Cardio, Pads, Integumentary Flashcards
who performs the cardiovascular assessment?
Performed by the PT
what is included in the cardiovascular assessment?
- evaluation of the patients medical status and history
- other symptoms they’ve been having
- physical examination
- assessment of the extremities
- results of diagnostic tests
what is an evaluation?
dynamic process in which the PT makes clinical judgements based on data gathered during the examination.
what is an examination?
process of obtaining a history, performing relevant systems review, selecting, and administrating specific tests, and measures.
what is an assessment?
process by which data are gathered, hypotheses are formulated, and decisions are made for further action.
what is the does the patients medical status and history say about the patient?
- includes patients systems of pain including the differentiation among types of pain (chest pain, angina, or myocardial infarction pain)
- dyspnea (shortness of breath)
- feelings of fatigue or generalized weakness
- palpitations
- dizziness
- edema
what does the patients physical examination include?
- pulses (radial, femoral, popliteal, pedal)
- heart sounds
- blood pressure
- respiratory rate
What must a PTA be able to do when it comes to treatment for patients who have cardiac and/or pulmonary disorders?
- reassess the patient as necessary
- monitor the patient in regard to treatment
- monitor the patient’s vital signs
- provide appropriate interventions to the patient
what are the two most common cardiovascular diagnoses?
- coronary artery disease (CAD)
- congestive heart failure (CHF)
what are the two most common pulmonary diagnoses?
- chronic obstructive pulmonary disease (COPD)
- asthma
what are common signs and symptoms of the cardiovascular assessment?
- diaphoresis
- decreased or absent pulses associated w/ peripheral vascular disease (PVD)
- cyanotic skin
- skin temperature cooling
- skin changes
- bilateral edema can be an indication of CHF
- unilateral edema may indicate thrombophlebitis (blood clot) or PVD
what is diaphoresis?
excess sweating associated with decreased cardiac output
what is cyanotic skin?
bluish or pale color of the skin; associated wi/ created cardiac output; or pallor, which is associated w/ PVD
how is the pulmonary exam different from the cardiovascular exam?
same with an addition of the inspection and palpation of the neck and thorax, and listening to abnormal inspiration and expiration sounds
what do crackle sounds indicate?
a collapsed lung or pulmonary edema
what do wheezes indicate?
asthma or COPD
what is a ventilation perfusion scan?
evaluates the circulation of air and blood within a patients lungs in order to determine the ventilation/perfusion. The ventilation part of the test looks at the ability of air to reach all parts of the lungs, while the perfusion part evaluates how well blood circulates within the lungs.
what does it mean when there is cheat wall expansion?
described by symmetry and amount of expansion
what does it mean when there is a chest wall excursion?
the difference b/w chest girth at maximal inhalation and maximal exhalation
what are the chest excursion measurements used to evaluate?
- effect of the restrictive pulmonary diseases; ankylosing spondylitis, idiopathic scoliosis, muscular dystrophy, spinal cord injuries, and chronic obstructive pulmonary disease, have on chest wall range of motion
what are some abnormal breathings?
- wheezing
- rales
- stridor
describe wheezing.
a high-pitches whistling sound during breathing. it occurs when air flows through narrowed breathing tubes.
describe rales.
a discontinuous sound the is like a milkshake being sucked up through a straw, or popcorn popping; caused by negative pressure of inhalation. Indicative of pneumonia and atelectasis.
what is cardiac rehab?
multidisciplinary and may include the physician, nurse, PT, PTA, OT, OTA, social worker, nutritionist, and exercise physiologist
what are the three phases of the cardio PT interventions?
I. hospital
II. outpatient
III. community-based or voluntary program
what happens at the hospital setting?
patient education, bed mobility/transfers, gait training, use of ankle pumps to prevent deep vein thrombosis
what happens at the outpatient setting?
patient education for self-monitoring of VS, ADLs, upper body therapeutic exercises, treadmill, stat. bike
what happens in a community-based or voluntary program?
fitness program
what is the secretion removal techniques?
secretion retention can interfere w/ ventilation and the diffusion of oxygen and carbon dioxide
what aggravates secretion removal techniques?
- inactivity
- inability to or limitation in cough
- smoking
what are techniques used to relieve high levels of secretions?
- postural drainage
- massage techniques such as percussion and vibration
- airway clearance technique
what is coronary artery disease (CAD) ?
an atherosclerotic disease process that narrows the lumen of coronary arteries, resulting in ischemia to the myocardium
dealing with CAD what are the clinical syndromes that are included?
