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APA > APA prac 1 > Flashcards

APA prac 1 Flashcards

1
Q

step by step guide according to rubric

A

-Set up environment & safety (breaks, stoppers, not only socks etc.)
-Introduction of self/role & sanitise
“My role as a physio is to assess, diagnose & treat a range of conditions… like how you have come in today for ???”
“I am here to help and offer my assistance as we work together to get you back to feeling your healthiest and best self!”
-Patient condition explanation - empathy link
-Intervention explanation & benefits (justify WHY)
-Opportunity to ask Qs consent & removal of clothing if required (acknowledge sensitive topics with caution)
-Contraindications
-Assessment with confidence
-Feedback

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2
Q

consent EX

A

Q1 do you understand what I’ve said?
Q2 do you have any questions
Q3 are you happy to proceed on that basis?

“see you’ve injured your _____, need to examine this area along with the structure around it. Therefore, do you mind changing into shorts?”

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3
Q

steps for massage

A
  1. Intro/consent - what, how, why, continue?
  2. consent for expose of area
  3. Assess before treatment intervention
  4. Make sure client is comfortable & appropriate use of towels
    -Explain the placement of towel & its reasoning to client - to avoid clothing getting dirty
  5. Ask client if they are sensitive if using a certain cream/oil
  6. Apply treatment intervention
    -Tell the patient what you’re doing and why
    -Constantly ask Qs & give feedback
    -Pain or discomfort?
  7. be careful getting up
    -dizziness
    -leave time to get changed

“Your skin looks good - no signs of any infection”
“do you have any allergies, I plan on using ____”
Consent
Ask for feedback throughout
“see you’ve injured your _____, need to see this area along with the structure around it. Therefore, do you mind changing into shorts?”

If the question indicates a condition and asks for test-retest, yes. If not, then you do not have to.

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4
Q

contraindications of massage

A

Acute contusions
* Breaks down clot, instead of keeping it

Acute inflammatory conditions
* Increase bleeding
* First 72 hours want present of inflammatory indicators as this starts the scarring process

Severe varicose veins
* Can cause blockage & compression, leading to a stroke
* Avoid the local area of them, send to doctor if across the whole leg

Open wounds/ Abscesses
* Interrupt healing & lead to further bleeding, introduce infection

Skin infections
* Swelling
* Redness
* Temperature (hot)

Failed or incomplete fracture healing

Thrombophlebitis and embolisms

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5
Q

indications/benefits of massage

A

Increased ROM or movement of muscle/joint

Stretch scar tissue/adhesions

Alleviate muscle cramps

Decrease pain

Remove edema

Increase blood flow

Lymphatic drainage

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6
Q

stroking

A

Stroking - stroking of the skin in any direction with the hand & palm moulding to the contours of the tissue

Travel from distal to proximal (bottom to top)
1. One hand is used to perform a short stroke with a fairly light touch, can be fast or slow
2. Second hand performs the same movement overlapping the first.

Slow stroking will relax and sedate and decrease muscle tone

Faster strokes will stimulate superficial blood flow, accelerate lymph drainage

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7
Q

effleurage

A

Effleurage - stroking utilizes longitudinal sweeping motion covering large areas of the body

Application
* Travel from distal to proximal (bottom to top)
* Usually applied in direction of lymphatic flow
* Like stroking (can have a bit more pressure) & also can be reinforced with one hand over the other, or using lightly clenched fist

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8
Q

kneading

A

Kneading - circular motion – tissue moved in a circular manner on the underlying tissue
* Performed with the palm, fingers or forehand

Application
Travel from proximal-distal or distal-proximal
1. Perform a circular movement with pressure on the upward part for about 25% of the circumference
2. Contact is still maintained for the rest of the circle
3. Contact is lifted to move on to the next circle

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9
Q

petrissage (picking up)

A

Petrissage - rhythmic lifting, rolling and squeezing of subcutaneous tissue
* Can incorporate wringing and kneading
* Performed across the muscle (usually)
* Travel from distal to proximal (bottom to top), but aim to pull tissue up & grasp it
* Hands stay relaxed, thumbs used from the hand

Application
Don’t pinch - it is a grasp & pull technique
1. Tissues compressed against underlying structures, then ‘picked up’, lifted, squeezed and released

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10
Q

trigger point

A

Trigger point therapy - direct pressure to specific point and held till pain subsides
· May not be able to apply pressure through skin if clothing is worn

Application
1. Deep stroking is performed by tips of fingers or thumbs
2. Direct/firm pressure may be applied to the specific point by thumb
3. Held like this usually until discomfort is said to be easing (8-12s)
4. Ease the pressure
5. Always stretch after trigger pointing

