● Gently palpate to assess perception of sensation on the skin. ● Assess skin turgor (elasticity) by gently pulling up a fold of skin; if it remains raised, skin is dehydrated and fragile. ● Ensure sufficient lubrication. ● In case of hair loss on the head or body (alopecia), respect client’s wishes about having head exposed, covered, and touched as the scalp may be itchy or tender. ● During the hair loss process, avoid the use of lubricant. ● Body-wide hair loss leads to easy chilling; offer the client a blanket. Musculoskeletal issues may present as: muscle pain, joint stiffness, or a risk for spontaneous fracture: ● Defer and refer: Muscle pain cannot be objectively verified by your assessment, especially for a client taking cholesterol-lowering statins. ● Avoid deep pressure, vigorous ROM, and stretches on clients taking corticosteroids for longer than two weeks, or anti-osteoporosis drugs. Gastrointestinal issues may present as: dry mouth, nausea, acute or chronic diarrhea, or constipation: ● Dry mouth: Offer the client water partway through a session. ● Nausea, chronic diarrhea: Avoid prone position, excessive touching of the abdomen, and rocking or jostling the client. ● Acute diarrhea is a contraindication to massage. ● Constipation: Offer a massage of the abdomen. Neurological issues may present as: headache, dizziness, drowsiness, and an inability to provide accurate feedback about pain, pressure, or temperature: ● Headache: Offer a scalp massage and encourage deep breathing. ● Dizziness: Avoid flat supine or prone positions, and rocking or jostling strokes. ● Drowsiness: Ask if the client wishes to end with stimulating strokes. ● Altered perception of sensation: Avoid extremes of touch, pressure, and temperature. Cardiovascular or hypertension issues : ● Avoid deep pressure and sustained gliding strokes. Hypotension issues : ● Ensure adequate warmth. Be prepared to assist the client on/off the table, and around the treatment space. Anemia issues : ● Ensure adequate warmth and avoid overtiring the client, if they are fatigued. Endocrine Hypoglycemia issues : ● Ensure that the client has a source of sugar on hand and if not, offer non-diet soda or fruit juice. Hyperglycemia issues : ● Refer for evaluation by primary health care practitioner. Respiratory issues may present as: Shortness of breath, wheezing, chest tightness, and coughing: ● Elevate client’s torso to 45 degrees when supine. ● Address hypertonic muscles of respiration. ● Slow pace of strokes to encourage deeper respiration. Lymphatic/immune system issues , or edema: ● Elevate affected extremities, except if congestive heart failure (CHF) is diagnosed. ● Increased susceptibility to infection, with a decreased ability to fight infection.
● Establish the level of compliance for each drug. List the side effects experienced by the client. Discuss whether side effects are discouraging compliance. Ask if client has consulted prescriber or dispensing pharmacist about side effects. The client may not realize that other drug options in same class may not cause similar side effects. ● Inquire about any medication changes before each session, document drug and/or dosage changes. ● Have you noticed anything different since you started taking this medication? The client may not connect emerging signs or symptoms with this or another drug: ● Reinforce the importance of accurate information for client safety and comfort. ● For clients taking multiple drugs for multiple or chronic conditions, complete a new health history form every 3-4 months. ● Accept the limits of your knowledge and avoid comments or questions about drugs that have been prescribed for a client and refer client questions back to the prescriber. ● Do not offer personal opinions regarding immunization, herbal supplements, pain medication choices, or any other choices made by the client. Interview guidelines for drug use Discuss the following questions for each drug: ● Why was this drug been prescribed? ● How do you take this drug? Identify IM, IV, implantation, or transdermal patch sites and avoid by at least a hand width. ● How often do you take this drug? ● Have you taken this drug today? ● Have you noticed anything different since you started taking this medication? ● If the client does not know the answers, ask who/which doctor prescribed it and seek further information is necessary. ● Keep inhalers handy. ● Keep emergency medications handy. ● Be sure to identify symptoms that may indicate a medical emergency in relation to the client’s condition, for example seizure or angina, and have an emergency plan in place. ● Clarify that providing service in case of known non- compliance may compromise client safety and your licensure. ● Advise that certain modalities/techniques maybe contraindicated, and that treatment may not be safe without compliance. ● Reports of pain, muscle, or joint stiffness unsupported by objective assessment indicate deferral of massage, and referral to the prescriber. ● Alert client that drug-related side effects alleviated by massage may return after massage, for as long as this drug is taken. Care for specific medical conditions and pharmacology effects Always be sure to remain within the scope of practice and consult supervisors, state regulations and other healthcare providers if uncertain about treatment related to medical or pharmacological cases. Never proceed if uncertain about the health, safety or best practice for the client. Integumentary issues of the skin and appendages may present as: bruising, rash, lesions, dryness, epidermal fragility, hypersensitivity, or a lack of touch sensitivity: ● Keep touch a hand-width away from a bruise, rash, or lesion.
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Book Code: MFL1227
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