● 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. Case study A massage therapist works at a spa where he believes the employer’s standards for cleanliness do not meet professional standards. The employer does not require oil or lotion containers to be cleaned as they are filled or at the end of the work day, does not require massage room surfaces to be cleaned on a daily basis, does not send dirty linens to a laundry service to be sanitized, and only requires hot stones heated in water to be sprayed with a disinfectant between clients.
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. ● Defer massage if you or a household member has been exposed to any infectious condition. ● Follow standard precautions for the prevention of transmission of pathogens in treatment space. Additional side effects Disrupted thermoregulation issues: ● Warm client? Use lotion and 100 percent cotton sheets. Gently blot excess perspiration, and be aware that chilling may follow. ● Chilly client? Warm client directly, not treatment room. Insomnia or agitation issues: ● Slow pace of strokes; avoid friction, vibration, and percussion. ● Ask if client prefers to be lulled to sleep or stimulated at session end. Fever or flu-like symptoms: ● Fever is a contraindication to techniques with circulatory intent. Mood swing issues: ● Assess medication compliance. ● Remain neutral; accommodate behavior within acceptable boundaries and workplace policies. Fatigue issues: ● Shorten session duration; limit techniques that require client participation. Utilizing drug information in patient assessment: ● 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 or contraindications created by health conditions. 2. Research each medication; summarize its side effects. 3. Draft a treatment plan that addresses: a. Cautions, contraindications.
b. Medication side effects. c. Therapeutic intentions. d. Assessments, positioning/draping. e. Modalities/techniques.
Reflection Are there any state or federal regulating bodies that govern proper sanitation procedures in a healthcare setting? In the potential absence of regulatory codes, whose responsibility does the client’s safety become? Analysis The answer to this problem may lie in each state’s particular regulations or the regulations suggested by each state’s massage licensing board, although it should be noted that the suggestions for cleanliness advanced by a massage therapy board may not have legal precedents.
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Book Code: MFL1225B
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