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11
Q

isotonic muscle strength test

A

OXFORD scale grade 0-5

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12
Q

isotonic muscle strength grades

A

Oxford
Grades 0-2 Muscle is acting on limb across gravity
0 no muscle flicker
1 muscle flicker
2 can move limb through ROM across gravity with the limb supported by therapist

Grades 3-5
Muscle is acting on limb against gravity
3 can move limb through ROM against gravity
4 can move limb through ROM against gravity and moderate resistance applied by therapist
5 can move limb through ROM against gravity & maximal resistance applied by therapist

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13
Q

hip abductors isotonic muscle strength test

A

Oxford

Grade 2 - lying supine (back)
-Move leg out to side with guidance

Grades 3-5 - lying on side with test side up
-Lift leg up with help from physio (stabilise at the hip)
-Lift leg up without help from physio
-Apply minimal resistance to thigh & work through ROM
-Apply maximal resistance to the thigh & work through ROM

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14
Q

hip extensors isotonic muscle strength test

A

Grade 0/1 - prone
-Patient attempts to squeeze glute with knee at 90° angle

Grade 2 - Lying on side with test side up
* Support leg at knee & hip & ask if they can move their leg backwards towards physio
* “move leg back towards me”

Grade 3-5 - lying prone (stomach)
-Ask the patient to flex knee to 90°
-Ask patient to extend/lift leg up towards the ceiling (stabilise at the trunk)
-Apply minimal resistance to hamstring & work through ROM
-Apply maximal resistance to hamstring & work through ROM

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15
Q

hip flexors isotonic muscle strength test

A

Grade 2 - Lying on side with test side up
-Support leg from inner side & ask them to slightly bend their knee
-Ask if they can move their leg forwards

Grades 3-5 - sitting over side of bed
-Patient holds onto side of the bed & assist hip flexion by lifting bent knee upwards
-Ask patient to lift their knee bent upwards (stabilise at the hip)
-Apply minimal resistance over quad & work through ROM
-Apply maximal resistance over quad & work through ROM

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16
Q

knee extensors isotonic muscle strength test

A

Grade 0/1 - lying on back
* Get patient to squeeze thigh

Grade 2 - lying on side with test side up
-Guide patient’s upper leg and have it slightly bent
-Get patient to try to straighten their knee

Grades 3-5 - sitting over side of bed
- Assess knee extension by straightening leg up towards ceiling with support
- Ask patient to straightening leg towards ceiling
- Apply minimal resistance over shin & work through ROM
- Apply maximal resistance over shin & work through ROM

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17
Q

knee flexors isotonic muscle strength test

A

Grade 0/1 - prone
-Physio supports leg with knee in partial flexion
-Get patient to squeeze hamstrings?

Grade 2 - lying on side with test side up
-Patient bends the leg at the knee back towards the physio

Grades 3-5 - Lying prone (stomach)
-Assess knee flexion by getting patient to bend leg towards their face
-With the knee at a 90° angle, apply minimal resistance at back of the calf towards the plinth, while getting patient to still bend their leg towards their face
-Do the same but with maximal resistance

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18
Q

isometric manual muscle testing

A

Position for grades 3, 4 & 5
Muscle is acting on limb against gravity

3 can move limb through ROM against gravity/can hold against gravity at the ROM to be tested
4 can move limb through ROM against gravity/can hold against gravity at the ROM to be tested
5 can hold limb in position against gravity & maximal resistance

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19
Q

hip abductors isometric manual muscle testing

A

Grades 3-5 - lying on side with test side up

-Lift leg up with help from physio (stabilise at the hip)
-Lift leg up without help from physio
-Apply minimal resistance to thigh & work through ROM
-Apply maximal resistance to the thigh & work through ROM

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20
Q

hip extensors isometric manual muscle testing

A

Grade 3-5 - lying prone (stomach)
-Ask the patient to flex knee to 90°
-Ask patient to extend/lift leg up towards the ceiling (stabilise at the trunk)
-Apply minimal resistance to hamstring & work through ROM
-Apply maximal resistance to hamstring & work through ROM

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21
Q

hip flexors isometric manual muscle testing

A

Grades 3-5 - sitting over side of bed
-Patient holds onto side of the bed & assist hip flexion by lifting bent knee upwards
-Ask patient to lift their knee bent upwards (stabilise at the hip)
-Apply minimal resistance over quad & work through ROM
-Apply maximal resistance over quad & work through ROM

22
Q

knee extensors isometric manual muscle testing

A

Grades 3-5 - sitting over side of bed
- Assess knee extension by straightening leg up towards ceiling with support
- Ask patient to straightening leg towards ceiling
- Apply minimal resistance over shin & work through ROM
- Apply maximal resistance over shin & work through ROM

23
Q

knee flexors isometric manual muscle testing

A

Grades 3-5 - Lying prone (stomach)
-Assess knee flexion by getting patient to bend leg towards their face
-With the knee at a 90° angle, apply minimal resistance at back of the calf towards the plinth, while getting patient to still bend their leg towards their face
-Do the same but with maximal resistance

