ADL Exam 1 Review Flashcards
APTA
American Physical Therapy Association
POC
Plan of Care
HIPAA
Health Insurance Portability and Accountability Act
Tasks a PTA CANNOT do
evaluate or re-evaluate, diagnose, or discharge a patient change the POC
Tasks a PTA CAN do
observe and measure pt status after initial eval by PT, treat within the scope of practice and POC, change/modify interventions within the POC after discussion with PT, treat patients per STATE practice act
What dictates what a PTA can do?
State Practice Act
Who is ultimately responsible for any successes or mistakes made by the PTA?
Physical Therapist
Factors a PT considers for decision to delegate care to the PTA
State Practice Act, PTA’s education and experience, payer regulations
What should a PTA do if he/she does not feel comfortable or competent performing a task the PT has delegated?
Communicate that to the PT, do not perform the task
How can PTA make modifications to the POC established by the PT?
speak to supervising PT about pt progress, if POC did not specify which modalities or exercises-can modify what is used, change weight/type/frequency of exercises
If negative changes to pt status–decrease intensity, change location of electrodes, stop exercises and monitor/notify
When to contact supervising PT
patient-not reaching goals
-has met established goals
-has a new medical status
-needs to be discharged
PTA has questions/concerns with POC
PT needs to change/update POC
CAPTE
Commission on Accreditation in Physical Therapy Education
HIPAA protects
privacy of patient’s medical records and other health information
HIPAA provides patient
access to their medical records
Appropriate people with whom to discuss pt care
Pt’s nurse, physician, and supervising PT
Inappropriate people/places to discuss pt care
neighbor, elevator, any non-private area, sister-in-law, open computer screen with pt’s record showing
P in SOAP note
Plan-intention for future sessions
O in SOAP note
objective data, information obtained through measurements and testing, interventions conducted
S in SOAP
subjective-information gained from direct conversing with patient or patient’s caregivers; includes pain rating
A in SOAP
assessment-indicate patient’s change in status as result of interventions conducted (changes in pain, ROM, strength, level of assist, etc)
Confirmation of patient identity
asking pt name, checking ID bracelet, checking medical ID number, confirmation of diagnosis
Number of forms of ID to check for best practice
2
Components of Informed Consent
education to patient of planned treatment, checked for precautions/contraindications, risks associated with treatment, benefits of treatment, time frame, costs, alternatives to treatment, allows for pt to ask questions
Importance of Informed Consent
to verify that the planned procedure is safe for the patient and to protect the provider legally
Effective communication
clear/concise directions, monitor facial expressions for pt response, know pt challenges (vision, hearing, cognitive, language barriers), be aware of environment, demonstrate, ask pt to demonstrate/teach-back, touch, allow time, develop rapport, repetition enhances learning! (see Box 1-7)
ICF
International Classification of Functioning, Disability and Health
Goal of ICF
to minimize effects of disability while maximizing pt function (ultimate goal is to assist with planning and communication across the government and other sectors, to provide common language and terms, to give an organized data structure, to serve multiple purposes
ICF terms
Health condition, body functions and structures, activity, participation, environmental factors, personal factors
helps a practitioner create clinical questions and attempt to answer or research those questions
PICO
PICO
Patient population involved, Intervention used, Comparative intervention, Outcome of each
EBRO recommendations
classification of study results and recommendations according to level of evidence; highest level is meta-analysis (systematic reviews), lowest level is expert opinion
Why are body mechanics important?
energy efficient, reduces stress on joints/ligaments/tendons, improves cardiac/respiratory function, encourages proper body control and balance, promotes safe movements
COG in adult
just anterior to S2-between symphysis pubis and umbilicus
Decreases work of lifting
lower COG, closer COG to object being lifted/pushed/pulled
increases stability
wider BOS; VGL within BOS
this trunk position has the greatest potential to cause damage when reaching or lifting
trunk flexion and rotation
Which time of day do more back injuries occur after attempting a lift
morning
An effective way to view a person’s body to assess posture
plumb line
sagittal plane plumb line landmarks
bisect ear, through bodies of cervical vertebrae, midline of acromion, through bodies of lumbar vertebrae, midline of greater trochanter, just anterior to knee, just anterior to malleolus
frontal plane plumb line assessment
level head and shoulders, midline sternum, level ASIS, legs slightly apart, no genu valgus or varus, normal arch in ankles, feet slightly outward toeing (7 degrees is normal)
Where to align plumb line in sagittal postural assessment
just anterior to ankle, relaxed/normal posture
features of lumbar lordosis
anterior pelvic tilt, lengthened and weak rectus abdominis, lengthened and weak gluteals, tight hamstrings, flexed hips
features of kyphosis
forward head, hyperextended cervical spine, increased flexion of thoracic spine, tightness in pectorals and rectus abdominis,
types of kyphosis
round back, Gibbus or humpback, Dowager’s hump
lateral curvature of the spine
scoliosis
the study of people’s efficiency in their working environment
ergonomics
causes of nonstructural scoliosis
poor posture, leg length discrepancy
lying posture that causes least amount of disc pressure
supine