- angina pectoris
- myocardial infarction (MI)
- cardiac failure or congestive heart failure (CHF)
CAD is treated medically by?
- diet
- medications
- activity restrictions
- surgical interventions
what is angina pectoris characterized as?
- substernal chest pain after exertion, as a result of decreased oxygen supple to the myocardium
- sudden onset of left-sided chest pain after exertion
- pain may radiate to the left arm or back
- may experience dyspnea (shortness of breath)
- chest pain is usually relieved by stopping the activity and placing nitroglycerin tablets under the tongue
what are the results of the myocardial infarction (MI) (aka ‘heart attack’)?
- necrosis of a portion of the cardiac muscle.
- necrosis or death of the heart muscle tissue is caused by an obstruction in the coronary artery. (caused by; a spasm, embolism, drug overdose, or coronary thrombus
what are the signs and symptoms of the MI?
- crushing chest pain, sense of heaviness in chest
- vomiting, sweeping, hypotension, weakness
- shortness of breath, lightheadedness
- radiating pain to left arm, back, jaw or neck
for coronary artery disease, what are the PT goals?
- increase patient’s knowledge of common signs and symptoms
- educate the patient in use of medications to control symptoms
- develop a treatment protocol for exercise
what is COPD?
chronic obstructive pulmonary diseases
what is emphysema?
- an abnormal increase in the size of air spaces distal to terminal bronchioles
- may develop following a smoking history
what is chronic bronchitis?
- chronic cough and sputum lasting at least 3 months for 2 consecutive years
- smoking history, cough, sputum, crackles and wheezes, frequent respiratory infections
what is asthma?
- chronic disease caused by increased reactivity of the tracheobronchial tree to various stimuli
- very prevalent amount children or young adults
what is the pneumonia?
not only a condition but also a general term for several types of inflammation of the lungs
what are the three types of pneumonia and what are the PT interventions?
(types) - aspiration - bacterial - viral (interventions) - similar to COPD - secretion removal - breathing exercises - airway clearance
a PTA reviews the initial evaluation that was completed by the PT. The chart says that the patient has ‘angina pectoris’. the PTA knows that this is:
- characterized by substernal chest pain
postural drainage, massage techniques such as percussion and vibration, and airway clearance techniques may be part of the PT’s POC for which of the following diagnoses?
COPD
what is pediatric physical therapy?
specializes in the treatment of children who have developmental dysfunctions and specific pediatric disorders
in the pediatric PT field therapists can be?
- direct care providers
- indirect care providers
what are direct care providers?
in hospitals and in early intervention programs (EIPs)
what are indirect care providers?
in educational settings, instructing teachers in facilitating attainment of educational goals for children 3-21 y/o
who is part of the pediatric team?
patient, patient’s family, PT/PTA, physician, nurses, social worker, psychologist, OT/COTA, SLP, special educators, teachers
in pediatric PT was models of service delivery/team interaction are there?
- multidisciplinary
- trans disciplinary
- interdisciplinary
how is the multidisciplinary model described?
- the child receives services from one to several providers working in isolation while treating the child.
- assess the child individually without input from the other teammates
how is the interdisciplinary model described?
- team members share responsibility for service delivery, form a single plan of intervention. (hospital systems generally conform to this model)
how is the trans disciplinary model described?
team members commit to work an learn across disciplinary boundaries and the families are integral parts of the team. assessments occur arena-style so that the child can be assessed by all team members at the same time
what is family-centered care?
a collaborative relationship between families and all health care professionals, including PT/PTA
what are the different types of screening tests?
(physician or nurse practitioner) - APGAR fro newborns - Denver developmental screen test - bailey scales of infant development (PT) - neonatal behavioral assessment scale (NBAS) - movement assessment of infants (MAI) - gross motor function measure (GMFM)
what is APGAR?
a method to quickly summarize the health of newborn children against infant mortality
For newborns, infants, and toddlers what happens in a Nero exam?
- stages of consciousness
- skeletal system and ROM assessments
- posture
neonatal reflexes that are present at birth and disappear or are integrated later in the child’s normal development:
- flexor withdrawal reflex
- crossed extension reflex
- suck/swallow relax
- palmar grasp reflex
- tonic labyrinthe reflex (TLR)
- symmetrical tonic neck reflex (STNR)
what is the flexor withdraw reflex?
flexion of a body part in response to a painful stimulus
what is a crossed extension reflex?
when the reflex occurs the flexors in the withdrawing limb contract and the extensors relax, while the other limb, the opposite occurs (stepping on a nail)
what is the suck/swallow reflex?
rhythmical sucking and swallowing movements in an infant when a finger is placed in the mouth.
what is the palmar grasp reflex?
when an object is placed in the infants’s hand and strokes the palm, the fingers will close and they will grasp it with a palm grasp
what is tonic labyrinthine reflex (TLR)?
tilting the head back while lying on the back causes the back to stiffen and even arch backwards, the legs straighten, stiffen and push together, the toes point, etc.
what is the symmetrical tonic neck reflex (STNR)?
bridging or transitional brainstem reflex that is an important developmental stage and is necessary for a baby for transitioning from lying on the floor quadruped crawling or creeping
what are the developmental milestones for newborns, infants, and toddlers?