24
Q

steps to apply heat

A
  1. Ensure care of environment to reduce risk of slip & infection spread
  2. Inform risks of heat burns & gaining consent
    Risks:
    • Burns can occur at 45°C+
    • Fainting: may only be noticeable when standing up after treatment, encourage patient to get up slowly
  3. Assess for contraindications
    • “Your skin looks good - no signs of any infection”
  4. Prepare patient including assessment of sensation (hot with test tubes or teaspoons)
  5. Prepare heat pack including wrapping & 2cm protective layer (at least 8 layers of towel or 2 layers of towel & the heat pack cover)
  6. Apply heat pack to patient, give appropriate warning & leave a bell with patient
    Warn/instruct patient:
    • All you should feel is a comfortable warmth
    • It should not feel hot.
    • If it does feel hot it could be burning you
    • Let me know immediately so I can remove the heat or put in more protective towel.
  7. Check the heat pack & patient comfort after 5 mins for adverse reactions (dizziness/fainting)
  8. Apply heat pack for 10-15mins
25
Q

contraindications to heat

A

excessive pain, swelling or oedema, acute injury, impaired sensation, wet dressing/adhesive tape, open wounds

26
Q

benefits of heat

A

assist with ____ injury, healing benefits associated with heat

27
Q

steps to apply cold

A
  1. Ensure care of environment to reduce risk of slip & infection spread
  2. Inform risks of cold burns & gaining consent
  3. Assess for contraindications
    • “Your skin looks good - no signs of any infection”
  4. Prepare patient including assessment of sensation (cold with test tubes or teaspoons)
  5. Prepare crushed ice pack including damp towelling & single layer
  6. Apply ice pack to patient to cover entire area with a compression bandage, give appropriate warning & leave a bell with patient
    Warn/instruct patient:
    • All you should feel is a comfortable cold
    • It should not feel icy cold
    • If it does feel too cold it could be harming you
    • Let me know immediately so I can remove the cold or put in more protective towel.
  7. Check the cool pack & patient comfort after 5 mins for adverse reactions
  8. For areas >2cm adipose tissue - apply cool pack for 20-30mins, every 2 hours
  9. For areas <2cm adipose tissue - apply cool pack for no more than 10mins OR insulating material b/n cold application & skin
    AFTER
    -might feel tender or numb, but stress importance of this being temporary and to seek assistance if numbness does not go away
28
Q

what cold is used for

A

Manage the magnitude of the inflammatory process, blood flow, initial swelling, secondary injury & pain
* Can also be used as an aid for recovery by these means

29
Q

contraindications to cold

A

Excessive pain, sensitivity to the cold, persistent numbness, severe cognitive impairment (dementia), deep vein thrombosis

30
Q

benefits to cold

A

assist with ____ injury, healing benefits associated with heat

31
Q

FWB

A

Full Weight Bearing (FWB) - no restrictions with weight bearing status

32
Q

NWB

A

Full Weight Bearing (FWB) - no restrictions with weight bearing status

33
Q

PWB

A

Partial Weight Bearing (PWB) - 0 to 50% weight through affected limb

34
Q

WBAT

A

Weight Bearing As Tolerated (WBAT) - 50 to 100% weight through affected limb

35
Q

PTWB

A

Protected Weight Bearing (PTWB )- weight bearing as tolerated but gait aids are mandatory at all times until further follow-up with the surgeon

36
Q

TWB

A

Touch Weight Bearing (TWB) - Light touch for balance only (10% weight), only minimal weight allowed i.e. not enough to crush an eggshell under their foot

37
Q

step to with crutches

A

crutches, affected leg, good leg

38
Q

step through with crutches

A

crutches & affected leg, good leg

39
Q

step to with frame

A

frame, affected leg, good leg

40
Q

step through with frame

A

frame & affected leg, good leg

41
Q

NWB pattern

A

step to
-crutches/gait aid, good leg
-affected leg doesn’t touch the floor

42
Q

steps to prescribe axillary crutches

A
  1. Intro & consent
  2. Ensure general patient wellbeing
    • Balance, coordination, prior experience with gait aids, if they’ve experienced nausea/dizziness?
  3. Ask about home environment
    • Are there stairs? Rails for supports? Does their doorway fit the crutches?
      *recommend limit of stairs/use elevator
  4. Check stoppers & safety
  5. Set crutch height, set handles
  6. Explain WB status & marching
  7. Demonstrate gait pattern
  8. Demonstrate navigating stairs (if required)
43
Q

steps to prescribe elbow crutches

A
  1. Intro & consent
  2. Ensure general patient wellbeing
    • Balance, coordination, prior experience with gait aids, if they’ve experienced nausea/dizziness?
  3. Ask about home environment
    • Are there stairs? Rails for supports? Does their doorway fit the crutches?
      *recommend limit of stairs/use elevator
  4. Check stoppers & safety
  5. Set crutch height, set handles
  6. Explain WB status & marching
  7. Demonstrate gait pattern
    Demonstrate navigating stairs (if required)
44
Q

sit to stand with crutches (left & right)

A

Left injury
* Crutches on right side (unaffected)
* Left arm on bed beside patient
* Use both arms to help patient up
* Dizzy?