position used during 75% of work that creates highest intervertebral disc pressure
sitting
Principles of workplace ergonomics
avoid sitting/standing for prolonged periods, use cushioned mats and supportive shoes for standing, maintain normal spinal curves, take breaks, distribute weight evenly, use high-low tables/step stools/properly fitted chairs and desks
most vulnerable location for potential injuries with incorrect body mechanics
lumbar spine
holding breath against a closed airway while performing physical activity; increases blood pressure
Valsalva
action to take if patient suddenly complains of pain during treatment session
stop treatment, assess situation, alert supervising PT if condition changes or gets worse
Potential risks/adverse effects of Valsalva
Syncope, hypotension, ruptured artery
causes of poor posture
Muscle weakness, Body deformities, Lax ligaments, Soft tissue tightness, Abnormal muscle tone, Abnormal pelvic angles or joint positions
COG is shifted forward, plumb line posterior to acetabulum, hyperextension at knee joints
swayback posture
Head tipped up, plumb line posterior to hip, slightly hyperextended knees
Military posture
Deep squat lift
hips below level of knees, feet parallel to each other, straddle object to be lifted, pull object close to body, maintain normal lumbar lordosis; heavy items
Power lift
hips don’t go below knees, feet parallel and behind object to be lifted, pull object close to body, maintain lumbar lordosis
Single leg stance lift (Golfer’s lift)
weight shifted to one leg with hip and knee slightly flexed, other leg kicked out behind keeping knee straight, flex forward at hips, grasp- using arm opposite side of leg being kicked out; for lightweight items only
Stoop lift
flex at hips and knees, maintain normal lumbar lordosis, bend and lift with one upper extremity, return to standing (avoid lateral bending of spine or twisting); for items that are below waist and can be reached without squatting
Straight leg lift (Waiter’s bow)
knees slightly flexed, lower extremities parallel to each other, maintain normal lumbar lordosis, pull object close to body; for lifting items out of trunk or back of truck
Normal adult resting heart rate
60-100 bpm
Age-predicted maximal heart rate
220-age
Normal adult respiratory rate
12-16 breaths per minute
Instrument used to assess oxygen saturation in blood; also measures pulse
pulse oximeter
Normal SpO2
95-100
blood pressure changes with age
increases as we age
causes of hypertension
decrease of elasticity in blood vessels, build up of plaque in arteries that narrows vessels
drop of 20 mmHg in systolic blood pressure or drop of 10 mmHg in diastolic pressure within 2-5 minutes of standing up, or if standing causes S/S; sudden drop in blood pressure as result of position change
orthostatic hypotension
normal adult blood pressure
less than 120 systolic AND less than 80 diastolic
hypertension stage 1
systolic 130-139 OR diastolic 80-89
hypertension stage 2
systolic 140 or higher OR diastolic 90 or higher
hypertensive crisis
systolic higher than 180 AND/OR diastolic higher thann 120
elevated blood pressure
systolic 120-129 AND diastolic less than 80
Factors that affect blood pressure
artery diameter/elasticity, age, exercise, positioning, emotion/stress
Factors that affect temperature
time of day, illness, food/fluid consumption, exercise, environment, pregnancy/menstruation
locations to take temperature
ear, rectal, axillary, temporal, oral
most accurate location for temperature reading
rectal
Factors that affect pain
medications, emotions, activity/exercise
most common way to assess pts pain
numeric pain rating scale
rating which indicates no pain on numeric pain rating scale
0
Factors that affect respiratory rate
age, body size/stature, exercise, positioning, disease processes
normal respiratory rate for infants
30-60 breaths/min
normal respiratory rate for children
18-30 breaths/min
difficulty breathing (shortness of breath)
dyspnea
pulse measurement sites
temporal, carotid, brachial, radial, femoral, popliteal, dorsal pedal, posterior tibial
Factors that affect heart rate
age, sex, anxiety/stress, environmental temperature, exercise, infection, medications/disease processes
Abnormal heart rate responses to exercise
HR not increasing or slowly increasing with exercise, increasing more than expected with exercise, or declining with exercise; HR declining with exercise, heart rhythm or volume changing with exercise
Position of arm for measurement of blood pressure at brachial artery
at level of heart
PPE required for Measles or Tuberculosis
Airborne: N95 mask
PPE required for chickenpox, herpes zoster or smallpox
Airborne Plus Contact: N95 mask, gown, gloves
PPE required for Mumps, Group A Streptococcus, Influenza
Droplet: mask if within 3 feet, gown and gloves only if skin lesions present
PPE required for MRSA, VRE, C Diff, lice, Zika, Impetigo
Contact: gown, gloves, dedicated equipment in room, mask for Zika
when to wash hands vs using alcohol rub
wound care procedures, treating patient with highly communicable disease, hands are visibly soiled
protective isolation is used to
protect immunocompromised patients, protect patients whose conditions or disease causes them to be at high risk of becoming infected, protect the patient from infections carried by visitors and caregivers
highly infectious disease that causes severe diarrhea, especially in older adults or those with compromised immune systems and is NOT killed by alcohol rub
C Diff (Clostridium Difficile)
goal of Safety Data Sheets
to allow chemical users quick and easy access to informatino about the chemicals they use, especially those related to safety concerns
length of time to scrub during handwashing
20-30 seconds
What is necessary to ensure infections are not spread throughout a facility
education and gentle reminders if necessary to ALL people employed in health care setting
