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PT exam 2 > E1 > Flashcards

E1 Flashcards

1
Q

what does obtaining a history entail

A

performing a system review
selecting/administering tests and measures to gather data about the patient/client

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2
Q

what does examination entail

A

comprehensive screening and condition-specific testing

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3
Q

what does examination allow for

A

diagnostic classification for the condition affecting the patient and possible outcomes (prognosis)

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4
Q

what are the main questions to ask yourself when going through patient interviews

A

why do we need particular information?

what will this information help our assessment?

what is the most appropriate way to collect the information?

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5
Q

what are aspects of body language

A

facial expressions
posture
visual contact
clothing

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6
Q

how much of the perceived meaning of conversation does body language account for?

A

55%

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7
Q

what are aspects of tone of voice

A

conversation vs interrogation
portrayal of genuine interest in understanding the things affecting the patient
avoiding terms like “i know how you feel”

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8
Q

how much perceived meaning does tone of voice hold in a conversation

A

38%

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9
Q

what are aspects of words spoken

A

avoidance of medical jargon
health literacy is low, be simple

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10
Q

how much perceived meaning does words spoken hold in a conversation

A

7%

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11
Q

what are the expressive components of patient interviews

A

body language
tone of voice
words spoken

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12
Q

what are aspects of the “act of listening”

A

hearing spoken words vs actively listening

focus on tone, emotion, expressions and changes in patient’s body language

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13
Q

how does the patient perceive you after the “act of listening”

A

valued, greater satisfaction
improves efficiency

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14
Q

what do you start with during the patient interview?

A

greeting the patient
introducing yourself
acknowledge the condition
mention purpose of the interview
ask for consent

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15
Q

after introduction, what needs to be checked

A

mental status
alertness, attention and cooperation

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16
Q

what is “arousal”

A

physiological readiness of a person for activity
usually refers to levels of consciousness

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17
Q

what is the progression of mental alertness from most to least

A

alert
lethargic
obtunded
stupor
coma

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18
Q

what is lethargic mental status

A

minimal responses, sluggish, slowed or apathetic

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19
Q

what is obtunded mental status

A

slow response to stimulus, disinterest in the environment, dulled

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20
Q

what is stupor mental status

A

general unresponsiveness
aroused by vigorous stimuli

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21
Q

what is coma mental status

A

unresponsive

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22
Q

what is “orientation”

A

an awareness of time, person, place and situation

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23
Q

what is considered normal orientation

A

A/Ox4

24
Q

when a patient is lethargic or selectively aware/responsive of the environment and stimuli what could a clinician do

A

ask patient to spell a short word backwards
count months forward and backward
count backwards by 3

25
Q

when asking orientation, what is the therapist assessing

A

memory
attention
language

26
Q

following orientation, what would the therapist ask

A

the history of the current problem

27
Q

what is included in the history of current problem

A

when was the onset / occurrence of pain
how did it start / how did it occur
mechanism of injury

28
Q

if a person has had the “current problem” in the past, how would that information be valuable

A

understanding what made it better, what was done for it, how long that lasted or how long the problem was around previously

29
Q

what is included under “history of pain”

A

location of pain
quantity of pain
quality of pain
variation of pain
modifiers of pain

30
Q

if a patient describes their pain as _____ what may that indicate?
sharp or dull
throbbing
shooting

A

sharp/dull = musculoskeletal
throbbing = inflammation process
shooting = nerve

31
Q

what is important to remember when obtaining demographic information in regards to diagnosis and prognosis?

A

different diagnoses may present differently in individuals depending upon age, sex, race/ ethnicity

prognosis may also be different for specific disorders based upon age, sex, race/ethnicity

32
Q

what falls under demographics

A

age
sex
race/ethnicity
primary language
socio-economic status
level of education

33
Q

what falls under anthropometric data

A

height
weight
dominant side

34
Q

when asking about prior level of funcitoning, what are we looking to gain

A

information about their
mobility
ability to complete selfcare - ADL
ability to do the things they want - IADL
work / occupation
recreational behaviors

35
Q

when asking about social history, what is included

A

social support - family structure, emotional support, economic support

cultural beliefs

36
Q

what does occupational history help us understand

A

physical / cognitive demands of the patient on a daily basis

37
Q

what does living environment include

A

community characteristics
structural characteristics
physical environment
devices and equipment

38
Q

what is community characteristics defined as

A

safety, resources, and/or public transportation

39
Q

what do structural / physical environment characteristics include

A

accessibility
safety
stairs / handrails
lighting
floor surface
grab bars and assistive devices

40
Q

what is the thing we’re trying to ask when talking about health beahviors

A

depression

41
Q

what are the 3 health behavior questions

A

“During the past month, have you often been bothered by feeling down, depressed, or hopeless?”

“During the past month, have you often been bothered by little interest or pleasure in doing things?”

“Is this something with which you would like help?” with three possible options: Yes, Yes but not today, or No

42
Q

when do you ask the third health behaviors question

A

of the first, second, or both questions are answered with a “yes”

considered a positive and the third is asked

43
Q

what are key things to remember when interviewing older adults

A

address them by their last name
setting up the environment with no distractions
accurate prior level of functioning
understanding support at home

44
Q

what can be asked during the conclusion?

A

what the patient’s goals are for therapy

45
Q

what is the presenting condition aspect of chart review

A

reason for admission
chief complaint
course of signs/symptoms prior
what prompted admission

46
Q

what is the review of systems

A

screening of systems, looking for signs/symptoms present that are associated with serious undiagnosed conditions

47
Q

what is the review of systems comprised of

A

closed ended questions specific to each system

48
Q

what are the systems asked about in review of systems

A

general health
cardiovascular
pulmonary
gastrointestinal
urinary
reproductive
endocrine
depression

49
Q

what is the difference between universal and standard precaution

A

uni - protection of everything
stand - relevance to each individual patient

50
Q

what are precautions found in chart review

A

PPE
allergies
unstable vitals
situations that would require a need to check vitals
mobility related precautions
pending imaging/lab results
pending physician consult

51
Q

what falls under health status in chart review

A

past medical / surgical history
list of medications
pending procedures/exams
social history

52
Q

who conducts the physical exams

A

hospitalist or physicians

53
Q

what is included in the physical exam

A

appearance
vital signs
mood/participation
cognition and speech

54
Q

what is systems review

A

examination of anatomical/physiological status of
cardiovascular/pulmonary
integumentary
musculoskeletal
neuromuscular systems

55
Q

what two medical professionals can discharge a patient

A

doctor and pt
doc - medical readiness
pt - functional readiness

56
Q

what can be done when correlating initial impression of a patient to subsequent exam findings

A

understanding of symptoms and the level of severity
ie - masking or exaggerating symptoms

PT exam 2 (9 decks)

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