side of the body, only.

Seizure Precautions

SEIZURE PRECAUTIONS:

  • Torso belt or similar device when left unattended in wheelchair
  • Lateral rails up with seizure pads when back to bed
  • Take showers instead of baths due to drowning risk
Spinal Precautions

SPINAL PRECAUTIONS:

No “BLTs”

  • No bending greater than 90 degrees at the hip
  • No lifting greater than 5 to 10 pounds, per doctor’s instructions
  • No twisting at the torso
  • Avoid prolonged sitting
Sternal Precautions

STERNAL PRECAUTIONS:

For Patients:

New Sternal Precautions Algorithm

Conservative Activity Guidelines (High Risk – Most conservative)

  • No lifting, pushing, pulling >10 pounds.
  • No shoulder flexion or abduction >90 when UE weighted.
  • Shoulder AROM in pain free range.
  • No scapular retraction past neutral.
  • Avoid active trunk flexion & rotation with supine <-> sit.
  • Splint with coughing and Valsalva.
  • No driving.

Moderate Activity Guidelines (Moderate Risk with Normal Healing)

  • No lifting, pushing, or pulling > 10 pounds.
  • No unilateral shoulder flexion or abduction >90 when UE weighted >5 pounds.
  • Shoulder and scapular AROM in pain-free range.
  • Avoid active trunk flexion & rotation supine <-> sit.
  • UE use with sit <-> stand while keeping shoulders in neutral position.
  • Splint with coughing and Valsalva.
  • No driving first 2 weeks.

Progressive Activity Guidelines (Low Risk with Normal healing)

  • No lifting, pushing, or pulling >10-20 pounds.
  • No unilateral shoulder flexion or abduction >90 when UE weighted >10 pounds each.
  • Full shoulder & scapular ROM.
  • Avoid trunk flexion and rotation resistance exercise.
  • Use UE with sit <-> stand as needed.
  • Splint with coughing and Valsalva.
  • Resume driving.

Traditional (Old-school) Sternal Precautions

  • No driving and no sitting in a passenger seat behind an airbag

  • Avoid straining or holding your breath during exercises, activities, or when using the toilet.

  • Avoid lifting
    • Don’t lift anything, regardless of weight, above shoulder level

    • Don’t pick up anything than weighs more than 10 pounds (no more than a gallon of milk).

  • Avoid pushing
  • Avoid pulling
  • Avoid reaching back

For Practitioners:

  1. Avoid simultaneous bilateral shoulder flexion, abduction greater than 90 degrees.
  2. Encourage unilateral UE active ROM as tolerated to facilitate functional mobility gains and reduce the risk of shoulder ROM impairments and muscle performance changes.
  3. Logrolling for bed mobility to avoid strong contraction of the abdominal muscles pulling on their superior sternal/costal attachment. Consider trunk stabilization activities.
  4. Avoid activities that may cause excessive Valsalva maneuver.
  5. Encourage chest splinting with pillow when coughing.
  6. UE strength/ROM testing for strength grades greater than 3/5 should be performed only if neurological changes are suspected to have occurred.
  7. Avoid full weight-bearing through upper extremities (e.g., gait training must be at least partial weight-bearing for ambulation)
  8. No use of bed ladder or trapeze.
  9. No driving and no sitting in passenger seat behind an airbag for 4 weeks.
Shoulder (Rotator Cuff Repair) Precautions

SHOULDER (ROTATOR CUFF REPAIR PRECAUTIONS:

  • Wear immobilizer sling at all times except for bathing, dressing, and exercises
  • Avoid actively move your operated arm away from your body.

  • Avoid using your hand if your pain increases.

  • Avoid leaning on the operated arm or bearing weight on it.

  • Avoid pulling up or pushing yourself up (chairs, beds, toilets, wheelchairs).

  • Avoid using the operated arm to reach behind your back for dressing or toilet hygiene.

  • Provide progressive shoulder activities and exercises to increase ROM and strength.

***Follow the referring surgeon’s specific guidelines for progression.

Standard Precautions

Standard Precautions apply to

1) Blood

2) All body fluids, secretions, and excretions, except sweat, regardless of whether or not they contain visible blood

3) Non-intact skin

4) Mucous membranes. Standard precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals.

  • Standard precautions includes the use of: hand washing, appropriate personal protective equipment such as gloves, gowns, masks, whenever touching or exposure to patients’ body fluids is anticipated.
Total Hip Precautions

TOTAL HIP PRECAUTIONS:

Posterolateral:

  • Avoid bending at the hips more than 90 degrees
  • Avoid crossing your operated leg over the other leg
  • Avoid turning your operated leg inwards

Anterolateral:

  • Avoid bending at the hips more than 90 degrees
  • Avoid crossing your operated leg over the other leg
  • Avoid turning surgical leg outward
  • Avoid moving your surgical leg outward to the side
Transmission-Based Precautions

Transmission-Based Precautions (i.e., Airborne Precautions, Droplet Precautions, and Contact Precautions), are recommended to provide additional precautions beyond Standard Precautions to interrupt transmission of pathogens in hospitals.

  • Transmission-based precautions can be used for patients with known or suspected to be infected or colonized with epidemiologically important pathogens that can be transmitted by airborne or droplet transmission or by contact with dry skin or contaminated surfaces. These precautions should be used in addition to standard precautions.
      • Airborne Precautions used for infections spread in small particles in the air such as chicken pox.
      • Droplet Precautions used for infections spread in large droplets by coughing, talking, or sneezing such as influenza.
      • Contact Precautions used for infections spread by skin to skin contact or contact with other surfaces such as herpes simplex virus.
Weightbearing Precautions

WEIGHTBEARING PRECAUTIONS:

  • Non-weight-bearing (NWB): The leg must not touch the floor and is not permitted to support any weight at all. The patient may hop on the other leg or use crutches or other devices for mobility. In this grade, 0% of the body weight may be rested on the leg.
  • Touch-down weight-bearing or Toe-touch weight-bearing (TDWB) The foot or toes may touch the floor (such as to maintain balance), but not support any weight. Do not place actual weight on the affected leg. Imagine having an egg underfoot that one is not to crush.
  • Partial weight-bearing (PWB): A small amount of weight may be supported by the affected leg. The weight may be gradually increased up to 50% of the body weight, which would permit the affected person to stand with his body weight evenly supported by both feet (but not to walk).
  • Weight-bearing as tolerated (WBAT): Usually assigned to people that can support from 50 to 100% of the body weight on the affected leg, the affected person independently chooses the weight supported by the extremity. The amount tolerated may vary according to the circumstances.
  • Full weight-bearing: The leg can now carry 100% of the body weight, which permits normal walking.
Wound Precautions

WOUND PRECAUTIONS:

Ecchymosis/Fragile Skin:

  • Be cautious when taking repeat blood pressures
  • Consider where you apply tapes and be careful when removing, e.g. water occlusive dressings after a shower

Pressure Injury/Ulcers:

  • Avoid prolonged sitting
  • Use appropriate seat and wheelchair cushions
  • Position on side lying with pillows when putting back to bed