Clinical Procedure Final Flashcards
What temp does skin have to be lowered to for local anesthesia?
56.5 degrees
Describe the physiological effects of superficial heat?
Increases blood flow
Increases tissue metabolism (so it encourages healing)
Pain relief and relaxation
Decrease mm spasm, joint and mm stiffness
Can increase ROM prior to exercising
Describe the physiological effects of superficial cold
Decreases blood flow
Decreases tissue metabolism
Minimizes bleeding and acute inflammation
Releases trigger points
Elevate pain threshold prior to exercising or after exercising
Procedure for spray & stretch
Position properly
Spray from 12-18 in away
Spray in unidirectional sweeps along the mm over the trigger point areas while maintaining a gentle and passive stretch
Evaluate the treatment response
List and describe the pathologic conditions commonly treated with massage
Adhesions, scarring, trigger points, restrictions in fascia/mm/joint capsule, ligaments, tendons, edema, spasms
What is an adhesion?
Bands of scar tissue joining two surfaces that are normally separated
What is a lesion?
Tissue destruction
What is a mm spasm?
Involuntary contraction of mm or muscle group
Identify the lobes of the lungs
The upper lungs on both sides have apical, anterior, and posterior segments.
The right lung has a middle lobe. The left lung does not but does have the Lingula.
The lower lungs on both sides have basal anterior, basal posterior, lateral segments, and superior segments.
What is ventilation?
Air moving through the lungs
Path of inspiration?
Mouth or nasal cavity, pharynx, larynx, trachea, primary-tertiary bronchi, terminal bronchioles, alveoli (distal respiratory unit)
The alveoli are known as…
distal respiratory unit
External respiration
Exchange of gases between lungs and blood
Internal respiration
Exchange of gases between blood and body cells
Tidal volume
Normal resting ventilation
Inspiratory reserve volume
Additional air that can be inhaled after a breath
Expiratory reserve volume
Amount of air that can be forcefully exhaled after a normal tidal volume exhalation
TLC total lunch capacity
Maximum volume of air that lungs can contain (6.0L)
Bronchioles
Smallest branches of the bronchi
Alveoli
Tiny sacs of lung tissue specialized for the movement of gases between air and blood
Pain triggers a number of pain-producing substances - what are some examples of these?
Potassium, serotonin, histamine, prostaglandins, leukotrienes, Bradykinin
- These can activate nociceptors and sensitize nerve endings
What does the spinothalamic tract transport?
Sharp and localized pain
What does the spinoreticulothalamic tract transport?
Diffuse, poorly localized, visceral pain as well
Gate control theory says that injury activates what pain fibers? and those are located where?
A delta and C fibers. In the dorsal horn of the SC. Excitatory and inhibitory influences determine if that signal moves “up the chain”
Endogenous Opiates theory of pain says that neurotransmitters called endogenous opiates descending control ____? And they operate at what level?
Mechanisms
Operating at the spinal cord level
They “block the gate” by interfering with A delta and C fibers trying to transmit to T cells
Examples of endogenous opiates
Enkephalins, endorphins, serotonin, dopamine
Tracheal breath sounds and bronchial breath sounds are similar. What is the difference?
Tracheal expiration is LONGER than inspiration and bronchial expiration is LOUDER than inspiration.
Both sounds are loud, high pitches, and hollow sounding.
T or F?
Fascia is stress sensitive
True. It will thicken in response to stressors.
What is the function of fascia in the body?
Stability, support of internal organs, nourishment with proper lymph exchanges
Slow and sustained pressure on fascia effects the ___ substance.
Ground substance
Stretching the fascia effects the ____
Fiber component
The acute/inflammatory phase after injury can be thought to have two main sections. What are they and describe the why behind each.
Coagulation and vasodilation.
Coagulation - platelets and coagulation to stop bleeding and minimize the infection risk
Vasodilation - lymph and artioles constricted, now they dilate to clear the edema and move in the proliferative phase
When are histamines and prostaglandins release in the healing phases
Acute/inflammatory
Phagocytes and macrophages are active in what healing phase?
Acute/inflammatory - they “ clean up” the site of the trauma
What is chronic pain?
It lasts for over three months, does not appear treatable, and could be referred pain
What type of nociceptor perceives mechanical and thermal stimulus?
A delta fibers
What type of nociceptor perceives chemical stimulus?
C fibers
What type of pain fiber (nociceptor) is myelinated?
A Delta. They are localized and fast!
What type of pain fiber is unmyelinated?
C fibers. Longer lasting. Burning, dull, poorly localized.
Where do ascending pain pathways enter the spinal cord?
At the dorsal horn.
McGill (MPQ) scale, visual analog, numeric pain rating…are all scales for measuring
Pain levels
In addition to pain, light touch, and dull touch, other senses to look for in patients include:
Temperature, vibration, proprioception, DTR (deep tendon reflexes)
Analgesia
inability to feel pain
Asensate
Without sensation
Anesthesia
loss of sensation
Cosmesis
Preservation, restoration, or bestowing of bodily beauty
The administration of thermal, mechanical, electromagnetic, acoustic, and light energies to produce biophysical effects at the cellular, tissue, oranix, and whole body levels
Therapeutic modalities
Three primary categories of therapeutic modalities
Thermal, electromagnetic, mechanical
Vasoconstriction, vasodilation, hemostasis/coagulation, phagocytosis - what phase of healing?
Inflammatory
Epithelization, collagen production, closure/contraction, revascularization = what phase?
Proliferative
Collagen balance/synthesis and lysis, collagen remodeling = what phase?
Remodeling
In the inflammatory phase of tissue healing, pain occurs because:
A delta and C nerve endings are triggered by chemicals at the site of the injury and pressure from edema
In which phase of tissue healing does phagocytosis occur?
Proliferative
Where are the T (transmission) cells located to close the “gate” for pain modulation?
Dorsal horn of spinal cord
The clear, watery substance known as transudate becomes exudate when:
There is an increase in plasma protein
Describe the internal changes in the body when pain occurs?
Decreased circulation, decrease O2 supply, decreased lymphatic cleaning
A pain assessment that involves diagrams and words for patients to circle locations and intensity of pain is:
McGill pain questionnaire
Therapeutic goal of superficial heat is to get tissues to
104-113 degrees F
What acts as the body’s thermostat?
Hypothalamus
Contract bath =
3 min cold with 1 min warm x 5-7 cycles
Temp range of contrast baths:
Cold: 50-64 deg F
Hot: 100-111 deg F
Temp range for Paraffin wax
113-129 deg F
What modality increase tissue temp change the most?
Fluidotherapy (convection!!)
Residual Volume
The volume of air remaining in lungs after maximum exhalation
Ideal pulse ox for exercise:
93-100%
A system of manual therapy that creates system of passive movement reeducation patterns (practitioner to pt)?
Feldenkrais
Position for postural drainage: right lobe lobe consolidation
Position left sidelying with elevation to 20”
Irritable band of contracted mm tissue
Trigger point
Which laboratory test serves as a marker of sufficient alveolar ventilation in a patient’s lungs
PC02
Normal body temp
97.3 - 99.1
Temp range for the hydrocollator?
158 deg - 167 deg F