- gross motor, fine motor, social, language, cognitive developments, and adaptive skills
for the pediatric PT treatment they should be:
- functional
- effective
- appropriate for the circumstances
what are some interventions that are using in orthopedic settings for pediatrics?
- rollator walker
- posterior rolling walker
- prone stander
- standing frame
- parapodium
what is cerebral palsy?
- term used to describe a group of disorders that are non progressive but often changeable motion impairment syndromes
- caused by lesions or abnormalities of the brain arising in the early stages of its development, during birth, or shortly thereafter
what are the cerebral palsy risk factors?
- those occurring prior to pregnancy
- those occurring during pregnancy
- those occurring during perinatal period
those occurring prior to pregnancy:
- genetics, viruses, infections, maternal drug exposure
those occurring during pregnancy:
- prematurity, low birth rate, brain hemorrhage, poor maternal nutrition, asphyxia
what are the classifications of cerebral palsy?
- spastic ( increased muscle tone, rigidity, abnormal postures and movements)
- hypotonic (muscle tone lower than normal being floppy like a rag doll)
- athetoic (writhing movements, fluctuation tone, poor stability)
what is another term for Down syndrome?
trisomy 21
what is down syndrome?
three copies of chromosome 21
what are some characteristics of Down syndrome?
sloping forehead, low-set small ears, small mouth, short broad hands
what is Duchenne muscular dystrophy (DMD)?
most common form of congenital, degenerative diseases of muscle tissue
what is scoliosis?
a lateral curvature of the spine like an “S” or “C” (ex. one shoulder higher than the other, one hip higher than other)
what are the three types of scoliosis?
structural, nonstructural, idiopathic
what are the classifications of scoliosis?
mild = <20 degrees of curvature severe = >60 degrees of curvature (curves >40 degrees typically need surgery)
what is spina bifida?
malformation of the spine in which the posterior portion of the bony canal containing the spinal cord is completely or partially lacking
what are the two classifications of spina bifida?
- spina bifida occulta (not visible)
- spina bifida cystic (visible)
what impairments do spina bifida include:
- urinary incontinence
- gait disturbances
- structural changes in the pelvis
when would an infant be able to sit up unsupported?
eight months
what is geriatric physical therapy?
treating older individuals who present w/ musculoskeletal and neuromuscular conditions and dysfunction common to the older adult
(geriatrics hip fracture patients) what does it mean when they are in ‘first day post op’ means?
patient begins ankle pups to prevent DVT, strengthening exercises for the Use and uninvolved LE, transfer from bed to chair with assistance.
(geriatrics hip fracture patients) what does it mean when they are in ‘fifth day post op’ means?
patient continue ROM exercises in the involved LE, performs bathroom transfers, continues gait trainer with walker or crutches with specific weight bearing status
(geriatrics hip fracture patients) what does it mean when they are in ‘six weeks post op’ means?
patient continues hip abductor muscle exercises in the involved LE, continues ambulation with a cane, walker, or crutches depending on WB status
what is integumentary physical therapy?
treats patients with skin disorders, most commonly wounds and burns
what is a first degree burn?
a mild burn that produces redness/inflammation of the skin but no blistering.
what is a second-degree burn?
a burn that blisters the skin and is more severe than a first degree burn
what is a third-degree burn?
a sever burn in which the skin and underlying tissues are destroyed and sensitive nerve endings are exposed
what is partial-thickness burn?
an alternative category for classifying burns which include both first and second degree burns
what is a full-thickness burn?
an alternative category for classifying burns which includes the third degree burn
what is the rule of nines?
the body surface is divided into areas representing 9% or multiples of 9%
- palm represents 1% of body surface
what are the PT treatments for burns?
- hydrotherapy
- debribement
- positioning of the affected body part
- ROM exercises
- elastic or pressure garments to prevent scaring
- edema control
- strengthening exercises
- breathing exercises
- functional training
what is serous?
clear, shiny, water like drainage with no foul odor.
