● Respiratory : Shortness of breath, wheezing, and chest tightness, 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, edema ○ Elevate affected extremities, except if congestive heart failure (CHF) is diagnosed. ○ Increased susceptibility to infection; decreased ability to fight infection. ○ Defer massage if you or a household member has been exposed to any infectious condition. ○ Follow Standard Precautions for prevention of transmission of pathogens in treatment space. Additional side effects ● Disrupted thermoregulation ○ Warm? Use lotion, 100 percent cotton sheets; gently blot excess perspiration; be aware that chilling may follow. ○ Chilly? Warm client directly, not treatment room ● Insomnia, agitation ○ Slow pace of strokes; avoid friction, vibration, percussion. ○ Ask if client prefers to be lulled to sleep or stimulated at session end. ● Fever, flu-like symptoms ○ Fever is a contraindication to techniques with circulatory intent. ● Mood swings ○ Assess medication compliance. ○ Remain neutral; accommodate behavior within acceptable boundaries, workplace policies. ● Fatigue ○ Shorten session duration; limit techniques that require client participation. Utilizing drug information ● Investigate possible side effects for each drug. ● Visually assess skin for areas to avoid. ● Identify cautions/contraindications. ● Describe available modalities, techniques. ● Discuss and obtain informed consent for safe, effective treatment. Apply information to the treatment plan: 1. Select Case Profile: identify cautions, contraindications created by health conditions. 2. Research each medication; summarize its side effects. 3. Draft a treatment plan that addresses: 4. Cautions, contraindications. bodywork. These include consent and appropriate boundaries when working on sensitive issues of the body. These also include what part of the therapist’s body touches the client, and ensuring to not touch the client accidently with loose clothing or hair. Protocols for draping must be in compliance with local laws, and standards of conduct. These regulations must be followed, including: moving draping; working only above draping; discussing clothing options with clients; and informing clients that they may stop the massage at any time if they feel uncomfortable. Strict adherence to ethical protocols for personal space will put clients at ease and allow clients to receive the benefits of treatment as well as promote trust, and set boundaries for an effective and safe therapeutic relationship. 5. Medication side effects. 6. Therapeutic intentions. 7. Assessments, positioning/draping. 8. Modalities/techniques.
○ Assess skin turgor (elasticity) by gently pulling up a fold of skin; if it remains raised, skin is dehydrated, fragile. ○ Ensure sufficient lubrication. ○ In case of hair loss on head or body hair (alopecia) respect client’s wishes about having head exposed, covered, and touched as the scalp may be itchy or tender. ○ During hair loss process, avoid use of lubricant. ○ Body-wide hair loss leads to easy chilling; offer blanket. ● Musculoskeletal: Muscle pain, joint stiffness, risk for spontaneous fracture: ○ Defer and refer: muscle pain not objectively verified by your assessment, for client taking cholesterol-lowering statin. ○ Avoid deep pressure, vigorous ROM, stretches on client taking corticosteroid for longer than two weeks, or anti- osteoporosis drugs. ● Gastrointestinal : Dry mouth; nausea; acute or chronic diarrhea or constipation: ○ Dry mouth: offer water partway through a session. ○ Nausea, chronic diarrhea: avoid prone position, touch of the abdomen, rocking or jostling. ○ Acute diarrhea is a contraindication to massage. ○ Constipation: offer massage of the abdomen. ● Neurological : Headache, dizziness, drowsiness, and inability to provide accurate feedback about pain, pressure, temperature ○ Headache: offer scalp massage; encourage deep breathing. ○ Dizziness: avoid flat supine or prone positions, rocking or jostling strokes. ○ Drowsiness: ask if client wishes to end with stimulating strokes. ○ Altered perception of sensation: avoid extremes of touch, pressure, temperature. ● Cardiovascular or hypertension ○ Avoid deep pressure, sustained gliding strokes. ● Hypotension ○ Ensure adequate warmth, be prepared to assist the client on/off table, around treatment space. ● Anemia ○ Ensure adequate warmth, avoid overtiring client, if fatigued. ● Endocrine ○ Hypoglycemia ▪ Ensure that client has source of sugar on hand and if not, offer non-diet soda, or fruit juice. ○ Hyperglycemia ▪ Refer for evaluation by primary health care practitioner. Personal space Safety is not limited to hygiene, skill, and scope of practice concerns. When considering the importance physical boundaries in maintaining a safe environment for the client, the generally accepted rule for personal space in Western cultures ranges from eighteen inches up to three feet between depending on the situation and personal preference. This range of personal space is reduced as therapists greet clients and review their intake information. Massage involves skin to skin contact that eliminates the accepted range of personal space completely. Massage implies that the amount of personal space during a massage is negated, but both the therapist and client must adhere to the physical boundaries outlined in ethical standards of practice. The focus of both parties should be on goals of the therapeutic plan based on the standards of conduct for massage and
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Book Code: MLA1224
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