Right injury
* Crutches on left side (unaffected)
* Right arm on bed beside patient
* Use both arms to help patient up
* Dizzy?

45
Q

sit to stand with frame (left & right)

A

Left injury
* Right arm on gait aid, left arm on bed beside patient
* Use both arms to help patient up
* Dizzy?

Right injury
* Left arm on gait aid, right arm on bed beside patient
* Use both arms to help patient up
* Dizzy?

46
Q

stand to sit with crutches (left & right)

A

Left injury
* Crutches on right side (unaffected)
* Left arm on bed beside patient
* Use both arms to help patient down
* Dizzy?

Right injury
* Crutches on left side (unaffected)
* Right arm on bed beside patient
* Use both arms to help patient down
* Dizzy?

47
Q

stand to sit with frame (left & right)

A

Left injury
* Right arm on gait aid, left arm on arm rest OR both hands on frame?
* Use both arms to help patient down
* Dizzy?

Right injury
* Left arm on gait aid, right arm on bed beside patient OR both hands on frame
* Use both arms to help patient down
* Dizzy?

48
Q

mobility assessment

A

ALWAYS a pick up frame (NWB or PWB)

Mobility assessment steps
Start with unaffected, then do affected
1. sensation testing
2. Patient lower limb AROM (ankle, knees, hips)
3. Patient lower limb strength (Ankle plantarflexion, ankle dorsiflexion, quads over fulcrum, SLR hip, glute)
4. Patient upper limb ROM
5. Transfer to sitting on edge of the bed
6. Reaction to sitting on edge of bed
7. Gait aid usage
8. Before transfer
9. Practice stand
10. Measure up for gait aid
11. Transfer process
12. Transfer to sitting
13. Once seated

49
Q

mobility steps 1-6

A
  1. sensation testing
    Broad screening (light touch)
    • Inner thigh
    • Outer thigh
    • Calf (check for DVT) - “no signs of heat or swelling”)
    • Bottom of feet
    • Top of feet
  2. Patient lower limb AROM (ankle, knees, hips)
    • Ankles - point & flex toes per side
    • Hips - abduct & adduct
    • Knee - knee bend to chest
  3. Patient lower limb strength (Ankle plantarflexion, ankle dorsiflexion, quads over fulcrum, SLR hip)
    Ankle
    • Push toes down against hand, swap & hold top of foot to flex toes to face
      Hip strength
    • Lift ankle up to ceiling per side
      Quads over fulcrum
    • Tense with towel under knee - try to straighten leg up
      Glutes
    • glute bridge lying on back
  4. Patient upper limb ROM
    -Push down through bed & use their arms to lift up
  5. Transfer to sitting on edge of the bed
    Hip injury = sit patient to opposite side of injury
    • Right hip, swing to left side
      Ankle/knee injury = sit patient to same side of injury
      To conduct
    • Bend knees up (shuffle to side if needed)
    • Cross arm over body to hold the side of the plinth
    • Guide legs up & around to help them sit up - encourage use of arm strength too
  6. Reaction to sitting on edge of bed
    Dizziness?
50
Q

mobility steps 7-13

A
  1. Gait aid usage
    Explain how to use gait aid
    Step to - gait aid, affected leg, good leg
    Step through - gait aid & affected leg, good leg
  2. Before transfer
    * May feel dizzy, let me know, etc.
    * Reinstate contraindications
    * Describe transfer (sit up, walk, sit down)
    * Lower bed so feet are on the floor comfortable
  3. Practice stand
    Left injury
    • Right arm on gait aid, left arm on bed beside patient
    • Use both arms to help patient up
    • Dizzy?
      Right injury
    • Left arm on gait aid, right arm on bed beside patient
    • Use both arms to help patient up
    • Dizzy?
  4. Measure up for gait aid
    * Adjust to wrist crease
    -Practice marching
  5. Transfer process
    * Adjust to wrist crease
    Practice marching?
  6. Transfer to sitting
    Left injury
    • Right arm on gait aid, left arm on arm rest
    • Use both arms to help patient down
    • Dizzy?
      Right injury
    • Left arm on gait aid, right arm on bed beside patient
    • Use both arms to help patient down
    • Dizzy?
  7. Once seated
    * Support affected limb (feels okay?)
    * Deep breaths
    * Ankle movements

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